Good Health And Wellness For Life

Botched Surgeries Lead to Inquiry

PROVIDENCE, R.I., Nov. 29 (AP) — The chief of the neurosurgery department at Rhode Island Hospital has stepped aside while officials investigate three incidents in which surgeons operated on the wrong side of a patient’s head.

The chief, Dr. John A. Duncan, will see patients but will not run the department, a spokeswoman for the hospital’s parent company, Lifespan, said Thursday.

Since February, three brain surgeons at the hospital have operated on the wrong side of a patient’s head; the most recent incident was on Friday.

In two cases, the doctors did not realize the errors until after they had opened the skull.

An elderly man died in August a few weeks after a surgeon mistakenly operated on the wrong side of his head.

Dr. David R. Gifford, director of the Rhode Island Department of Health, said that an autopsy was pending but that the department believed that the man’s death was not connected to the surgery. In the other two cases, the patients are fine, the department has said.

The hospital was fined $50,000 this week, reprimanded and ordered to make a series of changes that include improved training and additional safeguards.

Rhode Island Hospital is the largest hospital in the state and serves as the teaching hospital for the Alpert Medical School at Brown University.

Personal Health: A Common Casualty of Old Age: The Will to Live

Suicide is more common among older Americans than any other age group. The statistics are daunting. While people 65 and older account for 12 percent of the population, they represent 16 percent to 25 percent of the suicides. Four out of five suicides in older adults are men. And among white men over 85, the suicide rate — 50 per 100,000 men — is six times that of the general population.

Yet, says Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in the Bronx, “If you consider only major depression as the antecedent of elder suicide, you’ll miss 20 to 40 percent of cases in which there is no sign of mental illness.”

Dr. Kennedy, who is also affiliated with Albert Einstein College of Medicine, recently directed a symposium in New York on preventing suicide in older adults, designed to alert both mental health and primary care practitioners to the often subtle signs that an older person may try to end it all.

The Warning Signs

In interviews, he and other symposium presenters noted that detecting suicidal impulses in older people often depended on the ability of family members and friends to recognize warning signs and act on them. According to Gregory K. Brown, a suicide specialist at the University of Pennsylvania, in studies of what preceded elder suicides, “suicide ideation” — the wish to die or thoughts of killing themselves — appears not to have been taken seriously. In 75 percent of cases, the suicide victims “had told family members or acquaintances of their intention to kill themselves,” Dr. Brown said.

Dr. Kennedy put it this way: “This is not simply a doctor’s problem. We need to think of elder suicide more as a social problem and look out for individuals at risk.”

Primary care practitioners are also crucial to suicide prevention among the elderly because older people, and especially older men, are unlikely to seek out and accept mental health services but are often seen by family doctors and nurses within days or weeks of a suicide. Among suicide victims 55 and older, 58 percent visited a general physician in the month before the suicide. In fact, 20 percent see a general physician on the same day and 40 percent within one week of the suicide.

While major depression is the main precipitant of suicide at all ages, social isolation is an important risk factor for suicide among the elderly. And older men, more so than older women, often become socially isolated.

Widowers are especially at risk because older men in the current generation tend to depend on their wives to maintain social contacts. When wives die, their husbands’ social interactions often cease.

“Older males who live alone are an endangered species,” Dr. Kennedy said — particularly “in states like Wyoming, Montana and Nevada, where the social distance is great and firearms are a part of the culture.”

Many men are poorly prepared for retirement, and don’t know how to fill in the hours and maintain a sense of usefulness when they stop working. “They often sit around watching TV,” said Martha L. Bruce, a professor of sociology and psychiatry at the Weill Medical College of Cornell University in White Plains said.

And Dr. Kennedy said, “After retirement a lot of older men start drinking heavily, a sign of increased aggression turned inward.” He called heavy drinking or binge drinking a risk factor for suicide among the elderly.

