In 2009, close to 10 million cosmetic surgical and nonsurgical procedures were performed in the United States, down about 2 percent from the year before, the American Society for Aesthetic Plastic Surgery reports.

“Plastic surgery is feeling the effects of the recession, just like many other sectors of the marketplace,” Dr. Renato Saltz, president of the society, said in a news statement released Tuesday. “However, repeat patients and those putting off surgery are likely the reason for the small growth in non-surgical cosmetic procedures. Growth in demand will likely return as the recession eases and baby boomers’ offspring begin to explore surgical options.”

Men and women between the ages of 35 and 50 made up nearly half of the appearance-minded patients last year, racking up 4.4 million procedures. Next in line were 51- to 64-year-olds, representing just over a quarter of patients.

Breast augmentation was the most popular surgical procedure, with almost 312,000 such operations performed. Among men and women, the other top procedures were liposuction (nearly 284,000 operations); eyelid surgery (about 150,000 procedures); abdominoplasty (close to 128,000); and facelifts (more than 94,000).

Broken down by gender, after breast reduction, women most often opted for liposuction, eyelid surgery, abdominoplasty (tummy tuck) and breast reduction.

Men, on the other hand, sought liposuction most often, then rhinoplasty (nose surgery), eyelid surgery, male breast reduction and hair transplantation.

Many people seeking a more youthful look opted for nonsurgical services. Practitioners reported more than 2,557,000 Botox and Dysport treatments and more than 1,313,000 hyaluronic acid treatments (Hylaform, Restylane).

After the injectables, laser hair removal, microdermabrasion and chemical peels were most requested by men and women. For men, laser skin resurfacing was also a top seller.

In sum, Americans paid almost $10.5 billion for cosmetic procedures; $6 billion for various surgical procedures, and $4.5 billion for nonsurgical procedures, the society said.

SOURCE: 2010, news release, American Society for Aesthetic Plastic Surgery

“In our small sample, there was a 10-fold increased risk among those taking Coumadin [warfarin],” said study author Dr. Shyam Prabhakaran, an assistant professor of neurological sciences and head of the stroke program at Rush University Medical Center in Chicago. “I think we have raised a doubt that hasn’t been looked at before and should make us be sure that tPA is safe for these patients before we move forward.”

Current guidelines say that tPA, or tissue plasminogen activator, should be used quickly to dissolve a clot that is blocking a brain artery — within three hours after the first symptoms, as late as four and a half hours in some cases. But they say that the drug should be used only when a measurement called the international normalized ratio, or INR, which measures the tendency of blood to clot, is 1.7 or lower. A higher INR means a greater tendency to bleed.

The study, published online March 8 in Archives of Neurology, reported on the use of tPA in 107 people who had ischemic strokes, those caused by a blocked artery, from 2002 to 2009. Among them, the incidence of excess bleeding in the 13 people who had been taking Coumadin before the stroke was 30.2 percent, compared with 3.2 percent for those who had not been taking the drug.

Prabhakaran was quick to point out the faults in the study. “It is a single-center, retrospective study and not large enough so that it could be affected by sample size,” he said. “We need a larger data set from more centers.”

That information should be forthcoming now that an alert has been sounded, Prabhakaran said. “Other centers should now start presenting their data bases,” he said. “If their data indicate it is safe, the guidelines should not be changed. I think we will find, in the next year or two, other centers will start publishing their findings.”

A large number of Americans, most of them elderly, take Coumadin for a variety of reasons, including to prevent problems caused by atrial fibrillation, an abnormal heart rhythm, and to prevent clots from forming on artificial heart valves.

“This is an important study that talks about the risks we are well aware of when we use tPA for ischemic strokes,” said Dr. Ralph Sacco, professor and chairman of neurology at the University of Miami Miller School of Medicine. Sacco, president-elect of the American Heart Association and the first neurologist to hold that post, was a member of the group that set the guidelines for tPA use.

“The new updated guidelines that extended use of tPA beyond the three-hour window did exclude all patients taking Coumadin [from being] treated after three hours, regardless of INR level,” Sacco said.

He echoed Prabhakaran’s list of the new study’s shortcomings. “This is a non-randomized study,” Sacco said. “All-case studies always raise concerns about some bias.”

But attention must be paid, he said. “This raises the alarm level and makes us pause, as we always should, when we consider treating ischemic stroke,” Sacco said. “But it should not make us deviate from the guidelines.”

