Children with chronic conditions like asthma and heart disease were even more likely to be hospitalized when they missed visits, according to the study. In fact, children with chronic conditions who missed more than half of the recommended well-child visits had more than three times the risk of being hospitalized compared to children with chronic conditions who attended most of their visits.

'Well-child visits are important because this is where children receive preventive immunizations and develop a relationship with their provider,' says study lead author Jeffrey Tom, MD, MS, an assistant investigator with the Kaiser Permanente Center for Health Research in Hawaii. 'These visits allow providers to identify health problems early and help to manage those problems so the children are less likely to end up in the hospital.'

When he conducted the study, Dr. Tom was a senior fellow in the University of Washington Department of Pediatrics.

'Regular preventive care for children with special needs and chronic conditions is even more important, given the risk of possible complications for their conditions, often leading to hospitalizations,' added coauthor David C. Grossman, MD, MPH, a senior investigator at Group Health Research Institute in Seattle.

The study included 20,065 children who were enrolled in Group Health from 1999 to 2006. Researchers followed the children from birth until age 3.5 years or until their first hospital stay, whichever came first.

During the study period, Group Health recommended nine well-child visits between birth and 3.5 years. The visits start at three to five days and continue at 1, 2, 4, 6, 10 and 15 months, and at 2 and 3.5 years.

Most children in the study (76 percent) attended at least three-quarters of the recommended visits, for which Group Health required no copayment. The authors say the lack of copayment is an important incentive and likely one reason for such good adherence to visits among the study population.

Overall, 4 percent of children in the study — and 9 percent of children with chronic conditions — were hospitalized. The two most common reasons for hospitalization in both groups were pneumonia and asthma.

Children who missed more than half of their visits had 1.4 to 2.0 times the risk of hospitalization compared to those who attended most of their visits. Children with chronic conditions who missed more than half of their visits had 1.9 to 3.2 times the risk of hospitalization compared to those who attended most of their visits.

Authors caution that their findings might not apply to all health systems because the study was conducted in an integrated health care system where the majority of children attend most of their well-child visits and tend to have families with higher-than-average income and education. The authors were unable to adjust for income, education, race or ethnicity.

This study does not prove that missing well-child visits will increase the chance of hospitalization, although it does show an important association between these factors. The authors say one important reason for this link is that well-child visits allow for preventive care that keeps children from ending up in the hospital. An alternative explanation is that parents who miss well-child visits are also less likely to manage their children's illnesses and follow treatment regimens, which could result in higher rates of hospitalization.

Some prior studies have found an association between missing well-child visits and increased hospitalization, but others reported no link. The authors of this study conducted another study with similar findings in a fee-for-service medical setting in Hawaii. That study was published in the Archives of Pediatrics and Adolescent Medicine (now JAMA Pediatrics) in November 2010.

Authors of the study include Jeffrey O. Tom, MD, MS, with the Kaiser Permanente Center for Health Research in Hawaii; Rita Mangione-Smith, MD, MPH, with the University of Washington and Seattle Children's Research Institute; David C. Grossman, MD, MPH, with Group Health Research Institute and the University of Washington in Seattle; Cam Solomon, PhD, with Seattle Children's Research Institute; and Chien-Wen Tseng, MD, MPH, with the University of Hawaii and Pacific Health Research and Education Institute in Hawaii.

This study was supported by the Health Resources and Services Administration (grant T32HP10002-21), an agency of the U.S. Department of Health and Human Services — and by Group Health Cooperative and Group Health Research Institute.

About the Kaiser Permanente Center for Health Research
The Kaiser Permanente Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Ore., Honolulu and Atlanta. Visit kpchr.org for more information.

About Group Health Research Institute
Group Health Research Institute does practical research that helps people like you and your family stay healthy. The Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding. Visit grouphealthresearch.org for more information.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/newscenter.

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While there are factors that increase your risk for sleep apnea—including being overweight, being male, being 60 or older, smoking and a family history of the disorder, among others—it can happen to anyone.The good news is that it can be managed by dentists like Dr. Stern via a custom-fitted and closely monitored oral device that keeps your airway open while you sleep. This life-saving appliance is a more comfortable alternative to C-PAP (continuous positive airway pressure), a mask-like machine also worn during sleep."In our practice, we work with your doctor to solve your sleep apnea problem. Since many people see their dentist more often than they see their physician, we are in a unique position to carefully and inexpensively screen for this problem. Our training enables us to provide a proven, effective alternative to C-PAP, which is often not tolerated. When an oral appliance is a person's best option, we coordinate our care with sleep physicians to get optimal results," Dr. Stern says.Think sleep apnea might be an issue for you? Take the Epworth Sleep Score Test and call 732.483.8030 to get help now.

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"We are very pleased that studies across geographies and in both real-world and clinical trial settings continue to support the benefits to patients of the lower-profile SAPIEN XT valve," said Larry L. Wood, Edwards' corporate vice president, transcatheter valve replacement. "This report from the SOURCE XT Registry confirms the positive impact TAVR provides for patients' quality of life and heart function, which is once again profound."

The SOURCE XT Registry, a monitored and adjudicated prospective registry, is studying the use of the Edwards SAPIEN XT valve in a real-world commercial setting, treating high-risk and inoperable patients with severe symptomatic aortic stenosis. The study cited both the baseline and cardiovascular characteristics of the treated patients in confirming their high risk profiles. Despite this patient risk level, the one-year survival post-TAVR was 80.5 percent(1), and freedom from important procedural complications was notable: the study found that stroke occurred in 6.3 percent of patients, and it was reported that 93.8 percent of patients had none/trace or mild paravalvular aortic regurgitation.

The presentation also addressed a segment of the treated patients with a EuroScore of less than 15 percent, which primarily consisted of patients who were deemed inoperable due to conditions such as porcelain aorta, liver disease, frailty, cancer, dialysis and severe pulmonary hypertension.

The SOURCE XT Registry enrolled patients treated with the SAPIEN XT valve in 17 countries between July 2010 and October 2011. Patients were treated using a transfemoral (62.7 percent), transapical (33.3 percent), transaortic (3.7 percent) or subclavian (.3 percent) approach and will be followed out to five years.

The Edwards SAPIEN XT valve is an investigational device not yet available commercially in the United States. It is currently being evaluated in the U.S. in The PARTNER II Trial.

About Edwards Lifesciences
Edwards Lifesciences is the global leader in the science of heart valves and hemodynamic monitoring. Driven by a passion to help patients, the company partners with clinicians to develop innovative technologies in the areas of structural heart disease and critical care monitoring, enabling them to save and enhance lives. Additional company information can be found at www.edwards.com.

This news release includes forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. These forward-looking statements include, but are not limited to, Mr. Wood's comments and statements regarding clinical programs. Forward-looking statements are based on estimates and assumptions made by management of the company and are believed to be reasonable, though they are inherently uncertain and difficult to predict. Our forward-looking statements speak only as of the date on which they are made and we do not undertake any obligation to update any forward-looking statement to reflect events or circumstances after the date of the statement.

