Don't squint -- get reading glasses!

The AAD says repetitive facial movement -- like squinting -- overworks facial muscles, forming a groove beneath the skin's surface. This groove eventually becomes a wrinkle. Keep those eyes wide: Wear reading glasses if you need them. And get savvy about sunglasses, which can protect skin around the eyes from sun damage and keep you from squinting.

Eat more fish -- particularly salmon.

Not only is salmon (along with other cold-water fish) a great source of protein -- one of the building blocks of great skin -- it's also an awesome source of an essential fatty acid known as omega-3. Yale dermatologist Nicholas Perricone, MD, tells WebMD that essential fatty acids nourish skin and keep it plump and youthful, helping to reduce wrinkles.

Sleep on your back.

The American Academy of Dermatology (AAD) cautions that sleeping in certain positions night after night leads to "sleep lines" -- wrinkles that become etched into the surface of the skin and don't disappear once you're up. Sleeping on your side increases wrinkles on cheeks and chin, while sleeping facedown gives you a furrowed brow. To reduce wrinkle formation, the AAD says, sleep on your back.

Rough edges (left) smoothed by enamel shaping, and bonding (right).

Enamel Shaping

Enamel shaping or contouring is a quick and painless process of shaping natural teeth to improve their appearance. It is generally used to correct small imperfections such as uneven teeth or teeth that are slightly overcrowded. Results can be seen immediately. Enamel shaping is often combined with whitening, veneers, or bonding.

A 'prepared' tooth (left); the crown cemented into place (right).

Crowns

A crown is a tooth-shaped "cap" that's placed over a weak or damaged tooth to improve its shape, size, strength, or appearance. Most crowns last five to 15 years and can be made of metal, porcelain fused to metal, resin, or ceramic. Before a crown is seated, the existing tooth is filed down; then the crown is cemented over it, fully encasing the tooth. Onlays and 3/4 crowns cover the underlying tooth to a lesser extent.

A smile before (left) and after (right) the porcelain veneering process.

Veneers

Veneers are wafer-thin, custom-made shells that cover the front surface of teeth. Bonded to the front of the teeth, changing their color, shape, size or length, veneers can be made from porcelain or resin composite. Veneers offer a conservative approach to changing a tooth's color or shape compared to crowns, but the process is not reversible.

A chipped tooth before and after dental bonding.

Dental Bonding

Bonding is a procedure in which a tooth-colored resin is applied and hardened with a special light, ultimately "bonding" the material to the tooth to improve a person's smile. Among the easiest and least expensive of cosmetic dental procedures, bonding can repair chipped or cracked teeth, close gaps, change the shape of teeth, or be used as a cosmetic alternative to silver amalgam fillings.

Want to Improve Your Smile?

See what braces, crowns, veneers, teeth whitening, bridges, gum reshaping — or even a complete dental makeover — can do for your smile.

Causes of Sore, Swollen, and Bleeding Gums: Canker Sores

Common culprits behind painful gums are canker sores, or mouth ulcers. These painful sores can develop anywhere inside the mouth, including on the gums, and they often have a whitish center with red around the edges. You may experience one canker sore at a time, making only one area on your gums sore, or you may have multiple sores at the same time throughout your mouth.

While researchers don't know exactly what causes canker sores, and they're not contagious, there may be bacterial or viral involvement. People with certain autoimmune diseases may also be more likely to suffer gum problems caused by canker sores. Canker sores often recur over time.

Causes of Sore, Swollen, and Bleeding Gums: Chemotherapy

Chemotherapy can have a number of unpleasant side effects, including painful, swollen, and bleeding gums. Many people undergoing treatment for cancer suffer from stomatitis, which causes the development of painful sores and ulcers on the gums and throughout the mouth.

Causes of Sore, Swollen, and Bleeding Gums: Tobacco Products

Using cigarettes and other tobacco products can be extremely damaging to your gums, and people who smoke are far more likely to develop gum disease. You may find that your smoking habit gives you a number of gum problems from sensitive gums that bleed to painful sores.

Causes of Sore, Swollen, and Bleeding Gums: Hormonal Changes

Some women find that they experience gum problems during puberty, menstruation, pregnancy, and menopause. The increase in hormones during puberty can heighten blood flow to the gums, making them red, swollen, and sensitive. For women with menstrual gingivitis, the gums become red, swollen, and more likely to bleed shortly before each menstrual period. These problems typically subside after the period begins. Pregnancy gingivitis typically starts in the second or third month of pregnancy and continues through the eighth month, causing sore, swollen, and bleeding gums. The use of oral birth control products may cause similar gum problems. Though uncommon, some women going through menopause may find that their gums become extremely dry and therefore sore and likely to bleed.

7 Tips to Prevent Sore, Swollen, and Bleeding Gums

1. Brush your teeth at least twice each day. Make sure you follow proper brushing technique. If you're not sure what to do, ask your dentist or dental hygienist for a quick lesson at your next appointment.

2. Floss daily. It doesn't take more than a few minutes, but flossing may be the most important thing you can do to prevent gum problems now and in the future.

3. Eat a well-balanced diet. A balanced diet, including plenty of vitamin C and calcium, may minimize the likelihood of experiencing gum problems.

4. Drink plenty of water. Drinking water, especially after eating, can help wash food off your teeth and make it less likely that bacteria will form gum-damaging plaque.

5. Say no to tobacco. If you smoke cigarettes or use other tobacco products, try to quit.

6. Be cautious about extremely hot or cold foods and beverages. When you're experiencing gum problems, you may find you're more comfortable consuming lukewarm or cool foods and beverages.

7. Relax. Being stressed out raises levels of the stress hormone cortisol, increasing the likelihood of inflammation throughout your body, including in your gums.

Gum Problem Basics: Sore, Swollen, and Bleeding Gums

When you think about dental health, your focus is likely to be on preventing cavities in your teeth. But it's important to pay attention to your gums, too. Your gums play a major role not only in your dental health, but in your overall well-being.