SOURCES: Shyam Prabhakaran, M.D., M.S., assistant professor, neurological sciences, and director, stroke program, Rush University Medical Center, Chicago; Ralph Sacco, M.D., professor and chairman, neurology, University of Miami Miller School of Medicine, Miami; 2010, Archives of Neurology, online.

Heart failure, in which the heart weakens and can’t beat effectively, is the second most common diagnosis for people in hospice care, which is designed for people with only months to live. Only cancer sends more people to hospice.

Researchers found that blacks were 40 percent less likely to receive hospice care for heart failure than whites, and Hispanics were 50 percent less likely.

“Our findings document significant racial differences in hospice use and show that overall increases in the availability of hospice services in the 1990s have not erased racial differences in hospice utilization,” study author Dr. Jane L. Givens, a scientist at the Hebrew SeniorLife Institute for Aging Research, said in a news release from the institute.

Only about 30 percent to 50 percent of people who suffer from advanced heart failure live beyond a year. Researchers report that many people with advanced heart failure don’t go to hospice, even though it is frequently recommended.

The study appears in the issue of the Archives of Internal Medicin

The Indiana University study also found an association between high assault rates and stores that sell alcohol for off-premise consumption. These alcohol outlets appear to be associated with about 25 percent of simple assaults and about one-third of aggravated assaults, according to the researchers.

“A higher density of alcohol sales outlets in an area means closer proximity and easier availability to an intoxicating substance for residents,” study author William Alex Pridemore, a professor of criminal justice, said in a university news release. “Perhaps just as importantly, alcohol outlets provide a greater number of potentially deviant places. Convenience stores licensed to sell alcohol may be especially troublesome in this regard, as they often serve not only as sources of alcohol but also as local gathering places with little formal social control.”

Pridemore and colleague Tony Grubesic, a geography professor, compared Cincinnati crime statistics from January to June 2008 with the locations of alcohol sales outlets. The average density of assaults was 69 per square mile and the average density of alcohol outlets was 20 per square mile.

The researchers concluded that adding one off-premise alcohol sales site per square mile would create 2.3 more simple assaults and 0.6 more aggravated assaults per square mile. Adding one bar per square mile would lead to 1.35 more simple assaults, while adding one restaurant per square mile would lead to 1.15 more simple assaults.

“We believe that alcohol outlets, as a source of community-level variation in levels of interpersonal violence, deserve greater attention in the criminological literature,” Pridemore said. “The nature of our findings should encourage further investigation of the nature of the ecological association between alcohol, violence and other negative outcomes within communities.”

The study findings were scheduled to be presented at the annual meeting of the American Association for the Advancement of Science

The over-the-counter product, to be available in the first half of next year, contains prescription Zegerid’s original formula, Merck said. The 14-day course of treatment is taken once daily to treat frequent heartburn for up to 24 hours.

Zegerid OTC is a proton pump inhibitor (PPI), which works to suppress stomach acid.

Some 50 million adults in the United States have heartburn symptoms more than twice weekly (defined as frequent heartburn), and as many as 25 million have heartburn daily, the company said.

In a study, Dr. Walter A. Rocca at the Mayo Clinic in Rochester, Minnesota, and colleagues found a history of constipation about two times more frequent in a group of men and women with Parkinson’s disease than in an age-matched group of men and women who did not have the disease.

Parkinson’s disease is a degenerative brain disease that causes body tremors, rigid muscles, and difficulty walking and talking. The disease alters the body’s autonomic nervous system, which controls spontaneous body processes such as heart rate, digestion, salivation, and bowel function.

Chronic constipation is common among people who suffer from Parkinson’s and it has been suggested that constipation may precede the appearance of classic movement symptoms of the disease in some people. For example, in the Honolulu-Asia Aging Study, men who reported less frequent bowel movements had a significantly higher risk of Parkinson’s disease over 24 years than men who reported more frequent bowel movements.

To investigate further, Rocca’s team evaluated about 38 years of medical records of individuals living in Olmsted County, Minnesota. They compared constipation history in 196 men and women who developed Parkinson’s at an average age of 71 years, and 196 Parkinson’s-free “controls” of similar age and gender.

Roughly 36 percent of the Parkinson’s patients had a history of constipation compared with only 20 percent of the controls, a significant difference.