Forward-looking statements involve risks and uncertainties that could cause results to differ materially from those expressed or implied by the forward-looking statements based on a number of factors, including but not limited to, unexpected results of expanded clinical experience and unanticipated effects of regulatory, clinical and quality systems. These factors are detailed in the company's filings with the Securities and Exchange Commission including its Annual Report on Form 10-K for the year ended December 31, 2012.

Edwards, Edwards Lifesciences, the stylized E logo and Edwards SAPIEN XT are trademarks of Edwards Lifesciences Corporation.

(1) All percents for data in this press release are Kaplan-Meier estimates.

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In the trial, 3,731 overweight or obese people were randomised 2:1 to treatment with liraglutide 3 mg or placebo, both in combination with diet and exercise. In the trial, people without signs of prediabetes were treated for 56 weeks, followed by a 12-week follow-up period. People with signs of prediabetes at the time of randomisation are currently continuing treatment for two additional years. The announced results are for all people at 56 weeks.

From a mean baseline weight of 106 kg and a BMI of 38 kg/m2, the average weight loss for people treated with liraglutide 3 mg at 56 weeks was 8.0% compared to 2.6% for people treated with placebo. The proportion of people achieving a weight loss of at least 5% was 64% for liraglutide 3 mg and 27% for placebo. The proportion of people achieving a weight loss of at least 10% was 33% for liraglutide 3 mg and 10% for placebo treatment. All differences between liraglutide and placebo were statistically significantly different and the trial met all three co-primary endpoints.

Of all people participating in the trial, 61% had prediabetes at randomisation. At 56 weeks, 69% of the prediabetes subgroup treated with liraglutide 3 mg no longer showed signs of prediabetes, compared to 33% for the placebo-treated group. Of the 39% of the people without prediabetes at randomisation, 7% of the liraglutide 3 mg treated people developed prediabetes, compared to 21% of the people in the placebo group. Both differences between liraglutide 3 mg and placebo were statistically significant.

Finally, people treated with liraglutide 3 mg experienced statistically significant improvements in obesity-related risk factors, including blood pressure, cardiovascular risk biomarkers, lipids and patient-reported quality of life, compared to people treated with placebo.

In the trial, liraglutide was generally well tolerated. The 56-week completion rate was 72% and 64% for liraglutide 3 mg and placebo, respectively. Withdrawals due to adverse events were below 10% in both treatment groups. The most common adverse events were related to the gastrointestinal system and they diminished over time.

'We are very pleased with the results of this trial,' said Mads Krogsgaard Thomsen, executive vice president and chief science officer of Novo Nordisk. 'These data, together with previously reported phase 3 trials, consistently demonstrate clinically significant weight loss and improvements in obesity related risk factors in people with obesity.'

Novo Nordisk expects to complete the remaining phase 3a trial in the SCALE™ programme in the third quarter of 2013 and to file liraglutide 3 mg for regulatory review as a treatment for obesity in the US and EU around the turn of the year.

About liraglutide 3 mg
Liraglutide 3 mg is a once-daily GLP-1 analogue with 97% homology to human GLP-1. Like human GLP-1, liraglutide 3 mg acts as a natural satiety hormone to reduce appetite and food intake. Liraglutide 3 mg is not an approved treatment.

Liraglutide is currently approved and marketed at lower doses (1.2 and 1.8 mg once-daily as well as 0.9 mg in Japan) for type 2 diabetes only, under the brand name Victoza®. Victoza® is not approved for weight management and should not be prescribed for its treatment.

About the SCALE™ clinical programme
SCALE™ (Satiety and Clinical Adiposity – Liraglutide Evidence in Non-diabetic and Diabetic people) consists of four trials encompassing more than 5,000 people who are overweight and with comorbidities such as hypertension, dyslipidaemia, or type 2 diabetes or who are obese with or without comorbidities. In addition to demonstrating safety and efficacy for weight management with liraglutide 3 mg, each of the four trials has its own distinct focus:

SCALE™ Maintenance (422 people randomised) – a 56-week randomised, placebo-controlled trial designed to show weight loss maintenance in obese or overweight people with comorbidities who have successfully achieved a 5% or greater weight loss during a three-month run-in period of a lifestyle modification programme of low-calorie diet and exercise alone. The results of SCALE™ Maintenance were reported in 2010.

SCALE™ Diabetes (846 people randomised) – a 56-week randomised, placebo-controlled trial designed to demonstrate clinically meaningful and safe weight loss with liraglutide 3 mg in obese or overweight people with type 2 diabetes. The results of SCALE™ Diabetes were reported in March 2013.

SCALE™ Obesity and Prediabetes (3,731 people randomised) – a 56-week and 160-week randomised, placebo-controlled trial in obese or overweight people with comorbidities designed to demonstrate clinically meaningful and safe weight loss after 56 weeks of treatment with liraglutide 3 mg.

SCALE™ Sleep apnoea (approximately 340 people randomised) – a 32-week randomised, double-blind, placebo-controlled trial in obese people with moderate or severe obstructive sleep apnoea (OSA) to investigate the effect of liraglutide 3 mg in reducing the severity of OSA, in combination with diet and exercise

---
Novo Nordisk is a global healthcare company with 90 years of innovation and leadership in diabetes care. The company also has leading positions within haemophilia care, growth hormone therapy and hormone replacement therapy. Headquartered in Denmark, Novo Nordisk employs approximately 35,000 employees in 75 countries, and markets its products in more than 180 countries. Novo Nordisk's B shares are listed on NASDAQ OMX Copenhagen (Novo-B). Its ADRs are listed on the New York Stock Exchange (NVO). For more information, visit novonordisk.com.

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Running from January 1, 2013 until March 31, 2013 MasterCard donated 10 kopecks (3 cents) from every payment made in Russian POS with MasterCard® and Maestro® cards issued by Russian banks. On the start of the campaign it was reported that MasterCard will donate at least 30 million rubles, but the final amount was determined by the actual number of POS transactions over the past three months. Make Purchases and Give Hope is the first charity program of such scale conducted by MasterCard in Russia.

MasterCard's charity campaign involved such partners as Novikov Group and Ginza Project restaurants, TNK-BP gas stations, Svyaznoy Bank, Petrokommerts Bank, VTB24, Alfa Bank, MTS and others.

'Cancer remains the number one cause of death and despite its prevalence, is still an unexplored disease. By joining forces with Stand Up To Cancer we got closer to our common goal − victory over cancer. MasterCard will donate 34 000 000 Rubles to Stand Up To Cancer to support translational research in oncology. We are very thankful to all of our partners who joined the initiative and to all cardholders who supported the campaign,' said Ilya Riaby, Head of MasterCard in Russia, Armenia and Belarus.