In many instances, swollen and bleeding gums are a sign of gum disease. But there are a number of other factors that could be causing your gum problems. Whatever the cause of your sore, painful gums, there are steps you can take to minimize gum damage and discomfort.

Causes of Sore, Swollen, and Bleeding Bums: Improper Brushing Technique

In your quest to keep your teeth clean, you might be tempted to brush your teeth as vigorously as you can. Your gums are made of sensitive tissue, though, so brushing the wrong way could damage them.

Whether you opt for a manual or electric toothbrush, choose one with soft nylon bristles that have blunted ends. Even though you can find brushes with medium or hard bristles, they may damage the enamel on your teeth or cause red and swollen gums.

When you brush, make sure you use gentle, circular motions to massage and clean the teeth and gums. While many people use a back-and-forth motion, this motion can actually irritate and damage your gums, making them sore and more likely to bleed or recede.

Causes of Sore, Swollen, and Bleeding Gums: Improper Flossing Technique

We all know the importance of flossing every day to help remove plaque from places where your toothbrush cannot reach. To make sure that your healthy habit isn't causing swollen or bleeding gums, be gentle when you floss. Rather than forcing the floss between your teeth, carefully slide it up and down, following the curve of each tooth.

Causes of Sore, Swollen, and Bleeding Gums: Gum Disease

More than three-quarters of American adults over the age of 35 suffer from periodontal (gum) disease. While most people with gum disease have the less severe form, called gingivitis, between 5% and 15% of the population has a much more serious type of gum disease known as periodontitis.

When people do not practice proper dental hygiene, bacteria in the mouth form plaque on the teeth. These bacteria may cause your gums to become inflamed, which results in red, swollen, or bleeding gums. For many people with gingivitis, this inflammation is not painful. If you catch gingivitis early, it can be reversed and healed with proper oral hygiene. But left untreated, gingivitis can worsen and ultimately lead to tooth loss. Be sure to seek medical attention if you have the following symptoms, even if you are not experiencing any discomfort:

• changes in the way teeth fit together on biting, or in the fit of partial dentures
• formation of deep pockets between teeth and gums
• gums that bleed during and after toothbrushing
• loose or shifting teeth
• persistent bad breath or bad taste in the mouth
• receding gums
• red, swollen, or tender gums

When gingivitis progresses, it develops into periodontitis, a condition in which the gums and bones that hold the teeth in place can be severely compromised. The bacteria on the teeth release toxic substances that harm your gums and cause them to become infected. The infection and the inflammation that result when your body attacks the bacteria can degrade your gums and the bones in your jaw. You may experience exceptionally swollen, painful gums that are likely to bleed. If not treated, periodontitis can lead to tooth loss.

Be a little shady

Want to make your teeth look fashionably white--without the work? "Stick with blue-based red and pink lipsticks or clothes in dark colors," says Pia Lieb, D.D.S., a cosmetic dentist in New York City. Warm colors (yellow, orange, brown, warm shades of red) worn close to your mouth will only bring out the yellow in your teeth.

Feel the crunch

"Foods that are high in cellulose--a strong starchlike compound found in celery, carrots, and apples--act as natural abrasives, cleansing teeth and removing surface stains naturally," says Jeff Golub-Evans, D.D.S., a cosmetic dentist in New York City. And greens such as spinach, broccoli, and lettuce contain mineral compounds that form a film over the teeth, so pigments from other foods can't stain.

No-tech tricks

If you'd rather pass on the peroxide, check out these other options to whiten your smile

Bring on the baking soda

The refrigerator deodorizer also removes discoloration on your teeth. The abrasive particles polish the surface while a chemical reaction between baking soda and water lightens stains, says Jonathan B. Levine, a cosmetic dentist in New York City. (Warning: You can damage your enamel with the scrubbing, so don't do it more than once a week.) Just dip your toothbrush in the soda, or simply switch to a toothpaste that contains baking soda, such as Arm & Hammer Complete Care Toothpaste ($4 for 6 oz, drugstore.com).

If you go to a pro

The whitening agents dentists use are up to three times more powerful than at-home versions, so you'll see results faster than if you go solo. If you're looking for a dramatic, fast solution, consider power whitening: First, a protective rubber guard or barrier gel is placed over your gums to help avoid possible sensitivity to peroxide. Then the teeth are coated with a bleaching agent and a light is aimed at them to activate the ingredients. The procedure takes about an hour, and costs $500 to $700.

A cheaper (but slower) option: Your dentist can custom-fit you with plastic dental trays, kind of like retainers, which you fill with a peroxide gel and wear at home. You could see brighter teeth within a few days, though some people need up to four weeks to see results. Oh yeah, and it'll cost you $250 to $400.

Before you bleach

A first-timer should always consult her dentist before trying any tooth whitener, even an over-the-counter product, because not all teeth react to whitening the same way. Some types of dental work (like caps, crowns, and veneers) don't take to lightening because peroxide can't penetrate them. Stains caused by antibiotics, like tetracycline, are also tricky, because they can occur in the layers inside the tooth, which brighteners can't reach. Your dentist will be able to advise you about the best method for you.

How whiteners work

All bleaching methods use peroxide--whether in gel, strip, or liquid form--to dissolve surface stains, explains Debra Glassman, D.D.S., a cosmetic dentist in New York City. Teeth surfaces are made up of thousands of tiny dentinal tubules--hollow structures stacked horizontally, like thin straws. They're extremely porous and absorb pigments from food and drink. (Anything that can stain a white T-shirt can discolor your teeth, Glassman says.) Peroxide bubbles into the tubules and lightens those pigments.

15 Ways To Whiter Teeth

Take your choppers from dull to dazzling and give yourself something to smile about.