A particularly vulnerable time may be after the diagnosis of a life-threatening disease like cancer. Older men who were recently discharged from the hospital are also at high risk, Dr. Kennedy said. They need to be periodically screened for depressed mood, loss of interest in life and thoughts of killing themselves.

Serious personal neglect is another warning sign; people can commit a kind of passive suicide by failing to eat, letting themselves become dangerously sedentary or not taking needed medication.

Dealing With Depression

Contrary to what many people think, depression is not a normal part of growing older. Nor is it harder to treat in older people. But it is often harder to recognize and harder to get patients to accept and continue with treatment.

“Most people think sadness is a hallmark of depression,” Dr. Bruce said. “But more often in older people it’s anhedonia — they’re not enjoying life. They’re irritable and cranky.”

She added: “Many older people despair over the quality of their lives at the end of life. If they have a functional disability or serious medical illness, it may make it harder to notice depression in older people.”

Family members, friends and medical personnel must take it seriously when an older person says “life is not worth living,” “I don’t see any point in living,” “I’d be better off dead” or “My family would be better off if I died,” the experts emphasized. “Listen carefully, empathize and help the person get evaluated for treatment or into treatment,” Dr. Brown urged. He warned that “depressed older adults tend to have fewer symptoms” than younger adults who are depressed.

The ideal approach, of course, is to prevent depression in the first place. Dr. Brown recommended that older adults structure their days by maintaining a regular cycle and planning activities that “give them pleasure, purpose and a reason for living.”

He suggested “social activities of any type — joining a book club or bowling league, going to a senior center or gym, taking courses at a local college, hanging out at the coffee shop.”

Dr. Bruce suggests taking up a new interest like painting or needlework or volunteering at a place of worship, school or museum.

Dr. Brown notes that any activity the person is capable of doing can help to ward off depression and suicidal ideation. And he urges older people to talk to others about their problems.

Well: Moving Beyond Joysticks, and Off the Couch

As a new parent eight years ago, I swore never to buy a video game system, certain that my child would spend her leisure time reading and playing outside.

I recently remembered this vow while waiting in line for two hours outside the Nintendo store in Manhattan. Like hundreds of other parents, I was trying to get my hands on the Nintendo Wii, a popular video game system and one of the season’s hottest toys.

My conversion from video game critic to buyer is due in large part to some recent research showing that so-called active video games, like those played on the Wii, aren’t like the sedentary games played by the Atari generation. Far from creating couch potatoes, these games compel players to dance, jump and sweat.

While the active video games are clearly an improvement, excessive video game playing by kids is still cause for concern. Exposure to violent video game content is linked with aggression and antisocial behavior, and game playing has been shown to have a small but still measurable impact on time spent reading and doing homework for certain children.

Active video games are not a substitute for sports and outdoor play, but several studies show that the games can significantly increase a child’s level of activity while playing indoors.

In one New Zealand study, researchers studying game use by 21 children showed that active video games produced about as much activity as walking, skipping and jogging, according to the report in August in Pediatric Exercise Science.

Some of the new active video games burn more calories than walking on a treadmill, the American Academy of Pediatrics reported last year in its medical journal. In that study, researchers at the Mayo Clinic in Rochester, Minn., measured how many calories kids burned in 15 minutes of watching television, walking on a treadmill, playing a traditional seated video game (Disney’s Extreme Skate Adventure) or playing two active games. One of the active games, Dance Dance Revolution, requires players to follow steps using a dance pad, while Nicktoons Movin’ Jellyfish Jam uses the Sony EyeToy, which is controlled by body movements.

The EyeToy game burned about as many calories as walking on the treadmill, while dance pad users burned even more. The Mayo Clinic group is conducting a similar study of the Nintendo Wii.

Lorraine Lanningham-Foster, assistant professor at the Mayo Clinic, knows that the research into active video games will meet with skepticism. “There are people who think, no matter how you repackage it, they are still video games and kids shouldn’t be sitting down in front of the TV or a computer to play them,” Dr. Lanningham-Foster said. “But they’re not sitting down. That’s the whole aspect of these new games — they are moving.”