The money from MasterCard will be donated to scientific research funded by Stand Up To Cancer. Half of the funds will be granted to TRIO (Translational Research in Oncology) to hire strong research staff teams at cancer clinics in Russia and training for innovative research trials, particularly in the field of breast cancer. This effort will achieve an ultimate goal of having local clinical research teams that are self-sufficient and capable of participating confidently in other studies to benefit their institutions, physicians and most importantly, patients. Another part of the funds will be used for cancer research abroad.

'We are pleased that our program is being implemented in Russia with support of MasterCard. Stand Up To Cancer is designed to accelerate innovative research in the field of cancer treatment that will make the reality of the rapid application of new treatments and save lives now,' says Rusty Robertson, co-founder of Stand Up To Cancer. 'We are focused on transparency and the highest standards in matters of finance and are confident that we can help a large number of patients.'

Together Against Cancer (Stand Up To Cancer), a charitable program of the Entertainment Industry Foundation, is a unique initiative which sets its mission to bring innovative therapies, research and cancer treatment, and allow faster practical application of such methods to save lives now.

Together Against Cancer allows collaboration of the best scientists, and promotes collaboration, rather than competition of scientific efforts. Continuous Entertainment Industry support helps Together Against Cancer reach out to broader audiences and effectively promote its cause.

Famous Russian actors, musicians and journalists actively support Together Against Cancer program of SU2C by becoming ambassadors of the movement in Russia. Among these people are Ingeborga Dapkunaite, Konstantin Kryukov, Andrey Makarevich, Vladimir Pozner, Olga Shelest and Ivan Urgant.

TRIO (Translational Research in Oncology), is an international nonprofit organization that unites 2,000 scientists from 45 countries. TRIO has been working with Russian scientists since 2000. A unique network of leading international scientists allows TRIO to conduct innovative studies, getting closer and closer to the discovery of a universal systemic treatment of disease.

Read more at www.VmesteProtivRaka.ru.

MasterCard (NYSE: MA), www.mastercard.com, is a technology company in the global payments industry. We operate the world's fastest payments processing network, connecting consumers, financial institutions, merchants, governments and businesses in more than 210 countries and territories. MasterCard's products and solutions make everyday commerce activities – such as shopping, traveling, running a business and managing finances – easier, more secure and more efficient for everyone. Follow us on Twitter @MasterCardNews, join the discussion on the Cashless Conversations Blog and subscribe for the latest news.

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This book is an enthralling chronicle of the author's experience with infertility, from the initial realization through the use of extensive measures to become pregnant. This is a must read for all women and couples, who like the author, thought becoming pregnant would automatically happen when they wanted it to.  Anyone struggling with infertility or going through fertility treatments, especially in vitro fertilization or Intra Cytoplasmic Sperm Injection (ICSI), will easily relate to this book and feel less alone in their own journey.

http://www.amazon.com/Infertility-Motherhood-Emotional-Journey-ebook/dp/B00CF04L9E/ref=sr_1_1?ie=UTF8&qid=1369233013&sr=8-1&keywords=jennifer+spreng

Don't miss your opportunity to get it for free. Click on the link above today.

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'RSuite CMS has been a supporting member of SSP and an exhibitor at the annual conference since 2008,' stated Jeff Wood, vice president, business development at RSuite CMS. 'Scholarly publishing is complex and RSuite CMS was created to address the needs of this community---metadata management, XML early workflows, searchable repository, etc."

Since 2007, RSuite CMS has helped the world's leading scholarly publishers manage, produce, transform, and distribute content for books, journals, and digital media. Company representatives will be available at booth 213 to discuss specific publishing needs and demonstrate the latest version of the software.

For more information about RSuite CMS or to schedule a demo at the Society for Scholarly Publishing conference, please email info@rsicms.com.

About RSI Content Solutions
RSI Content Solutions accelerates publishers' revenue and profit growth through better content management. Since 2000, RSI Content Solutions has provided publishers, media companies, and technical publishers with award-winning software solutions that transform their businesses to provide clients with the ability to deliver content in any format, to any channel, at any time. RSI Content Solutions products include RSuite CMS—a content management system for publishers and DocZone DITA—a SaaS XML component content management system for technical publishers. For more information, please visit www.rsicms.com.

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Statement Highlights:
·  Stroke costs are predicted to more than double in the next 20 years.
·  Americans 45-64 years old are expected to have the highest increase in stroke incidence.

EMBARGOED UNTIL 11 a.m. CT/12 noon ET, Wednesday, May 22, 2013 
DALLAS, May 22, 2013 — Costs to treat stroke are projected to more than double and the number of people having strokes may increase 20 percent by 2030, according to the American Heart Association/American Stroke Association.

In a statement published in Stroke, an American Heart Association journal, the association cites the aging U.S. population as the main reason for the increases and predicts that by 2030:

·  Almost 4 percent of U.S. adults — nearly one in 25 — will have a stroke. This translates into an additional 3.4 million people with stroke in 2030.
·  Costs to treat stroke may increase from $71.55 billion in 2010 to $183.13 billion.
·  Annual costs due to lost productivity could rise from $33.65 billion to $56.54 billion.
·  Americans currently 45-64 years old are expected to have the highest increase in stroke at 5.1 percent.
·  Stroke prevalence is projected to increase the most among Hispanic men between now and 2030, and the cost of treating stroke in Hispanic women is expected to triple.

'Strokes will absolutely strain the healthcare system,' said Bruce Ovbiagele, M.D., M.Sc., professor and chairman of the Department of Neurology at the Medical University of South Carolina, Charleston.

Caring for survivors is expensive because stroke can cause long-term disability, he said.

'Ninety percent of stroke patients have residual disability and only 10 percent recover completely after a stroke,' Ovbiagele said. 'Policy makers at all levels of governance should be aware of this looming crisis so that we can consider practical ways to avert it.'

The fourth leading cause of death and one of the top causes of preventable disability in the United States, stroke occurs when blood flow to the brain is interrupted by a blood clot or a bleeding vessel. Without oxygen-rich blood, brain cells die.

'Getting patients specialized acute stroke care as soon as possible is critical. During every minute of delayed treatment, brain cells are dying. EMS systems nationwide should take patients directly to a designated stroke center equipped to quickly diagnose and administer drugs to restore blood flow to the brain,' Ovbiagele said.

Hispanics and blacks have a higher rate of stroke incidences and worse outcomes, and individuals without insurance have a 24 percent to 56 percent higher risk of death from stroke than those with insurance coverage, the statement said.

Stroke rates are particularly high among people 45-64, who are too young to receive Medicare, less able to afford medications and more likely to have diabetes and obesity, compared to older stroke survivors, Ovbiagele said.

The Affordable Care Act is expected to expand insurance coverage to an additional 32 million Americans and to increase emphasis on prevention and wellness. These types of policy changes should help reduce the number of strokes, deaths and related costs when the law is fully implemented in 2014. For example:

·  86 million Americans have already gained access to free preventive screenings and services, such as high blood pressure and cholesterol screening and tobacco cessation services, through Medicare and most private health plans.
·  Expanding access to insurance coverage should improve access to primary care and the medications needed to control risk factors and help prevent stroke and to improve access to acute stroke treatment for those who were previously uninsured.