If you've toyed with the idea of whitening your teeth but haven't actually done the deed, consider this: "Since teeth naturally yellow as we age, whitening them will automatically make you look younger," says Kim Harms, D.D.S., a practicing dentist and a spokesperson for the American Dental Association. What's more, a 2008 Columbia University study found that women with healthier-looking teeth earn more than those with less sparkling grins. Do you need any more reasons to whiten up?

Healthy Mouth, Healthy Body

With the mouth and body so closely linked, dentists and physicians should collaborate more closely, Karabin says. "Physicians need to be trained to examine the mouth, and dentists need to understand more about systemic disease so they can pick up on some of the cues."

The findings also serve to bring home the importance of oral hygiene. Brush twice a day with a toothbrush with soft or medium bristles, Genco says. Clean between your teeth daily with floss, or try some of the interdental picks available at drugstores. If your gums bleed with flossing and don't stop after three to four days, see your dentist.

In most cases, gum disease isn't painful. So even if you're feeling fine, visit your dentist regularly for professional cleanings and oral exams. You may find out more than you ever expected. "Today, more dentists aren't just looking at teeth and gums," says Cram. "They're giving you a good medical exam."

Oral Health and Premature Birth

Ob-gyns always knew that preterm and low-birth-weight births could be triggered by infections in the body," says Karabin. "They looked for urinary tract infections and throat infections, but never really thought about the mouth until a periodontic researcher looked into it."

Karabin credits that researcher, Steven Offenbacher of the University of North Carolina School of Dentistry, for establishing that severe periodontal disease in the mother can lead to a sevenfold increase in the risk of premature birth. Remember those cytokines? Turns out they also increase the level of the hormone prostaglandin, which triggers labor, says Karabin. Fortunately, studies show that treating gum disease and improving oral hygiene in pregnant women can reduce the risk of premature birth.

Other conditions that indicate a link between dental health and overall health include:

• Osteoporosis. Osteoporosis and tooth loss often go hand in hand because the same decrease in mineral density that boosts the risk of hip and other fractures affects the jawbone and teeth. Measures taken to prevent or treat osteoporosis in postmenopausal women are likely to also help prevent severe gum disease, Genco says.
• Rheumatoid arthritis. A study released in June 2008 found that patients with rheumatoid arthritis (RA) were nearly eight times more likely to have periodontal disease. RA, like periodontal disease, is an inflammatory disorder, which may help explain the link, Karabin says.
• Alzheimer's disease. A 2005 study of identical twins showed that in twin pairs where one had dementia and the other didn't, the ones with dementia were four times more likely to have gum disease by midlife.

Oral Health and Heart Disease

People with periodontal disease are nearly twice as likely to suffer from coronary artery disease as those without, according to the American Academy of Periodontology. One theory is that oral bacteria attach to fatty plaques in the coronary arteries and contribute to the clots that can lead to heart attacks. Another is that inflammation increases plaque buildup.

Although evidence has been mixed, more than 20 "good-sized" studies have demonstrated the relationship between gum disease and heart disease, Genco says. But that relationship is still not confirmed as with other known risk factors such as smoking or obesity. Genco is planning a major study to see whether treating gum disease can forestall a second heart attack in people who have already had one.

Recent analysis suggests that common oral problems could increase the risk of cardiac problems. Indra Mustapha, DDS, a periodontist who teaches at Howard University in Washington, D.C., and colleagues analyzed the results of other research studies and found that periodontal disease with signs of bacterial exposure was associated with greater risk of heart disease.

The American Heart Association states, "At this time, promoting dental treatment expressly to prevent atherosclerotic cardiovascular disease and/or acute cardiovascular events is not recommended."

Oral Health and Diabetes

Karabin has diagnosed several cases of diabetes from her dentist's chair. "When I see a patient with multiple abscesses in their mouth ... I immediately think 'diabetes.' I will send that patient for a glucose tolerance test." Nearly one-third of people with diabetes are unaware that they have it, and dentists can play a big role in diagnosing these patients, Genco says.

Diabetes and gum disease appear to influence each other in a vicious circle. Infections of any kind, including gum disease, cause the body to produce proteins called cytokines, which increase insulin resistance and make blood sugar more difficult to control, Karabin says. Conversely, uncontrolled diabetes impairs the body's healing mechanism, which makes it harder to control gum disease, Cram says

.

How Gum Disease Spreads

Periodontal disease is an infection caused by unhealthy bacteria that lodge between the teeth and gums. Simply brushing your teeth is enough to put some of those bacteria into your bloodstream, says Robert J. Genco, DDS, PhD, an oral biologist at the University of Buffalo. The bacteria then travel to major organs where they can spur new infections.

Inflammation also plays a role in spreading the effects of bad oral health. Red and swollen gums signal the body's inflammatory response to periodontal bacteria. "If you have inflammation in your mouth, certain chemicals are produced in response that can spread [through the bloodstream] and wreak havoc elsewhere in the body," Cram says.

Evidence is mounting of the importance of the "mouth-body connection," as it is known, as dental problems are linked to a growing list of other ailments.

What Your Dental Health Says About You Common oral problems have been linked to heart disease, diabetes, premature birth, and more.

It's easy to ignore the effects of poor oral hygiene because they're hidden in your mouth. But gum disease produces a bleeding, infected wound that's the equivalent in size to the palms of both your hands, says Susan Karabin, DDS, a New York periodontist and president of the American Academy of Periodontology.

"If you had an infection that size on your thigh, you'd be hospitalized," Karabin says. "Yet people walk around with this infection in their mouth and ignore it. It's easy to ignore because it doesn't hurt ... but it's a serious infection, and if it were in a more visible place, it would be taken more seriously."

You may think that the worst consequence of poor dental health would be lost teeth and painful times in the dentist's chair. But a growing body of evidence is linking common oral problems to illnesses including heart disease, stroke, diabetes, premature birth, osteoporosis, and even Alzheimer's disease. In most cases, the strength and exact nature of the link is still unclear, but they suggest that dental health is important for preserving overall health.