After allowing for differences in age, smoking, coffee drinking, the use of constipation-inducing drugs, and constipation during the 19 years prior to the onset of Parkinson’s disease, Parkinson’s patients remained about two times more likely than controls to have a history of constipation.

The association between constipation and Parkinson’s was evident long before the onset of the disease, the researchers note. “Indeed, the association remained significant when restricted to constipation documented more than 20 years before the onset of Parkinson’s disease,” they note in a report in the journal Neurology.

The findings, say the investigators, suggest that constipation is an early manifestation of the neurodegenerative process underlying Parkinson’s disease. This study, Rocca added in comments to Reuters Health, “adds new evidence to accumulating literature” suggesting that Parkinson’s disease has a very long preclinical period.

However, because constipation has many causes not specifically related to nervous system function it is not a specific marker for Parkinson’s disease, Rocca noted.

Further investigations are needed to confirm and additionally evaluate the potential link between constipation and Parkinson’s disease, Rocca said.

Currently, there are no tools besides surgery to see if people with advanced colorectal cancer that has spread to the liver are responding to treatment with chemotherapy and Roche unit Genentech’s cancer drug Avastin.

And many patients with this advanced form of cancer are poor candidates for surgery.

“For the patient, you would have to wait for the tumor to resurface to have a sense for whether the treatment was working,” Dr Jean-Nicolas Vauthey of the University of Texas M.D. Anderson Cancer Center said in a telephone interview.

“We had no good tool to evaluate response,” said Vauthey, whose study appears in the Journal of the American Medical Association.

He said the findings are preliminary and need to be confirmed in a much larger study, but they do suggest CT scans might help doctors offer more personalized treatment for their patients.

Vauthey, a surgeon, said most doctors rely on tumor shrinkage to see if patients are responding to treatment, but he said that is not always a good indicator of response.

In surgery patients, doctors could tell by examining changes in the size and structure of tumors whether a patient was responding to the drug combination — the standard of care for most patients with advanced colorectal cancer — and had a good chance at survival.

Working with radiology specialists, the team applied some of these same characteristics to develop screening characteristics for CT scans.

To test these, the researchers analyzed a total of 234 colorectal liver metastases from 50 patients who had their tumors removed after treatment with Avastin and chemotherapy between 2004 and 2007.

All patients had CT scans at the start and end of the treatment. Radiologists studied the images for changes in the shape and structure of the tumors. They noticed that in patients who had a good response, the tumors changed into almost cyst-like structures with well-defined borders.

And they found they could classify patients into one of three categories, with type 1 patients having a good response and the best chances of survival, and those with type 2 or type 3, having poorer or no response.

The team then analyzed data on 82 patients whose colon cancer was too advanced for surgery. In those patients whose CT scans suggested they had a good response, median survival rose to 31 months, compared with 19 months in those who had an incomplete or no response to the drug, Vauthey said.

Given that most doctors and laypeople know (or should know) the benefits of exercise and its impact on healthy bodies, the authors of a new study, appearing in this week’s online issue of the Proceedings of the National Academy of Sciences, are hoping the findings can influence public policy.

Doctors “have known the principal idea for 3,000 years: A healthy mind lives in an healthy body,” said study senior author H. Georg Kuhn, professor for regenerative neuroscience at the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg in Sweden. “We are aiming at politicians and educators who decide on academic curricula and budgets and how sport fits into the picture of academic success.”

The study also found that genetics played a lesser role in explaining the mind-body link than did environment.

“This gets back to empowerment. You can’t determine that exercise or eating well isn’t going to help you because of your genetic background,” said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. “This is showing you that, regardless of genes, what you choose to do and how you choose to live can make a difference.”

The relationship between physical activity and cognitive function has been studied before, but usually in older adults (in relation to dementia) and in children.

And studies that focused on young adults, as these authors did, have tended to be smaller.

“Young adulthood is the time span in which important behavioral habits and cognitive functions are shaped,” explained Kuhn. “It is the period when academic performance has the biggest impact on the future life.”

This is also a time when the central nervous system is still developing, he noted.

The study was an extremely large one, involving 1.2 million Swedish men born between 1950 and 1976.

More than 250,000 of the men were sibling pairs and more than 3,000 were twins, of which 1,432 were identical twins.