Statement co-writers are Larry B. Goldstein, M.D.; Randall T. Higashida, M.D.; Virginia J. Howard, Ph.D.; S. Claiborne Johnston, M.D., Ph.D.; Olga A. Khavjou, M.A.; Daniel T. Lackland, Dr.P.H., M.S.P.H.; Judith H. Lichtman, Ph.D.; Stephanie Mohl, B.A.; Ralph L. Sacco, M.D., M.Sc.; Jeffrey L. Saver, M.D.; and Justin G. Trogdon, Ph.D. Author disclosures are on the manuscript.

For the latest heart and stroke news, follow us on Twitter: @HeartNews.

###

The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events. Strict policies are enforced to prevent these relationships from influencing the association's science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical companies and device manufacturers, is available at www.heart.org/corporatefunding.

Additional resources, including multimedia, are available in the right column: http://newsroom.heart.org/news/costs-to-treat-stroke-in-america-may-double-by-2030?preview=f5e49418c9fd3bf2b6cc25e89de6194d

For Media Inquiries: (214) 706-1173
Darcy Spitz: (212) 878-5940;  darcy.spitz@heart.org
Julie Del Barto (broadcast): (214) 706-1330;  julie.delbarto@heart.org
For Public Inquiries: (800) AHA-USA1 (242-8721)
heart.org and strokeassociation.org
 

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NeuroStar TMS Therapy was administered to patients as determined by the evaluating physician, consistent with labeled use.  Patients who received benefit from acute NeuroStar TMS Therapy were tapered from their TMS regimen and observed through 52 weeks of follow-up.  Clinical assessments (CGI-Severity of Illness, PHQ-9 and IDS-SR) were obtained at three, six, nine and twelve months.  Concurrent medication use and TMS reintroduction for recurrent symptoms was recorded and summarized during the long-term follow up.
 
Compared with baseline, there was a statistically significant reduction in mean [SD] CGI-S, PHQ-9 and IDS-SR total scores at the end of acute treatment (5.1 [0.9] versus 3.2 [1.5], 18.3 [5.2] versus 9.6 [7.0], and 45.7 [11.0] versus 27.4 [15.8], all P less than 0.0001), which was sustained throughout the 52 week follow-up (3.0 [1.5], 9.4 [7.2], and 27.3 [16.1], all P less than 0.0001), respectively.
 
About Neuronetics, Inc.
Neuronetics, Inc., is a privately-held medical device company focused on developing non-invasive therapies for psychiatric and neurological disorders using MRI-strength magnetic field pulses.  Based in Malvern, PA, Neuronetics is the leader in the development of TMS Therapy, a non-invasive form of neuromodulation.  For more information, please visit www.neuronetics.com or www.neurostar.com.
 
NeuroStar®, NeuroStar TMS Therapy® and TMS Therapy® are registered trademarks of Neuronetics, Inc.
 
# # #

53-51043-000 Rev A
 

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They found that, as women age, their egg cells become riddled with DNA damage and die off because their DNA repair systems wear out. Defects in one of the DNA repair genes—BRCA1—have long been linked with breast cancer, and now also appear to cause early menopause.

'We all know that a woman's fertility declines in her 40s. This study provides a molecular explanation for why that happens,' said Dr. Susan Taymans, Ph.D., of the Fertility and Infertility Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute that funded the study. 'Eventually, such insights might help us find ways to improve and extend a woman's reproductive life.'

The findings appear in Science Translational Medicine.

In general, a woman's ability to conceive and maintain a pregnancy is linked to the number and health of her egg cells. Before a baby girl is born, her ovaries contain her lifetime supply of egg cells (known as primordial follicle oocytes) until they are more mature. As she enters her late 30s, the number of oocytes — and fertility — dips precipitously. By the time she reaches her early 50s, her original ovarian supply of about 1 million cells drops virtually to zero.

Only a small proportion of oocytes — about 500 — are released via ovulation during the woman's reproductive life. The remaining 99.9 percent are eliminated by the woman's body, primarily through cellular suicide, a normal process that prevents the spread or inheritance of damaged cells.

The scientists suspect that most aging oocytes self-destruct because they have accumulated a dangerous type of DNA damage called double-stranded breaks. According to the study, older oocytes have more of this sort of damage than do younger ones. The researchers also found that older oocytes are less able to fix DNA breaks due to their dwindling supply of repair molecules.

Examining oocytes from mice, and from women 24 to 41 years old, the researchers found that the activity of four DNA repair genes (BRCA1, MRE11, Rad51 and ATM) declined with age. When the research team experimentally turned off these genes in mouse oocytes, the cells had more DNA breaks and higher death rates than did oocytes with properly working repair systems.

The research team's findings stemmed from their initial focus on BRCA1, a DNA repair gene that has been closely studied for nearly 20 years because defective versions of it dramatically increase a woman's risk of breast cancer.

Using mice bred to lack the BRCA1 gene, the NICHD-supported scientists confirmed that a healthy version of BRCA1 is vital to reproductive health. BRCA1-deficient mice were less fertile, had fewer oocytes, and had more double-stranded DNA breaks in their remaining oocytes than did normal mice.

Abnormal BRCA1 appears to cause the same problems in humans—the team's studies suggest that if a woman's oocytes contain mutant versions of BRCA1, she will exhaust her ovarian supply sooner than women whose oocytes carry the healthy version of BRCA1.

Together, these findings show that the ability of oocytes to repair double-stranded DNA breaks is closely linked with ovarian aging and, by extension, a woman's fertility. This molecular-level understanding points to new reproductive therapies. Specifically, the scientists suggest that finding ways to bolster DNA repair systems in the ovaries might lead to treatments that can improve or prolong fertility.

Senior author Kutluk Oktay, M.D., of New York Medical College (NYMC), in Rye and Valhalla, collaborated with colleagues at NYMC and researchers at Istanbul Bilim University, Turkey; Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York; and Yeshiva University, New York.

The work was supported by grants HD53112 and HD61259.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute's website at http://www.nichd.nih.gov/.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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Study Highlights:

• Many people with implantable defibrillators may safely participate in a number of vigorous sports.
• The study challenges some current science recommendations advising against vigorous competitive sports for people with implantable defibrillators.
• People with implantable defibrillators should decide, with their physicians, about whether they can participate in vigorous competitive sports.

An implantable cardioverter defibrillator (ICD) in the chest is somewhat similar to a pacemaker, delivering one or more electrical shocks to restore a normal heartbeat when it detects a dangerous rhythm.

Some science recommendations advise people with ICDs not to participate in competitive sports more vigorous than golf or bowling.

'But these recommendations were based on the best judgment of physicians, not actual data looking at the safety of more rigorous sports,' said Rachel Lampert, M.D., lead author of the study and associate professor of medicine at the Yale School of Medicine in New Haven, Conn.