"We need to educate the public that the mouth isn't disconnected to the rest of the body," says Sally Cram, DDS, a periodontist in Washington, D.C., and spokeswoman for the American Dental Association.

(Do you visit your dentist for regular checkups? Why or why not? Talk with others on WebMD's Dental Health: Support Group board.)

Gasping Cardiac Patients Need CPR Don't Hold Off Chest Compressions if Cardiac Patient Is Gasping

Nov. 24 2008 -- People in cardiac arrest need CPR -- even if they're gasping for air.

Bystanders, and even some doctors, sometimes hold off giving CPR (cardiopulmonary resuscitation) if a collapsed cardiac patient is still struggling to breathe. That could be a big mistake.

Cardiac arrest patients are more than five times more likely to survive if bystanders attempt resuscitation while the patient is still gasping, say Bentley J. Bobrow, MD, director of Arizona emergency medical services, and colleagues.

"Gasping is most frequent soon after collapse, and decreases with time," they note. "Bystander resuscitation efforts markedly improve survival in patients who are gasping from cardiac arrest."

Most people have been taught CPR techniques that alternate vigorous chest compressions with "breath of life" mouth-to-mouth ventilation. Bobrow's earlier work has questioned the value of mouth-to-mouth resuscitation, as it distracts rescuers from concentrating on the more important chest compressions.

And mouth-to-mouth resuscitation obviously is hard to perform on a person who is gasping -- a major reason why bystanders hesitate to resuscitate cardiac arrest patients who gasp.

Bobrow argues that rescuers should forget about mouth-to-mouth and focus on chest compressions. That means putting one's hands one atop the other over the patient's breastbone, locking one's elbows, and pressing down hard and rapidly until help arrives.

"When that person collapses, your hands are their heart," Bobrow told WebMD earlier this year. "If your hands are not on their chest, they have no heartbeat."

Bobrow's team analyzed records on 113 out-of-hospital cardiac arrest calls made in 2008 to the Phoenix Fire Department emergency dispatch center. In 39% of those calls, the patient had abnormal breathing.

Another analysis of 1,218 cardiac arrest patients treated by emergency medical services (EMS) found gasping was very common -- and that it most often happens soon after a patient collapses.

Among patients who had a cardiac arrest in the presence of EMS rescuers, 33% were gasping. If EMS arrived within seven minutes, 20% of patients were gasping; 14% were gasping when EMS arrived in seven to nine minutes, and only 7% were still gasping if EMS arrived more than nine minutes after the collapse.

Most importantly, 39% of cardiac arrest patients survived if treated while still gasping. Only 9% survived if they did not gasp when treated.

"The recognition and importance of gasping [after cardiac arrest] should be taught to bystanders and emergency medical dispatchers so as not to dissuade them from initiating prompt resuscitation efforts when appropriate," Bobrow and colleagues conclude.

CT Scans for Clogged Arteries? Not Yet Study Suggests Scans Can't Yet Replace Catheter Angiogram to Find Clogged Arteries

Nov. 26, 2008 -- Newer CT scans are pretty good at detecting clogs in arteries -- but they aren't ready for prime time, a new study suggests.

The gold standard for finding clogged arteries is the angiogram. This requires inserting a thin catheter into an artery in the groin and running it up into the arteries near the heart. It takes 30 to 45 minutes plus another hour of recovery; complications, though rare, include heart attack and stroke.

CT scans take just a few seconds, and no blood is shed. The downside is that they expose patients to relatively high levels of radiation. A 2007 study linked up to 2% of all U.S. cancers to CT radiation.

When obtaining pictures of the heart, CT scanners with a higher number of detectors provide more detailed images in a shorter amount of time. So the newer CT scanners, which use "64-row" technology, give much better images than the older "16-row" machines.

But are they good enough for routine use?

To find out, Johns Hopkins researchers Julie M. Miller, MD; Joao A.C. Lima, MD; and colleagues at nine centers in seven nations performed 64-row CT scans on 291 patients suspected of having blocked arteries. After getting the CT scans, all the patients underwent angiography.

As it turned out, 56% of the patients did indeed have angiogram-demonstrated coronary artery disease. And the CT scans worked pretty well. They detected blocked arteries 85% of the time, and 90% of the arteries they said were blocked actually had blockages.

On the other hand, the CT scans misclassified 13% of patients.

"CT angiography cannot replace conventional coronary angiography in this population of patients at present," Miller and colleagues conclude.

However, the researchers suggest that the scans are "an alternative diagnostic tool" that can help doctors "rule in or rule out" blocked arteries when patients aren't able to undergo other indirect tests, such as stress tests.

Not so, suggests an editorial by Rita F. Redberg, MD, director of women's cardiovascular services, and Judith Walsh, MD, MPH, of the University of California, San Francisco.

Although the current study was carefully done, Redberg and Walsh note, "It does not advance our knowledge of the appropriate use and possible benefits of the technology."

As the authors conclude that CT scans still can't replace traditional angiograms, Redberg and Walsh say the study "adds to the body of research failing to prove a benefit of the new procedure."

"Without such evidence, a high-resolution cardiac CT angiographic image of the heart is just another pretty picture," Redberg and Walsh write. Research regarding the prognostic implications and downstream effects of heart CT scans will be required to better define the role of this technology in patient care.

The Miller study was funded by Toshiba, which makes one of the 64-row CT devices used in the study. Miller, Lima, and other study authors report grant support from Toshiba; Lima and other study authors report receiving speaker fees from Toshiba.

The Miller study and the Redberg/Walsh editorial appear in the Nov. 27 issue of the New England Journal of Medicine.

Having a Bad Boss Is Bad for the Heart Study Shows Working for an Incompetent Boss Can Raise Risk of Heart Disease

Nov. 24, 2008 -- People who consider their bosses to be unfair, arbitrary, inconsiderate, and generally deficient in managerial skills are at greater risk for having a heart disease event such as a heart attack, a new Swedish study shows.

