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Also known as the “blackout game,” “pass-out game,” “scarf game” and “space monkey,” among other monikers, the activity involves intentionally trying to strangle oneself or another, using hands or some sort of noose to briefly achieve an euphoric state.

The “game” can also cause seizures, headaches, bone breaks and brain injury — if not death.

A survey in the January issue of Pediatrics, which was published online Dec. 14, reports that almost one-third of family doctors and pediatrics are unaware of the “game.” And although two-thirds of physicians said the issue should be discussed during office visits, only 2 percent reported actually having done so.

“Myself having seen three to four kids affected by this, it seems to me if it’s preventable and it causes death, it should be talked about,” said Dr. Nancy Bass, senior author of the paper and an associate professor of pediatrics and neurology at Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center in Cleveland.

Bass had not heard of the game at the time she saw her first choking-game patient, she said.

“There needs to be a more standardized approach to education [of doctors],” said study first author Dr. Julie McClave, a pediatric resident at Rainbow Babies. “Hopefully by giving more information about warning signs and how prevalent this is in adolescents, more physicians will be aware.”

According to McClave, warning signs parents and physicians should be aware of include bruise marks or red marks around the neck; severe frequent headaches; blood vessel breaks on the face or eyes; red eyes; aggressive behavior or a change in behavior; unusual demands for privacy, such as locked bedroom doors; and wear marks on furniture, such as bunk beds or closet rods.

A report released earlier this year from the U.S. Centers for Disease Control and Prevention (CDC) found that, between 1995 and 2007, at least 82 youths died from playing the “choking game.”

Prevalence data indicate that 11 to 20 percent of teenagers have played the game, said McClave.

“That’s high and more prevalent than many physicians realize,” she said.

“The concern I have is that . . . this is much more prevalent and the death numbers are even higher than we in the medical profession know,” Bass added.

This may be confounded by the fact that many casualties from the “game” may be erroneously attributed to suicide or unintentional choking.

This survey of 163 pediatricians and family doctors revealed that more than 68 percent had heard of the choking game, the majority of those (61.3 percent) through popular news sources, indicating they had only a superficial knowledge of the phenomenon.

General practitioners were more likely to know of the game than pediatricians.

Not many doctors said they had actually seen a patient who had played the game although, the authors stated, this doesn’t match up with prevalence data, suggesting that at least some physicians are missing cases.

Some experts questioned whether the doctor’s office was actually the right place to make a dent in choking game statistics.

“The odds of an appointment being scheduled with a physician when the adolescent has physical evidence is not likely (unless the parent notices something is up and brings the adolescent in to be checked out),” said Dr. Karen Sheehan, medical director of the Injury Prevention and Research Center at Children’s Memorial Hospital in Chicago. “I think physicians need to screen for it by asking the adolescent as they would any other risky behaviors — drinking, smoking, sexual activity,” she added.

“Primary care physician time is always limited. I really wonder if that’s the best venue,” added Dr. G. Patricia Cantwell, professor and chief of pediatric critical care medicine at the University of Miami Miller School of Medicine. “Pediatricians and family practitioners can [also] play an active role in the community to get some of these things accomplished.” That could include public service messages and messages in school settings.

The U.S. Centers for Disease Control and Prevention offers these suggestions to help prevent poisonings at home:
Keep your child away from areas with peeling paint or chewable items covered with lead-based paint.
Make sure chemicals, cleaning products and medications are safely stored where your child can’t reach them.
Schedule an annual inspection of gas appliances to make sure they aren’t leaking.
If you are using chemicals inside, open windows and turn on fans to help ventilate the area.

The finding results from the examination of the genetic makeup of 152 children with bipolar disorder, which can make people susceptible to major mood swings, and 140 children without the disorder. They linked variations in a gene known as RORB to the kids with bipolar disorder.

“Our findings suggest that clock genes in general, and RORB in particular, may be important candidates for further investigation in the search for the molecular basis of bipolar disorder,” the study’s co-author, Dr. Alexander Niculescu, of the Indiana University School of Medicine, said in a news release from the publisher of BMC Psychiatry, which has published the findings online.

The gene, which is mainly expressed in the eye, pineal gland and brain, is thought to be tied to the body’s circadian rhythm.