Researchers followed 372 ICD recipients, ages 10-60, for an average of two-and-a-half years each. They included competitive athletes, high school and college athletes and others who participated in vigorous sports such as running, basketball, soccer, tennis, volleyball, skiing and snowboarding.

In this prospective multinational registry, researchers found that although some athletes received shocks during sports for life-threatening and non-life-threatening heart rhythms, there were no injuries or deaths related to the shocks or the underlying abnormal rhythms.

Seventy-seven people received 121 shocks during the study. Of the total study population:

• 10 percent received shocks while participating in competition or practice.
• 8 percent received shocks during other physical activities.
• 6 percent received shocks while resting.

These data suggest that athletes should decide, with their physicians, whether to return to vigorous sports after discussing their specific situation and preferences, Lampert said.

Co-authors are: Brian Olshansky, M.D.; Hein Heidbuchel, M.D.; Christine Lawless, M.D.; Elizabeth Saarel, M.D.; Michael Ackerman, M.D.; Hugh Calkins, M.D.; Mark Estes, M.D.; Mark S. Link, M.D.; Barry J. Maron, M.D.; Frank Marcus, M.D.; Melvin Scheinman, M.D.; Bruce L. Wilkoff, M.D.; Douglas P. Zipes, M.D.; Charles I. Berul, M.D.; Alan Cheng, M.D.; Ian Law, M.D.; Michele Loomis, APRN; Cheryl Barth, B.S.; Cynthia Brandt, M.D.; James Dziura, Ph.D; Fangyong Li, M.S. and David Cannom, M.D. Author disclosures are on the manuscript.

Boston Scientific, Medtronic and St. Jude Medical funded the study.

Read more from the American Heart Association about abnormal heart rhythms and living with an ICD.

For the latest heart and stroke news, follow us on Twitter: @HeartNews.

For updates and new science from Circulation, follow @CircAHA .

###

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position.  The association makes no representation or guarantee as to their accuracy or reliability.  The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

For Media Inquiries: (214) 706-1173
Tagni McRae: (214) 706-1383;  Tagni.McRae@heart.org
Bridgette McNeill: (214) 706-1135;  Bridgette.McNeill@heart.org
Julie Del Barto (broadcast): (214) 706-1330;  Julie.DelBarto@heart.org
For Public Inquiries: (800) AHA-USA1 (242-8721)
heart.org and strokeassociation.org
 

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"Many researchers have been working on such a diagnostic test for a long time — for me, it has been 20 years," says lead investigator Massimo Raimondo, M.D., a gastroenterologist at Mayo Clinic in Florida. "But for the first time, we have found a very strong candidate molecular marker.

"We all want a foolproof method to detect pancreatic cancer in our patients so that we can deliver appropriate therapy, as soon as possible," Dr. Raimondo adds. "While we know more research is needed, including validation of our findings, we can't help but be excited about this advance."

Pancreatic cancer and chronic pancreatitis both produce the same signs of disease in the pancreas, such as inflammation, but cancer in the organ is a life-threatening disorder that must be treated immediately and aggressively, Dr. Raimondo says.

The research team, which included investigators from Mayo Clinic in Rochester, Minn., tested a method that examined secretions from the pancreas during a routine upper endoscopy.

In patients suspected of having chronic pancreatitis or pancreatic cancer, physicians use a thin flexible scope to examine the upper digestive tract. In this study, during such routine endoscopies, physicians injected the substance secretin intravenously, to fool the pancreas into believing the stomach contains food that the pancreas needs to help digest. The organ then secreted juice rich in enzymes to help break down the food, along with exfoliated cells, and the researchers collected some of this fluid.

They examined the juice for markers that might distinguish the two disorders, and discovered that the altered gene CD1D, as a single marker, detected 75 percent of patients later diagnosed with pancreatic cancer, but was present in only 9 percent of patients with chronic pancreatitis.

"CD1D performed much better than any other pancreatic secretion marker previously tested in identifying pancreatic cancer," Dr. Raimondo says.

The research team is working on further improving the accuracy of this promising molecular diagnostic approach.

"These results on Dr. Raimondo's carefully collected samples are really exciting and have clear practice-changing implications," says co-author David Ahlquist, M.D., who led the collaborating laboratory team at Mayo Clinic in Rochester. Diagnostic accuracy well above 90 percent is possible, he says.

When such a biomarker test is perfected, it could be used not only to distinguish pancreatic cancer from chronic pancreatitis, but, potentially, as a screening test for patients at high risk for pancreatic cancer, Dr. Raimondo says.

The study was funded by grants from the Charles Oswald Foundation.

###

About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit MayoClinic.com or MayoClinic.org/news.

Journalists can become a member of the Mayo Clinic News Network for the latest health, science and research news and access to video, audio, text and graphic elements that can be downloaded or embedded.

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American Heart Association Meeting Report - Abstract 218 - Embargoed until 9:45 a.m. CT/10:45 a.m. ET Friday, May 17, 2013

May 17, 2013 

Study Highlights:

• An experimental, inexpensive iPhone app transmitted ECGs faster and more reliably than traditional emailed photo transmission.
• The app could help save lives by speeding diagnosis and treatment for the deadliest type of heart attack.

The app could help save lives by speeding treatment for the deadliest type of heart attack known as STEMI (ST segment elevation myocardial infarction), in which a clot blocks blood flow to the heart.

A critical step in prompt, effective STEMI treatment is rapid transmission of anelectrocardiogram (ECG) image from emergency medical personnel on site with a patient directly to the hospital to be viewed by a doctor. The ECG may show evidence of a heart attack, allowing doctors to prepare for immediate treatment upon the patient's arrival.

Traditionally, ECG images are sent through specialized commercial systems. Some hospitals use cell phones to take photos of ECGs, which require large files to maintain clarity and can be slow and unreliable, particularly in signal-limited environments.

'Simple cellular technology can save lives,' said David R. Burt, M.D., the study's lead author and an associate professor of emergency medicine at the University of Virginia School of Medicine in Charlottesville. 'This system may make pre-hospital ECG transmission a more inexpensive and reliable option. That can translate to faster treatment and saved lives.'

In this study:

• iPhone images were transmitted in 4-6 seconds, compared to 38-114 seconds for actual-size and 17-48 seconds to send a large-size e-mail image.
• The app's failure rate at 120 seconds was less than 0.5 percent, compared to a 3 percent to 71 percent e-mail failure rate.

They tested the app more than 1,500 times with Sprint, AT&T, and Verizon in an urban area. The researchers are currently testing the app in rural areas with limited cell-phone access and in comparison with commercial proprietary systems.

'In many places, it may be feasible to transmit vital ECGs over commercial cell-phone networks, saving money, and allowing areas without commercial ECG transmission systems to still connect pre-hospital emergency medical services with STEMI treatment centers,' Burt said.

Each year in the United States, nearly a quarter of a million people experience STEMI. Survival depends upon immediate treatment to restore blood flow. Yet many patients don't make it to the hospital in time.