And stress that workers think is caused by bad managers adds up, increasing risk of heart problems over time, the researchers report in the Nov. 24 issue of Occupational and Environmental Medicine.

Swedish scientists tracked the heart health of more than 3,000 male workers between 1992 and 1995. Their occupational health records then were matched with national registry data on hospital admissions and death from ischemic heart disease up to 2003.

During the monitoring period of almost a decade, 74 cases of fatal and non-fatal heart disease events such as heart attack, unstable angina, or cardiac arrest occurred. The more competent that workers ranked their managers, the lower their risk of serious heart problems.

The association between perceived leadership of managers and the risk of serious heart problems among workers increased the longer an employee worked for the same company, the study showed, suggesting that stress caused by bad bosses may increase over time.

The researchers suggest that companies take steps to improve managers' deficient skills, as rated by their subordinates, to ward off serious heart disease of workers.

"One could speculate that a present and active manager, providing structure, information, and support, counteracts destructive processes in work groups, thereby promoting regenerative rather than stress-related physiological processes in employees," writes Anna Nyberg of the Karolinska Institute and the Stress Research Institute at Stockholm University.

Rating the Bosses

Participants used a rating system for their senior managers, grading them on such things as how good they were at communicating and offering feedback, their success at managing change, their ability to set goals, and how much they delegated.

Higher leadership scores were found to be associated with lower risk for heart disease, and the association was "robust to adjustments for education, social class, income, supervisory status, perceived physical load at work, smoking, physical exercise, [body mass index], lipids, fibrinogen, and diabetes."

In short, the study shows that bad bosses can be hazardous to the health, and even to long life, of the people who work for them.

In another recent study, the researchers say, employees who were exposed to what they perceive as an adverse psychological work environment were found to be at a 50% excess risk of cardiovascular disease. The results from that study, the researchers write, "have considerable clinical implications, especially since psychosocial stressors at work are relatively common."

The researchers say evidence is mounting that the perceived quality of managerial behavior affects worker health. Workers are concerned about "considerate behavior" of bosses, how well managers are able to stimulate employees intellectually, and their ability to communicate with those who work under their supervision.

Questions used to rate bosses included such statements as "I am criticized by my boss if I have done something that is not good" and others about how well managers communicate their expectations.

What was clear was that workers who felt their bosses had trouble communicating information -- not just negative thoughts -- were at increased risk of developing heart problems. Training of managers about how to do their jobs better might be a good start, the researchers suggest.

Heart Risk Profile: Treatment Motivator Learning Your 'Cardiovascular Age' Can Help You Stick to a Heart Treatment Plan

Nov. 26, 2007 -- Putting heart disease risk factors into perspective with an age-related heart risk profile may be a powerful motivator to help people take their treatment seriously.

A new study shows people with abnormal cholesterol levels who received a printout from their doctor describing the probability of developing heart disease in the near future were more likely to adhere to their treatment plan than others.

The profile put their heart disease risk factors into perspective by calculating their cardiovascular age. Cardiovascular age was calculated by adding the difference between life expectancy for a person with heart disease of their age from the average life expectancy at the same age.

For example, based on high cholesterol and other heart disease risk factors, a 50-year-old might expect to live another 25 years vs. 30 years for the average 50-year-old, resulting in a cardiovascular age of 55.

Age Gap in Heart Risk

Researchers found people with a larger "age gap" between cardiovascular age and actual age were highly motivated to adhere to their cholesterol treatment plan, including taking cholesterol-lowering drugs and making healthy diet and lifestyle changes.

The results after a year of follow-up showed people with a larger age gap also experienced greater reductions in low-density lipoprotein (LDL "bad" cholesterol) levels. People who received their risk profile were also more likely to achieve cholesterol level targets.

"Communicating risk is consistent with many of the recommendations to improve adherence, including enhancing self-monitoring and using the support of family and friends," write researcher Steven A. Grover, MD, of McGill University in Montreal, in the Archives of Internal Medicine.

In an editorial that accompanies the study, Rod Jackson MBChB, PhD and Sue Wells, MBChB, MPH of the University of Auckland say putting various heart disease risk factors together into a heart risk profile puts the risk into perspective and motivates those at risk to take action.

"For most patients, their actual blood cholesterol level or blood pressure becomes clinically meaningful only when considered in combination with other risk factors and when the cardiovascular risk is calculated," they write.

Depression May Up Heart Attack Risk Study Shows Depressed Heart Attack Patients Less Likely to Exercise, Raising Their Cardiac Risk

Nov. 25, 2008 -- Cardiac patients who are depressed are less likely to exercise, which increases their risk of a cardiac event such as a heart attack or heart failure, a new study suggests.

So heart patients who experience depression may be able to lower their cardiac risk simply by getting more physical activity.

It's long been recognized that patients who suffer from depression are more likely to have heart attacks or other cardiac events. But the reason for the association has been unclear. According to the new study, published in The Journal of the American Medical Association, the higher risk may be due to behavioral factors, especially physical activity levels.

Researchers looked at 1,017 heart disease patients. All were outpatients at clinics in the San Francisco area. They were recruited between 2000 and 2002, and followed until early 2008.

Participants completed a questionnaire to gauge whether or not they had depressive symptoms. Out of the group, 199 had depressive symptoms. The depressed patients were more likely to smoke, were less likely to take their medications as prescribed, and were less physically active.

Among the participants with depression, 10% had a cardiac event during the follow-up period. Among the non-depressed participants, 6.7% had a cardiac event. Cardiac events included heart failure, heart attack, stroke, transient ischemic attack (sometimes referred to as a "mini-stroke"), or death.

Even when the researchers made mathematical adjustments that accounted for other health issues and the severity of heart disease at the outset of the study, the group with depression was still 31% more likely to have a cardiac event than the group without depression. However, when lifestyle factors were also accounted for, there was largely no difference between the likelihood of a cardiac event for the depressed group and for the non-depressed group. In the final statistical model, the researchers found that physical inactivity alone was associated with a 44% greater rate of cardiovascular events.