A recent Kaiser Family Foundation survey found that half of all 4- to 6-year-olds had played video games, and one in four played several times a week. Fisher-Price has introduced an active game system for 3- to 6-year-olds called the Smart Cycle. The cycle, the 13th most popular toy on Amazon.com, allows the child to control a video game by pumping the pedals.

The bigger worry for many parents isn’t whether kids are getting enough exercise, but whether video games interfere with real sports activities and time with friends and family or distract children from academic pursuits.

Researchers from the University of Texas at Austin looked at how nearly 1,500 adolescents and teenagers, ages 10 to 19, spent their time, and compared the habits of video game players with nonplayers. (The data were collected in 2002 and 2003, before the new active games were popular.)

Over all, there were no significant differences between gamers and nongamers in the time they spent with parents and friends, or involved in sports or other active leisure activities, according to the report in July in The Archives of Pediatrics and Adolescent Medicine.

Among girls, video-game play had no effect on reading time. But for every hour a boy played a video game during the school week, he read just two minutes less than a boy who didn’t play video games. Notably, nongaming boys didn’t read much at all either — spending only eight minutes a day with a book.

Video games didn’t affect boys’ homework time. But girls who played video games during the week spent 13 fewer minutes on homework, representing about one-third less time, than nongamers. But the meaning of that finding is not clear, as high-academic achievers often spend less time on homework as well.

Researchers say far more study is needed to understand what type of children play video games and how time spent playing games affects other parts of their lives. “The notion is, if kids weren’t watching TV and playing video games they’d be reading or outside running up and down a soccer field,” says Elizabeth A. Vandewater, a co-author of the Texas study who is now a senior research health analyst at Research Triangle Institute, a social science group in North Carolina. “It’s not an even trade-off.”

The American Academy of Pediatrics says children under 3 shouldn’t spend any time in front of the television or video games. And parents who do buy active video games should still make sure that a child’s overall media diet of computer use, television, videos and games does not exceed the academy’s recommendation of less than one to two hours a day.

“As a parent, you still have to regulate and monitor what they’re doing,” Dr. Lanningham-Foster said. “It still boils down to limits.”

E-mail: well@nytimes.com.

Really? : The Claim: Growing Pains Are Caused by Growth Spurts

THE FACTS

The aches and pains strike in the middle of the night for no apparent reason. For decades, doctors have dismissed them as normal signs of growing in small children, and said the pain was harmless.

Most textbooks attribute these “growing pains” to the stretching of leg muscles, caused by the rapid growth of bones.

But despite widespread acceptance of this claim, there is virtually no evidence that it’s true. Most studies have found instead that the pains — which can affect nearly half of all children — result from brittle bones and physical activity, in particular overuse from running, climbing and jumping during the day.

In 2005, for example, a study in The Journal of Rheumatology recruited 39 children with symptoms of growing pains and compared them with a control group. After ultrasound tests, the researchers found that the children in the pain group had decreased “bone speed of sound” — a measure of bone strength and breakability — suggesting that they suffered instead from “a local overuse syndrome.”

Other studies have had similar results, and some have also found that restless leg syndrome and other conditions are sometimes confused with growing pains. Researchers say that rather than dismiss the pains, parents can alert their pediatricians or try massages and a pain reliever.

THE BOTTOM LINE

Research suggests that growth spurts do not cause pain.

scitimes@nytimes.com

Scientists Use Monkey Clones to Extract Stem Cells

Researchers in Oregon are reporting that they used cloning to produce monkey embryos and then extracted stem cells from the embryos.

Not only is this the first time such cells have been produced in any animal other than a mouse, but the method, the researchers say, should also work in humans. In 2004, South Korean researchers reported making stem cells from cloned human embryos, but the claim turned out fraudulent.

“We hope the technology will be useful for other labs that are working on human eggs and human cells,” the lead researcher of the group, Shoukhrat Mitalipov at Oregon Health and Science University in Beaverton, said in a telephone interview. “I am quite sure it will work in humans.”