The American Heart Association recommends surgical treatment within 90 minutes of hospital arrival, or clot-busting medication within 30 minutes. The association initiated a national system of treatment and referral centers known as Mission: Lifeline® to help ensure standard of care.

Co-authors are Richard Zhang; Steven Fowler; Jonni Seal; and Stephen D. Patek, Ph.D.

The University of Virginia Wireless Internet Center for Advanced Technology funded the study. Additional disclosures are on the abstract.

Follow news from the Quality of Care and Outcomes Research Scientific Sessions 2013 via Twitter: @HeartNews; #QCOR13.

###

Statements and conclusions of study authors presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the association's policy or position.  The association makes no representation or guarantee as to their accuracy or reliability.  The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

Any B roll, animation or images related to this release are in the right column of this link:http://newsroom.heart.org/news/diagnosing-heart-attacks:-theres-an-app-for-that?preview=58b596b9a7626a055ae10cd394b8312b

For Media Inquiries: (214) 706-1173
Cathy Lewis: (214) 706-1324;  cathy.lewis@heart.org
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Julie Del Barto (broadcast): (214) 706-1330;  julie.delbarto@heart.org
For Public Inquiries: (800) AHA-USA1 (242-8721)
www.heart.org and www.strokeassociation.org
 

— WebWireID174817 —

In the trial, 74 patients were treated for six months on-demand, or 12 months by a prophylactic regimen of 40 U/kg or 10 U/kg N9-GP once weekly. The median bleeding rate for patients treated on-demand was 15.6 episodes per year. Patients on prophylaxis had a median annualised bleeding rate of 1.0 and 2.9 episodes per year, when treated with weekly doses of 40 U/kg and 10 U/kg, respectively.

Among patients randomised to receive 40 U/kg N9-GP, 99% of bleeding episodes were treated with only one infusion, and two-thirds of the patients experienced complete resolution of bleeding in their target joints. Patients in this dose group also reported an improvement in quality of life during the trial.

Pharmacokinetic data documented a steady state half-life of 110 hours.

In the trial, N9-GP appeared to have a safe and well-tolerated profile. No patients in the trial developed inhibitors, and no apparent differences between the treatment groups were observed with respect to adverse events and standard safety parameters.

'We are very excited about the strong results from this trial, which could represent a paradigm shift in the treatment of haemophilia B,' said Mads Krogsgaard Thomsen, executive vice president and chief science officer of Novo Nordisk. 'The trial demonstrated that once-weekly prophylactic administration of N9-GP can reduce the risk of bleeds by more than 90% compared to on-demand treatment and enable 99% of the few occurring bleeds to be stopped with a single dose.'

Novo Nordisk is expecting the two remaining phase 3 trials in the paradigm™ programme involving paediatric patients and patients undergoing surgery respectively to be completed within the next 12 months. Regulatory submission of N9-GP in all major markets is expected in 2015 to enable validation of the commercial scale production.

About N9-GP and paradigm™
N9-GP is a proprietary glycopegylated recombinant factor IX for patients with haemophilia B. Glycopegylation is a well-established protraction technology applied by Novo Nordisk on recombinant factor IX. The technology increases the circulating half-life of recombinant factor IX allowing for lower bleeding frequency with less frequent intra-venous dosing.

The paradigm™ programme is a Novo Nordisk registered trademark for trial conducted with N9-GP. The programme currently comprises seven clinical trials investigating pharmacokinetics, immunogenicity, efficacy and safety of N9-GP in adult and paediatric haemophilia B patients as well as in patients undergoing surgery.

-----
Novo Nordisk is a global healthcare company with 90 years of innovation and leadership in diabetes care. The company also has leading positions within haemophilia care, growth hormone therapy and hormone replacement therapy. Headquartered in Denmark, Novo Nordisk employs approximately 35,000 employees in 75 countries, and markets its products in more than 180 countries. Novo Nordisk's B shares are listed on NASDAQ OMX Copenhagen (Novo-B). Its ADRs are listed on the New York Stock Exchange (NVO). For more information, visit novonordisk.com.

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'Fujifilm is a pioneer in developing innovative medical solutions and understands the need for better efficiency in healthcare facilities with reliable, easy to use equipment that improves patient care while containing costs,' said Kurt Cannon, Vice President of Sales, Marketing & Operations, Endoscopy Division, FUJIFILM Medical Systems, U.S.A., Inc. 'Fujifilm offers some of the most advanced endoscopic equipment in the world. The Sonart endoscopic ultrasonography system with its high-resolution, high-quality ultrasound and endoscopic imaging, is one such example.'

Medical professionals in the fields of gastroenterology and pulmonology have recognized performance and high quality imaging in a compact design as valuable modalities. The new system is equipped with innovative image processing technology called ZONE Sonography™ and Sound Speed Correction Technology that provides excellent diagnostic capabilities. Compact, yet comprehensive, Sonart brings a new approach to endoscopic ultrasound, easily integrating into a slim endoscopic procedure cart with video processor and light source. The result is a mobile one-cart solution for all your endoscopic needs.  

For added convenience, the system can be used in conjunction with the EG-530UR2 radial scope and the EG-530UT2 convex scope.  While the EG-530UR2 radial scope provides unique forward viewing, the design of the EG-530UT2 convex scope permits passage of therapeutic devices and needle position guide on the ultrasound image. These features combined with high quality images enable medical professionals to deliver accurate patient results.

Digestive Disease Week (DDW) provides a forum for showcasing the latest innovations in gastrointestinal products and services. Visit Fujifilm at DDW 2013 (Booth #1019) to learn more or speak with a Fujifilm representative.  For more information, please visit www.fujifilmendoscopy.com.

About Fujifilm
FUJIFILM Medical Systems U.S.A., Inc. is a leading provider of diagnostic imaging products and medical informatics solutions to meet the needs of healthcare facilities today and well into the future. From an unrivaled selection of digital x-ray systems, to the Synapse® brand of PACS, RIS and cardiovascular products, to advanced women's health imaging systems, Fujifilm has products that are ideal for any size imaging environment. The Endoscopy Division of FUJIFILM Medical Systems U.S.A., Inc., supplies high quality, technologically advanced, FUJINON brand endoscopes to the medical market. FUJIFILM Medical Systems U.S.A., Inc. is headquartered in Stamford, CT. For more information visit www.fujimed.com and www.fujifilmendoscopy.com.

FUJIFILM Holdings Corporation, Tokyo, Japan, brings continuous innovation and leading-edge products to a broad spectrum of industries, including electronic imaging, digital printing equipment, medical systems, life sciences, graphic arts, flat panel display materials, and office products, based on a vast portfolio of digital, optical, fine chemical and thin film coating technologies. The company was among the top 10 companies around the world granted U.S. patents in 2012, and in the year ended March 31, 2013, had global revenues of $26.7 billion*. Fujifilm is committed to environmental stewardship and good corporate citizenship. For more information, please visit www.fujifilmholdings.com.