"These findings raise the hypothesis that the increased risk of cardiovascular events associated with depression could potentially be preventable with behavior modification, especially exercise," the researchers write. "Exercise training can improve both depressive symptoms and markers for cardiovascular risk."

The researchers point out that their study could not discern whether depression led to inactivity or if inactivity led to depression. Regardless, the incorporation of exercise into a comprehensive depression treatment plan may be beneficial to many patients who suffer from both depression and heart disease.

Attend Religious Services, Live Longer Study Shows Regular Attendance at Religious Services Cuts Risk of Death

Nov. 25, 2008 -- Going to church -- or any kind of religious service -- may prolong your life.

A new study shows that older women who regularly attend religious services reduce their risk of death by 20%. The study was published in Psychology and Health.

Researchers from Yeshiva University's Albert Einstein College of Medicine grouped all religions together, looking only at whether the women attended services regularly and whether those services brought them comfort.

Organized religion creates a social network with regular routines, which is known to enhance well-being. However, even when researchers adjusted for that factor, the women going to services were still less likely to die.

"Interestingly, the protection against mortality provided by religion cannot be entirely explained by expected factors that include enhanced social support of friends or family, lifestyle choices, and reduced smoking and alcohol consumption," lead author and clinical assistant professor of psychology Eliezer Schnall says in a news release. "There is something here that we don't quite understand. It is always possible that some unknown or unmeasured factors confounded these results."

Researchers evaluated 92,395 postmenopausal women participating in the Women's Health Initiative Observational Study, a national, multi-ethnic, long-term study aimed at addressing women's health issues funded by the National Institutes of Health. The women, all between the ages of 50 and 79, answered questions about their behaviors, health, and religious practices.

Researchers followed participants for an average of 7.7 years and made adjustments for known risk factors, such as age and health history, when evaluating risk of death. They found that women attending religious services at least once per week showed a 20% mortality risk reduction compared to those not attending services at all.

In addition to looking at mortality broadly, researchers examined the risk of death from cardiovascular disease. They did not find that religion had an impact on the women's risk of death by this particular cause.

Group: Soft Plastic Toys Are Health Risk Consumer Group Concerned About Health Risks From Chemical Called Phthalates

Nov. 25, 2008 -- A consumer watchdog group is urging parents to avoid buying soft plastic toys this holiday season because of a risk that the toys may contain toxic chemicals.

Toys containing the chemicals, called phthalates, can no longer be manufactured or imported after February 2009, according to a product safety law that passed Congress over the summer.

But the group says the Consumer Product Safety Commission is allowing the toy industry to circumvent the law. The agency wrote a letter last week telling manufacturers they can still sell their existing stocks of phthalate-containing toys even after the ban takes effect in February.

"They're giving the industry a loophole," says Liz Hitchcock, a public health advocate for the U.S. Public Interest Research Group (U.S. PIRG).

Phthalates are a group of chemicals used to soften vinyl and other plastics. Congress banned use of the chemicals in toys because of evidence they can have health effects including early puberty, reproductive defects, and lower sperm counts in boys.

U.S. PIRG offered the following tips for avoiding unsafe toys:

• Don't buy soft toys made of "PVC" (polyvinyl chloride) plastic. Many of these contain phthalates and may not be labeled.
• Avoid play cosmetics with xylene or toluene or phthalates.
• Avoid cheap metal play jewelry, key chains, and similar products. Many of these products contain lead.
• Avoid toys with small parts that can pose a choking hazard to young children. Bring along a toilet paper tube on your shopping trip. Any toys or parts that fit inside the tube are too small for children aged 3 and under.

The new law stands to increase the budget and personnel at the Consumer Product Safety Commission and give the agency tougher recall authority.

The agency's move on phthalates sparked angry reactions from several Democratic members of Congress, who accused the Bush Administration of avoiding the intent of the new law.

Julie Vallese, a Consumer Products Safety Commission spokeswoman, says that the agency was not trying to give toy makers a way out of meeting new rules on phthalates. She said the wording of the law sets new standards for phthalates but does not automatically ban their sale in toys.

"Where U.S. PIRG's criticism should be is on Congress. If they don't like the language that they used, Congress has the authority to fix it," Vallese tells WebMD.

Joan Lawrence, vice president for safety standards and regulatory affairs for the Toy Industry Association, defends the industry's safety record. "The industry has been massively inspecting and testing toys since last year and government has too," she says. "The fact is, there are just far fewer issues. There's strong science that says phthalates are safe as used in toys."

Lawrence is critical of advice to avoid purchasing soft plastic toys. "I don't know that that's helpful for parents," she says. "Many soft toys don't contain pthalates, so parents will be avoiding a lot of toys for no reason."

Tofu & other soy products: getting your protein from plants.

Soy: It’s High in Protein, Too

Soy products, such as tofu, soy burgers, and other soy-based foods, can offer a high-protein diet a nutritious plant-based source of protein. An added bonus: Consuming 25 grams of soy protein daily may also help lower cholesterol and protect against heart disease.

Eggs: take time to crack a few in a high-protein diet.

Eggs: Affordable, Convenient, & Tasty

Eggs are perhaps the most classic and certainly least expensive form of protein. The American Heart Association says an egg a day is safe for healthy adults, so you may want to get cracking with eggs when you’re on a high-protein diet.

Seafood gets along swimmingly in a high-protein plan.

Lots of Protein, Healthy Fats

Fish is a no-brainer -- it’s loaded with protein and almost always low in fat. Even the types that have more fat, such as salmon, are a good choice. That’s because the fat in fish is generally the heart-healthy kind known as omega-3 fatty acid -- and most diets don’t contain enough of this good-for-you fat.

Pork: A tender addition to a high-protein diet.