“Bipolar disorder is often characterized by circadian rhythm abnormalities, and this is particularly true among pediatric bipolar patients,” Niculescu said. “Decreased sleep has even been noted as one of the earliest symptoms discriminating children with bipolar disorder from those with attention-deficit hyperactivity disorder,” he added. “It will be necessary to verify our association results in other independent samples and to continue to study the relationship between RORB, other clock genes and bipolar disorder.”

Since 1998, many countries have mandated folic acid (vitamin B9) fortification of foods to decrease the incidence of neural-tube defects in newborns. By October 2009, the flour produced in these countries, plus the flour that is fortified voluntarily, represented 30 percent of the world’s wheat flour produced in large mills. In addition, some 40 percent of those living in the United States also take dietary supplements containing folic acid, the researchers noted.

However, “Folic acid fortification and supplementation may not necessarily be as safe as previously assumed,” said lead researcher Dr. Marta Ebbing, from the Department of Heart Disease at Haukeland University Hospital in Bergen. “Public health and food safety authorities should take this into consideration.”

In Norway, foods are not supplemented with folic acid, making it the ideal place to investigate whether or not the supplement increases the risk for cancer, Ebbing noted.

“The study shows that treatment with folic acid for approximately three-and-a-half years was associated with a 21 percent increased risk of cancer and an increased risk of death after six-and-a-half years of follow-up in a large population of patients with ischemic heart disease living in Norway, where there is no folic acid fortification of foods,” she said.

The report is published in the Nov. 18 issue of the Journal of the American Medical Association.

For the study, Ebbing’s team collected data on 6,837 patients with heart disease from two trials. These trials were designed to see if vitamin B could lower homocysteine, a protein associated with an increased risk of heart disease.

In the studies, patients were randomly assigned to receive folic acid plus vitamins B12 and B6, folic acid plus B12, or B6 alone, or a placebo. These trials ran from 1998 to 2005, and were followed through the end of 2007.

The researchers found that patients who received folic acid had a 21 percent increased risk for developing cancer. In addition, of the 341 patients who received folic acid and developed cancer, 136 died — a 38 percent increased risk compared with patients who did not take folic acid and developed cancer.

The most common cancers associated with folic acid were colorectal, lung, prostate and blood cancer, the researchers noted.

In all, 16.1 percent of the patients who were given folic acid plus vitamin B12 died from any cause, compared with 13.8 percent of patients who received neither folic acid nor vitamin B12, the researchers said.

Bettina F. Drake, an assistant professor of surgery at the Alvin J. Siteman Cancer Center of the Washington University School of Medicine in St. Louis and co-author of an accompanying journal editorial, said that “while the results by Ebbing and colleagues provide some short-term data that is important in helping us understand the complexities in the association between folic acid and cancer risk, this report does not nullify the vast potential long-term benefits that folic acid fortification may have on population health.”

Drake noted that the dose of folic acid given to patients in the Norwegian studies was significantly higher than what most people in the United States get. “U.S. fortification appears to have left the population well within safe limits,” she said.

The true effect of folic acid on cancer may take many years of follow-up to determine, Drake said.

Cancer prevention efforts do not start or end with folic acid, Drake added. “Cessation from cigarette smoking for all who currently smoke and prevention of smoking in our youth and adolescents remains the highest priority for cancer prevention,” she noted.

“For those who do not smoke, eating a healthy diet and exercising to avoid weight gain or maintain weight loss will translate to lower risk of cancer, diabetes and other chronic conditions,” she said. “These are population-wide changes that take time, and the benefits of such lifestyle changes can take years to realize. Sometimes study results do, too.”

Removing polyps is believed to reduce the risk of colon cancer by 60 to 90 percent.

Researchers from the University of California, Los Angeles, analyzed data on 477 people who had colonoscopies in a one-year span at a Veterans Affairs hospital. Colonoscopies that started at 8:30 a.m. or earlier detected 27 percent more polyps per patient than colonoscopies performed at a later time, according to the study.

The improved rate in the early morning may be due to improved bowel preparation the night before, according to the researchers. They also suggested that doctor fatigue might also play a role in declining detection as the day wears on.