* At an exchange rate of 83 yen to the dollar.
 
All product and company names herein may be trademarks of their registered owners.

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'Fujifilm is proud to re-establish our position in the pulmonary market with our newly released line of bronchoscopes and endoscopic ultrasound bronchoscope,' said Kurt Cannon, Vice President of Sales, Marketing & Operations, Endoscopy Division, FUJIFILM Medical Systems, U.S.A., Inc. 'The Sonart system meets the diverse imaging needs for a wide spectrum of clinical disciplines – from pulmonology to thoracic surgery.  It encompasses advanced technology and excellent imaging performance in a compact system, enabling comprehensive patient care.'

Medical professionals in the fields of pulmonology and gastroenterology have recognized performance and high quality imaging in a compact design as valuable modalities. The new system is equipped with innovative image processing technology called ZONE Sonography™ and Sound Speed Correction Technology that provides excellent diagnostic capabilities. Compact, yet comprehensive, Sonart brings a new approach to endoscopic ultrasound, easily integrating into a slim endoscopic procedure cart with video processor and light source. The result is a mobile one-cart solution for all your endoscopic needs.

For added convenience, the system can be used in conjunction with the EB-530US ultrasound video bronchoscope.  With a distal end outer diameter of 6.7mm, the EB-530US scope is designed to reduce patient discomfort and improve maneuverability, insertion capability and physician efficiency. Equipped with high-resolution, ultra small Super CCD chip technology, this scope offers bright, vivid high-resolution endoscopic images. Unique design features of the EB-530US include a 10° forward oblique view for optimal visualization of the vocal cords and optimal positioning of the ultrasonic transducer for visibility during needle aspiration; dual light guides - one on each side of the accessory channel for even illumination; and exceptional bending capability to facilitate precise targeting of accessories. These features, along with high quality images, provide for confident ultrasound diagnosis.

The American Thoracic Society is a leading international medical association dedicated to advancing lung, critical care and sleep medicine and provides a forum for showcasing the latest innovations. Visit Fujifilm at ATS 2013 (Booth #1007) to learn more or speak with a Fujifilm representative. For more information, please visit www.fujifilmendoscopy.com .

About Fujifilm
FUJIFILM Medical Systems U.S.A., Inc. is a leading provider of diagnostic imaging products and medical informatics solutions to meet the needs of healthcare facilities today and well into the future. From an unrivaled selection of digital x-ray systems, to the Synapse® brand of PACS, RIS and cardiovascular products, to advanced women's health imaging systems, Fujifilm has products that are ideal for any size imaging environment. The Endoscopy Division of FUJIFILM Medical Systems U.S.A., Inc., supplies high quality, technologically advanced, FUJINON brand endoscopes to the medical market. FUJIFILM Medical Systems U.S.A., Inc. is headquartered in Stamford, CT. For more information visit www.fujimed.com and www.fujifilmendoscopy.com .

FUJIFILM Holdings Corporation, Tokyo, Japan, brings continuous innovation and leading-edge products to a broad spectrum of industries, including electronic imaging, digital printing equipment, medical systems, life sciences, graphic arts, flat panel display materials, and office products, based on a vast portfolio of digital, optical, fine chemical and thin film coating technologies. The company was among the top 10 companies around the world granted U.S. patents in 2012, and in the year ended March 31, 2013, had global revenues of $26.7 billion*. Fujifilm is committed to environmental stewardship and good corporate citizenship. For more information, please visit www.fujifilmholdings.com .

* At an exchange rate of 83 yen to the dollar.
 
All product and company names herein may be trademarks of their registered owners.
 

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American Heart Association Meeting Report - Abstract 270 - Embargoed until 8:30 a.m. CT/9:30 a.m. ET, Friday, May 17, 2013

May 17, 2013 

Study Highlights:

• Controlling heart disease risk factors — like high cholesterol, high blood pressure and smoking — varies widely among outpatient practices.

Researchers compared electronic health records of 115,737 patients in 18 primary care and cardiology practices participating in The Guideline Advantage™, a collaboration of the American Cancer Society, American Diabetes Association and American Heart Association that aims to reduce risks for chronic diseases. They found:

• The percentage of people whose hypertension was under control (less than 140/90 mm Hg) ranged from 58.7 percent to 75.1 percent.
• The percentage of diabetic patients with cholesterol under control ('bad' low density lipoprotein cholesterol under 100 mg/dL) ranged from 53.8 percent to 100 percent.
• The percentage of patients screened for smoking, and receiving a tobacco cessation intervention, ranged from 53.8 percent to 86.1 percent.

'It's eye-opening for practices to see how much better or worse they're doing than their peers on nationally derived measures of quality. They can learn to improve in collaboration with others instead of alone,' he said.

Co-authors are Vincent Bufalino, M.D.; Eric D. Peterson, M.D., M.P.H.; and Adrian Hernandez, M.D., M.H.S. Additional disclosures are on the abstract.

Follow news from the Quality of Care and Outcomes Research Scientific Sessions 2013 via Twitter: @HeartNews; #QCOR13.

###

Statements and conclusions of study authors presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the association's policy or position.  The association makes no representation or guarantee as to their accuracy or reliability.  The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

Any B roll, animation or images related to this release are in the right column of this link: http://newsroom.heart.org/news/control-of-heart-disease-risk-factors-varies-among-outpatient-practices?preview=a99de3e49457a56bd4d42f5c2b9ce4fe

For Media Inquiries:  (214) 706-1173
Cathy Lewis: (214) 706-1324;  cathy.lewis@heart.org
Tagni McRae: (214) 706-1383;  tagni.mcrae@heart.org
Julie Del Barto (broadcast): (214) 706-1330;  julie.delbarto@heart.org
For Public Inquiries:  (800) AHA-USA1 (242-8721)
www.heart.org and www.strokeassociation.org
 

— WebWireID174807 —

Once His Holiness and the panellists had taken their seats on the stage of the Overture Center for the Arts, which was filled to capacity, proceedings both in the morning and afternoon opened with a musical-poetic performance by Logan Phillips, Molly Sturges and Aaron Stern of the Academy for the Love of Learning, who presented musical and poetic notions of a happier world, such as 'we are a beautifully sung song.'

Richie Davidson introduced his old friend Dan Goleman, moderator of the morning's session, who began by making clear that the discussions aimed to talk about being well in every sense; exploring different ways in which we can flourish. Richie referred to findings that changes in the body can be attributed to stress, but that there is new work to show that happiness and well-being have positive effects on the body too. His Holiness asked how you measure well-being and Richie said they rely on self-report. His Holiness was asked if he had advice on how to make well-being more widespread.

'I think you already know what I think.' he replied, 'But these people in the audience may not have heard it before. At this point everyone here feels at ease, but if I think of you as somehow different from me, if I think that I'm Tibetan, I'm Buddhist, an Easterner, I'm a monk or even something grand like His Holiness the Dalai Lama, this kind of thinking automatically creates a gap between us. It results in a sense of unease. On the other hand, if I consider you as another human being, just like me, then that source of anxiety disappears.