The monkey stem cells were genetically identical to an adult monkey, Semos, whose cells were cloned. They are a sort of universal cell that can, in theory, develop into any tissue or organ.

Medical researchers and patient advocacy groups have long hoped to use human embryonic stem cells to study diseases and supply replacement cells to treat them. So far, though, stem cell research has not yielded cures, and many obstacles lie ahead.

An advantage of using cloning to obtain stem cells is that they would genetically match a patient’s cells, making it unnecessary to suppress the immune system if the stem cells are used in treatment. Cloning could also produce stem cells that genetically match patients with complex diseases like Alzheimer’s. That might let scientists study those cells and understand how the diseases progress.

With the monkey work, some researchers say, cloned human embryonic stem cells seem more feasible. There is no way to know, of course, whether it will be harder or easier to repeat the work with humans. “I’m very enthusiastic,” said Dr. Leonard Zon, director of the stem cell program at Harvard’s Children’s Hospital. “The next step is definitely doing it in humans.”

Groups opposing human cloning and the destruction of human embryos to extract stem cells say the report makes it more urgent than ever to draw a moral line.

“I certainly think that this represents a new threshold in the entire discussion,” said the Rev. Tadeusz Pacholczyk, director of education at the National Catholic Bioethics Center. “At this point, it becomes essential to ask a question as a society: Are there ever going to be circumstances where it is morally justifiable to clone human beings?”

The report on cloned stem cells, which appears in the Nov. 22 issue of Nature, was published online yesterday, after some details of the work had filtered into the news media.

Dr. Mitalipov said his team showed that the cloned cells had features characteristic of universal cells. For instance, they developed into monkey heart cells and nerve cells.

The team also put the cells in mice, where they turned into a wide array of cell types.

The stem cells, Dr. Mitalipov says, “can contribute to any cell of the body.”

The scientists began by removing skin cells from a 9-year-old adult male rhesus macaque and inserted them, along with all their genes, into monkey eggs whose genetic material had been removed.

The egg, in a part of the cloning process that remains mysterious, reprogrammed the genes from the skin cells, bringing them back to the state they were in when embryo development begins.

The reprogrammed genes took over developing the eggs. A result was monkey embryos that were genetically identical — clones — of the adult male monkey. A few days later, the investigators extracted stem cells from the embryo clones, destroying the embryos in the process.

Most attempts at cloning failed. The investigators started with 304 egg cells from 14 female macaques and ended up with two stem cell lines. One line had an abnormal Y chromosome. The other, Dr. Mitalipov said, appeared normal.

But, he speculates, one reason for the success was finding a gentle way to take the genetic material out of monkey eggs.

In previous attempts, the investigators had used a method that worked well in mice. They marked the egg’s chromosomes with a dye that glowed under ultraviolet light. That let them see the chromosomes and be sure that they were removed before they inserted the adult cell with its genes into the egg.

The dye and ultraviolet light, the researchers surmised, might damage the egg. So they used a new method that shines polarized light through the egg, allowing them to see the chromosomes directly, without dyes.

Randall Prather, professor of reproductive biotechnology at the University of Missouri, said he had had similar problems with the dyes and ultraviolet light when he tried to clone pigs. His group succeeded by going in blindly and plucking the nuclei out of the pigs’ eggs, he said.

“Each system has a quirk to make it work,” Dr. Prather said.

Dr. Mitalipov said that once his group decided to use its modified methods of producing the cloned embryos, it took just a few months to produce the stem cells.

Dr. Mitalipov says his group’s next project is to use its new method to try to create cloned monkeys that carry genes for human diseases. The researchers would add human disease genes to adult skin cells before starting the cloning.

A result would be cloned monkeys that had the human disease gene in every cell. Scientists could study those monkeys to understand the causes and treatment of the disease.

“We hope,” Dr. Mitalipov said, “to model every known human disease.”