Look for Pork Tenderloin

It may surprise you to learn that pork tenderloin is a white meat. What’s more, the cuts available today are 31% leaner than they were 20 years ago. If you’re interested in a high-protein diet, you may want to plan on pork.

Poultry also has a big part in a high-protein diet.

Think White Meat

Chicken and poultry pack plenty of punch in a high-protein diet, and if you enjoy the white meat you’ll be eating a lot less fat than if you choose dark. To slim your meal down even further, remove the skin, which is bursting with saturated fat.

Lean beef: it’s one star of a high-protein diet.

Say Hello to High-Protein Steak

Nothing says protein like a nice juicy steak. And if you’re careful to choose a lean cut, you can get all of the protein with far less fat. In fact, a lean cut of beef has barely more saturated fat than a similar size of skinless chicken breast.

Not all high-protein diets are the same.

Starting a High-Protein Diet

High-protein diets come in many forms, and not all are created equal. The most nutritious high-protein plans are low in fat and moderate in carbohydrates, rather than high in fat and low in carbohydrates. The following slides present a variety of foods that fit the high-protein diet bill.

How do high-protein diets work?

Curbing Appetite Plays One Role

Besides curbing appetites, high-protein diets may also change a person’s metabolism. When carbohydrates are severely restricted, the body begins burning its own fat for fuel – a state called ketosis. Ketosis may shed weight, but it’s also associated with headaches, irritability, nausea, kidney trouble, and heart palpitations.

Why should you start a high-protein diet?

The Goal Is Weight Loss

High-protein diets take a page from the low-carb craze. The goal is to lose weight by eating more protein-packed foods, which often means consuming fewer carbohydrates. The portion of total calories derived from protein is what defines a high-protein diet. In a typical diet 10%-15% of daily calories come from protein. In a high-protein diet, this number can be as high as 30%-50%.

Eating a gluten-free diet -- it’s not always a piece of cake.

Going Gluten-Free Has Its Drawbacks

The gluten-free diet isn’t always easy. People who benefit generally need to stick with the diet for life. That means giving up many staples, such as bread and pasta, and treats like cake and cookies. But it’s getting ever easier to find gluten-free alternatives, and careful planning can help you stay gluten-free long-term. Remember: Check with your health care provider before making any major dietary changes.

What do we know about a gluten-free diet and autism?

Gluten-Free Diet and Autism

Some parents believe a gluten-free diet can help children with autism, although the idea is controversial. The theory suggests children with autism are sensitive to gluten, and avoiding the protein can improve certain symptoms, such as speech or social behavior. At present, there is not enough research to confirm or refute the effectiveness of gluten-free diets in people with autism.

Why should you enjoy a gluten-free diet?

To Stay Symptom-Free

For most people with celiac disease, even a little gluten can damage the intestines, and include symptoms like gas and bloating, changes in bowel movements, weight loss, feeling very tired, and weakness. That’s why going gluten-free can be a big help to those with celiac disease or gluten allergies. Note: Check with your health care provider before making major dietary changes.

A note about eating out when you’re on a gluten-free diet.

When Dining Out, Talk It Out

One of the biggest challenges in maintaining a gluten-free diet is decoding a restaurant menu. Don’t be shy. Talk with your server or the chef and explain your dietary needs -- they’re there to satisfy you.

You’re in luck: Veggies and fruits are all gluten-free!

There’s So Much More to Enjoy

Along with wine, potatoes, and rice there’s even more delicious food and drink that’s safe to enjoy on a gluten-free diet, such as eggs, fruits, vegetables and milk products.

A small note: When using frozen or canned fruits and vegetables, check for additives that might contain gluten. The same goes for processed cheese spreads and flavored yogurts.

Wine is still part of the party on a gluten-free diet.

Cheers! You Can Still Raise a Glass

Wine and liquors are generally gluten-free, so you can still raise a glass and offer a toast, no matter what the occasion.

No more beer (maybe) when you’re going gluten-free.

Beer Contains Wheat -- Who Knew?

Unfortunately for fans of the six-pack, most beers are made with barley malt. While there are some gluten-free beers, it’s best to check with your doctor or dietitian about whether these are safe for you.

Most candy is definitely in for a gluten-free diet.

Enjoy Sweet and Chewy Treats

Marshmallows, gumdrops, plain hard candies -- these are all usually gluten-free. But it doesn’t have to stop there. Look for specialty bakeries that may be able to create custom-ordered gluten-free cakes, pies, and other treats, too.

You’ll need to change how you celebrate when you’re eating gluten-free.

Avoid Most Cookies and Cakes

While a gluten-free diet won’t contain most traditional cakes, pies, cookies, and other celebratory treats -- which are loaded with wheat flour -- there are still lots of ways to satisfy your sweet tooth.

Instead of breaded meats, enjoy pure chicken, fish, beef, and more!

Who Misses the Breading?

You don’t need to hide the succulent charms of fresh chicken, fish, and beef under a bunch of bread. Go for unprocessed meat without the additives and you’ll be eating right for a gluten-free diet. Do keep in mind that hot dogs and deli meats are processed, so check the ingredients for additives that might contain gluten.

Beware of breaded foods when you’re eating a gluten-free diet.

Steer Clear: Chicken Nuggets & Fish Sticks

Check the ingredients, but the breading on most chicken nuggets and fish sticks is generally made from wheat flour.

Rice cakes can fill the spread-able, snack-able bill when you go gluten-free.

Rev Up Munchies With Rice Cakes

Who needs crackers when rice cakes and corn chips can host all sorts of spreads and dips? Another gluten-free crunchy snack: popcorn.

You’ll need to find alternatives for crackers in a gluten-free diet.

Most Crackers Are Made of Wheat

Check out the ingredients label and you’ll find that most crackers have wheat as one of their main ingredients. Your mission? Find an alternative venue for your favorite cheese spreads.

On a gluten-free diet, there’s still a lot to enjoy.