The researchers took information from the time the men were conscripted into the military (age 18), which is compulsory in Sweden. This information was then correlated with information on the men’s prior academic performance, how many siblings they had and what socioeconomic class they came from.

Better cardiovascular fitness was associated with higher intelligence, although muscle strength was not, the researchers found.

“The emphasis at gyms is for strength over aerobic capacity but aerobic fitness is where we need to pay our focus,” said Dr. Jonathan H. Whiteson, co-director of the Joan and Joel Smilow Cardiopulmonary Rehabilitation and Prevention Center at NYU Langone Medical Center in New York City.

The twins portion of the analysis showed that environmental factors accounted for more than 80 percent of the equation, and genetics for less than 15 percent.

Any number of factors could explain why better cardiovascular fitness through exercising impacts brain function, including improved blood flow to the brain, diminished anxiety, enhanced mood and less fatigue, Whiteson said.

“We’ve known that aerobic exercise has been associated with improved cognitive performance. We’ve known that from studies dating back from the ’70s,” he said. “They picked the area of young men which may not have had a lot of research. This confirms what we’ve already known about younger and older individuals.”

“Anxiety sensitivity has been called a fear of fear,” study author Andres Viana, a graduate student in psychology at Penn State, said in a news release. “Those with anxiety sensitivity are afraid of their anxiety because their interpretation is that something catastrophic is going to happen when their anxious sensations arise.”

Viana and colleagues analyzed questionnaires completed by 94 volunteers, average age 19, who were moderate to high worriers. The questionnaires assessed worry, generalized anxiety and depression.

The responses showed that anxiety sensitivity significantly predicted depression symptoms. The researchers also found that two of the four issues that comprise anxiety sensitivity — the “fear of cognitive dyscontrol” and the “fear of publically observable anxiety symptoms” — specifically predicted depression symptoms. The two other issues — the “fear of cardiovascular symptoms” and the “fear of respiratory symptoms” — weren’t significant predictors of depression.

“What we found was that the fear of the cognitive sensations typical of anxiety, like the inability to concentrate, was related to depression. And we also found that the link exists in people who are afraid of symptoms that could potentially have social implications or symptoms of anxiety that may be subject to negative evaluation,” Viana said.

In a move likely to reassure American women, U.S. House and Human Services Secretary Kathleen Sebelius said in a statement the U.S. Preventive Services Task Force that issued the guidelines on Monday does not set federal policy and does not affect what services the government will pay for.

Critics of the new guidelines said they would lead to more cancer deaths and expressed fear insurance companies would use them to justify denying coverage for mammograms to women in their 40s.

“The Task Force has presented some new evidence for consideration but our policies remain unchanged,” Sebelius said in a statement.

“Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action,” she said.

The proposed changes address healthy women with an average risk of breast cancer, not women who have a family history of breast cancer or some other special risk.

The guidelines were swiftly rejected by cancer experts, and the American Cancer Society said it would not change its recommendations for routine mammograms starting at age 40.

Recommendations from the U.S. Preventive Services Task Force, an independent panel of experts sponsored by the U.S. Agency for Healthcare Research, typically set the standard for preventive services in the United States.

“There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country,” Sebelius said.

“I want to address that confusion head on,” she said.

“The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government,” she said.

She said there has been long-standing debate in the United States over when routine screening mammograms should start, and how often they should be done.

“What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect, and fight breast cancer, the second leading cause of cancer deaths among women.”

She advised women to “keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you.”

Representative Dave Camp, the ranking Republican on the Ways and Means Committee, said the new guidelines amount to rationing. “This is what happens when bureaucrats make your health care decisions,” he told the New York Times on Tuesday.

Democrats bristled at the suggestion that the new guidelines were motivated by cost, something the panel has denied.

“If we can cut through the Republicans’ political gamesmanship on this issue, the new breast cancer recommendations, as always, were an attempt to put the best possible evidence in the hands of women and their doctors, so they can assess their own risk and benefit,” Congresswoman Rosa DeLauro, a Democrat from Connecticut said in a statement.

“To suggest that our bill, the Affordable Health Care for America Act, does anything other than reduce cost, ensure that insurers stop discriminating against women, and improve the health insurance system for the 192,000 American women diagnosed with breast cancer each year, is absurd,” DeLauro said in a statement.

Breast cancer is the top cancer killer of women globally, killing 500,000 annually.