“We may find that setting a cap on the duration of endoscopic work shifts or other types of adjustments may be helpful,” Dr. Brennan M.R. Spiegel, director of the UCLA/Veterans Affairs Center for Outcomes Research and Education and a co-author of the study, said in a UCLA news release.

He emphasized that colonoscopy is an effective way to screen for colon cancer at any time of the day and said that people should not worry about getting early morning procedures.

“The impact of appointment time for any individual is very, very small,” Spiegel said. “Patients should feel confident that colonoscopy is helpful regardless of time of day and should be more focused on the quality and experience of their doctor rather than the time of their appointment.”

Previous studies have found that polyfluoroalkyl chemicals (PFCs) are present in the bodies of most people. In this new study, a team at the Boston University School of Public Health analyzed the association between serum cholesterol levels and four PFCs: perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS).

The analysis of data from the National Health and Nutrition Examination Survey revealed that people with levels of PFOS, PFOA and PFNA in the top 25 percent had higher total and non-HDL cholesterol (primarily the “bad” LDL cholesterol) than those with levels in the lowest 25 percent.

The association was most noticeable for PFNA, with a 13.9 milligram per deciliter difference in estimated cholesterol levels between people with the highest and lowest levels of the chemical, the study authors noted.

The researchers found little evidence of a link between PFC levels and body size or insulin resistance, according to the report in the Nov. 2 issue of the journal Environmental Health Perspectives.

“Though these results are based on cross-sectional data and are exploratory, they are consistent with much of the human epidemiologic literature and indicate that polyfluoroalkyl chemicals may be exerting an effect on cholesterol at environmentally relevant exposures,” wrote first author Jessica Nelson and colleagues. “Our study affirms the importance of investigating polyfluoroalkyl chemicals other than PFOS and PFOA, particularly as industrial uses of PFOS and PFOA decline and other polyfluoroalkyl chemicals are substituted.”

The Family Caregiver Alliance offers these suggestions:
Make sure the person is paying attention when you speak. Start out by saying his or her name.
Speak clearly, slowly, simply and directly. Shorter sentences are best.
Be kind and respectful, even if you’re frustrated. Don’t treat an adult like a child.
Don’t yell if the person has trouble hearing or understanding. Just move closer and try again.
Listen, and involve the person in the conversation.

The American Academy of Orthopaedic Surgeons offers these suggestions:
Soak the foot in warm water three or four times each day.
When not soaking, make sure the foot is clean and dry.
Wear open-toed sandals or similar while the condition heals. Otherwise, opt for comfortable shoes that don’t squeeze the toes.
Carefully wedge a small piece of clean cotton or waxed dental floss between the skin and the toenail. Be sure to change this packing daily.
Use an over-the-counter pain reliever such as ibuprofen or acetaminophen.
You should start to see improvement within two or three days. If you don’t, contact your doctor.

Because of their weakened immune system, AIDS patients are at increased risk for so-called AIDS-defining malignancies, which include cancers such as cervical carcinoma, non-Hodgkin’s lymphoma and Kaposi’s sarcoma.

There has been speculation that non-AIDS-defining malignancies are becoming more common among HIV patients because antiretroviral drugs help them live longer. But this new study by researchers at University of Texas Southwestern Medical Center in Dallas suggests other factors may exist.

The researchers analyzed 1997 to 2004 data from more than 100,000 patients in the U.S. Veterans Affairs Healthcare System and found that HIV-infected patients were 60 percent more likely to have anal, lung, Hodgkin’s, melanoma or liver cancer than patients without HIV.

“It’s a genuine increase in the incidence of these cancers,” lead author Dr. Roger Bedimo, an assistant professor of internal medicine, said in a university news release. “The increase is more visible because these patients are living longer, but our findings suggest that the increased number of non-AIDS-defining malignancies is not simply the result of their longer lives.”

The study appears online and in the October print issue of the Journal of Acquired Immune Deficiency Syndromes.

One controversial theory is that antiretroviral therapy itself may increase the risk of non-AIDS-defining malignancies, the study authors noted.

“The second hypothesis is that HIV-infected patients somehow, either by their lifestyle or other circumstances, are more subject to the traditional risk factors than non-HIV patients,” Bedimo said. “The third hypothesis is that HIV or another undetected virus increases a patient’s risk for developing cancer intrinsically.”