'I'm very happy and encouraged to be here. Some scientists don't even accept the existence of mind, they think there's only the brain. If that were the case we ought to be able change the way we live through surgery. However, the proper way to train the mind is by using the mind itself, not in connection with the next life or anything like that, but focussing on a healthy society and a happier humanity here and now. Everybody wants a happy life and a peaceful mind, but we have to produce peace of mind through our own practice.

'Modern science's interest in mind or consciousness is new, and so is the public interest in mind and emotional training. Have I spoken for too long?'

Jonathan Patz noted the news that for the first time the amount of carbon dioxide in the atmosphere has reached 400 parts per million. He said scientists are very concerned that if this continues and reaches 450ppm it will be very dangerous. He recalled that last time he and His Holiness met, they talked about global climate change and he had explained that it would bring heat-waves, hunger and drought. His Holiness had responded:

'If we have the knowledge we have to act.'

He talked about work he has done concerning the peregrine falcon, which is an endangered species. It was only when the focus shifted to habitat and the context of the falcons' lives that they began to be effective.

'Consequently,' Patz said, 'when we think of prospects for our own species, we need to see ourselves in the context a healthy environment, which means a healthy planet.'

His Holiness remarked that this is clear evidence of the need to focus on long term interests, of our need for moral principles and a sense of responsibility.

Don Berwick talked about developments in health care noting that when he began his career all children with leukaemia died, but now they don't. However, health costs continue to increase, which means that spending on education, for example, has dropped. He mentioned three mistakes with regard to health care: the belief that more is better; the belief that the way to health is through technological solutions rather than looking at what we eat and how we live; and the belief that we can treat the body but not the mind. He said that when he explains that sometimes less is more, people feel they are being deceived.

His Holiness agreed that new findings are sometimes not easy to accept, which is why the public needs to hear more from experts like those on the panel. This is a role which the media can play; they should give such experts more exposure. People need to understand that if they want to live long and be comfortable, they may have to change some of the things they are used to.

Ilona Kickbusch began with the observation that she was both happy and unhappy to be the only woman on the panel. She said that great strides have been taken in relation to global health, but that we are reaching the limits of this particular model, the 'vertical disease model'. Consequently, there is a need to rethink what health is, to combine a drive for equity and health care reform.

Last time His Holiness and Richard Layard met, he told him about Action for Happiness, which His Holiness asked to join. He explained that the movement has since been successfully launched and has attracted 30,000 members. What's more, some governments have begun to adopt some of its objectives regarding well-being, among them Bhutan and the UK. Meanwhile the OECD, the club of developed nations, has drawn up codes to measure well-being rather than depending only on economic indicators; this is a major revolution.

Less encouraging was his report that within the context of general well-being, mental health is not taken sufficiently seriously, which amounts to discrimination. He said there is treatment and good prospects for recovery, but overall mental health is not regarded as seriously as physical health. He asked His Holiness how he interprets this finding.

'Knowledge of the mind is limited.' His Holiness said, 'People have only a superficial view of what mind is, which is a cultural issue. I agree that the brain is complex and sophisticated, but the mind and emotions are also sophisticated and complex. Maybe it's due to a fundamental misunderstanding that it's the physical that you have to fix. We need to view these things in a different way. Because we take physical health seriously we have codes of physical hygiene, I'm proposing that equally important are codes of mental and emotional hygiene.'

Richard Layard concluded with two facts: every human being wants to be happy and every human being is equally important. If we acknowledge these, we can work to increase the spread of happiness. His Holiness responded that if we can let people know that adopting this or that measure will improve their peace of mind and improve their physical health, it will lead to a more attractive solution.

Moderator for the afternoon was Arianna Huffington, who began with the observation that our world has become unmanageable. She also remarked that while we all have a place of inner strength within us, most of us are not there most of the time and we need to ask how we can get there more often.

Richie Davidson offered five facts about well-being for consideration. 1. Well-being is a skill, 2. Well-being seems to be universally related to the mind's well-being. He referred to a study that asked people: what are you doing? is your mind focussed? and are you happy? The response showed that people's well-being is higher when they are focussed, but also that their minds wander a good deal. When the mind wanders performance suffers. It is a source of suffering; people are not happy living this way. His Holiness recognised Richie's description of the wandering mind, saying he is familiar with it too.

Richie continued to explain the facts about well-being. 3. Well-being is associated with patterns of both mind and body. 4. Well-being has three aspects - returning to calm after a stressful event; mindfulness and generosity. 5. There is an innate disposition towards well-being, demonstrated by findings that young babies show a preference for altruistic behaviour.

Arianna asked what we can do to ensure that such well-being becomes more widespread. His Holiness replied:

'I mentioned this morning - education, in schools but also through our various media. We need to see reports of positive as well as negative news. Basic human nature is gentle. We are born from our mothers, who show us affection. We are social animals and depend on each other to survive. People who receive more affection from their mothers are happier and more secure. The basic gentle nature we are born with tends to become dormant as we grow up, we need training and education from an early age to ensure that it remains fresh instead. This is an example of using our human intelligence for the well-being of ourselves and society.'

Jonathan Patz said that his theme for the afternoon was interdependence. Without awareness of interdependence we won't understand that our energy consumption is affecting the world's climate. We need to be mindful of that, just as we need to be mindful of our consumption. His Holiness commented:

'We must address these problems like global climate change and the global economy as one community. We can't expect our population of 7 billion human beings to live the life of a hermit. When the world population was smaller each country was self-sufficient, but today's reality is that everyone is interdependent; the old way doesn't work anymore. For example, you spend a huge amount of money and resources on developing and maintaining nuclear weapons, and yet, because, quite rightly, no one dares use them, the money is in effect wasted. We must find ways to change the way things have been done until now.'

Matthieu Ricard suggested that we have so far underestimated the power of mental health, but expressed confidence that this can change. Arianna wanted to know if His Holiness feels we have reached a tipping point. He replied:

'If we make consistent effort, based on proper education, we can change the world. We are selfish, that's natural, but we need to be wisely selfish, not foolishly selfish. We have to concern ourselves more with others' well-being, that's the way to be wisely selfish. We have the ability to take the long-term benefit into account. I think it is possible to make real change in this century.

'Education is the best way to train ourselves that we will secure our own well-being by concerning ourselves with others. It is possible to create a better world, a more compassionate, more peaceful world, which is not only in everyone's interest, but is everyone's responsibility to achieve.'

His Holiness offered each member of the panel a kata, a white silk scarf, and then standing hand in hand with them at the front of the stage, energetically appealed to the audience.

'Great changes start with individuals; the basis of world peace is inner peace in the hearts of individuals. This is something we can all work for. If what you've heard here interests you, if you think it's something you can act on, share it with others. If there are a thousand people here and each of you shares this with ten friends, ten thousand people will hear about it, and so on. That's the way we can change our minds and change the world. Thank you.'

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