Dig in to Rice and Potatoes

On a gluten-free diet? Say hello to filling, flexible, good-for-you rice and potatoes. You can top them with just about anything, mix them into meals, or enjoy them on their own. Still mourning the loss of your favorite pasta? Here’s a secret: When you’re really craving a bowl of spaghetti, it is possible to find gluten-free pasta – just think rice noodles.

Going gluten-free? Say “arivadercci!” to pasta.

Pasta Is Made of Wheat

It’s true, no matter what its shape or name, most pasta is made out of wheat. So you’ll need to avoid spaghetti, macaroni, shells, and spirals when you’re on a gluten-free diet.

Fortunately, you have gluten-free cereal choices, too.

Enjoy Corn and Rice Cereals

Corn and rice-based cereals are good breakfast alternatives, but it’s crucial to read labels carefully, as some may also contain malt. You may want to check your supermarket’s health-food section for gluten-free products.

Many breakfast cereals are a gluten-free no-no.

Lots of Cereals Have Gluten

Traditional breakfast cereals are another casualty for people on a gluten-free diet. Cream of Wheat is obviously out, but so are many other favorites. Cheerios contain wheat starch, while Frosted Flakes use malt flavoring. Any cereal containing wheat, barley, rye, or malt must be avoided.

Fortunately, bread doesn’t have to be made out of wheat.

You Have Gluten-Free Bread Choices

Many health foods stores and some major supermarkets now carry gluten-free products, including an assortment of breads. These are often made with rice or potato flour instead of wheat. Just check the label to make sure it says “100% gluten-free.”

Most breads won’t fit into a gluten-free eating plan.

Say Bye-Bye to Bread … Mostly

Perhaps the most difficult step in a gluten-free diet is bidding farewell to bread as you know it – that includes white, wheat, marble, and rye. Also off limits are bagels, muffins, croissants, hamburger buns, scones – you get the idea. Yes, even pizza. But don’t despair – there are alternatives.

Learning to read labels is vital when you’re shopping for a gluten-free diet.

Gluten “Red Flags”

People on a gluten-free diet need a sharp eye for labels. Some ingredient red flags are obvious, like wheat, wheat gluten, barley, or rye. But some foods have “stealth” gluten. Two terms to watch for are malt (which is made from barley) and hydrolyzed vegetable protein (it often contains wheat). And while oats may offer an alternative for those eating gluten-free, they may also increase symptoms, including abdominal pain, bloating, and diarrhea.

Going gluten-free? These tips can help.

What Is a Gluten-Free Diet?

Before tackling the gluten-free diet, let’s get to know our culprit. Gluten is a specific type of protein, but one you won’t find in meat or eggs. Instead gluten is found in wheat, rye, and barley. Going gluten-free means avoiding these grains. A gluten-free diet is essential for most people with gluten allergies or celiac disease, a condition which causes intestinal damage when gluten is eaten.

Don't pull weights up under your chin.

#3: Upright Row

The problem: Pulling weights, a barbell, or a weighted cabled bar up under your chin is a big no-no because it can compress the nerves in the shoulder area, impinging the shoulder.

Try this safer military press.

A Safer Military Press

A safer shoulder alternative: When doing the military press, keep the bar or dumbbells in front of your head. Stand with the weight no lower than the collarbone and keep your upper body upright. The exercise can also be done seated. Always sit straight against a back support, and keep the natural curve in your spine, with upper back and glutes pressed to the chair.

Don't do this risky move.

#2: Military Press Behind the Head

This shoulder move, in which you lift weights or a barbell up and down behind the head, can cause the same problems as the lat pull-down behind the head.

Try the lat pull-down in front of your body.

A Safer Lat Pull-down

On the pull-down machine, lean back a few degrees, use a wider-than-shoulder grip, and bring the bar down in front of your body to the breastbone, pulling shoulder blades down and together. Contract your abdominals to stabilize the body, and avoid using momentum to swing the bar up and down. The lat pull-down works the muscles of the upper back.

Don't do this move behind your head.

#1: Lat Pull-down Behind the Head

The problem: Only people with very mobile shoulder joints can keep their spines straight enough to do this exercise properly. So the move -- done wrong -- can lead to shoulder impingement or worse, a tear in the rotator cuff. And if the bar hits the back of the neck, it could injure cervical vertebrae.

Workout Not Working?

Who has time to waste on ineffective, risky exercises? Not you. So ditch these nine moves that may not deliver the results you want -- and may even cause injury.

Exercise for Energy

Besides altering your diet, exercise is a tried-and-true way to boost energy and mood. Even a single 15-minute walk can be energizing, and the benefits increase with more frequent physical activity. Studies indicate that regular exercise can relieve depression and trigger physiological changes that make more energy available throughout the day.

Energy Drinks & Gels

Most energy drinks and gels infuse the body with simple carbohydrates – in other words, sugar, which the body can quickly convert into energy. This is a convenient way for high-intensity athletes to keep going, but the benefits for the rest of us are dubious. Energy drinks are usually high on calories and low on nutrients.

Energy Supplements

Energy supplements are often touted as an alternative to coffee or other stimulants. Many of these supplements actually contain caffeine or similar chemical substances. Examples include kola nut, yerba mate, green tea extract, and guarana. These supplements may give you a temporary boost, but experts say the effect is probably not much different than drinking ordinary coffee.

Frequent Meals

Another strategy for stabilizing blood sugar, energy, and mood: Eat small meals and snacks every three to four hours, rather than a few large meals. Energy-sustaining snacks include peanut butter on whole-grain crackers, half a turkey sandwich with salad, or whole-grain cereal with milk.

Breakfast

For anyone hoping to boost energy and mood, skipping breakfast is not an option. Studies show that people who eat breakfast every morning enjoy more energy and a better mood throughout the day. The best breakfasts deliver plenty of fiber and nutrients through whole-grain carbs, good fats, and some type of lean protein.