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Am Fam Physician. 2000;62(4):726

“You've Got Mail.” The practice of physicians using e-mail to communicate directly with patients is an idea whose time has come. According to a report from Medem, Inc., in San Francisco, an e-health network founded by some leading U.S. medical specialty societies and the American Medical Association, physicians' use of e-mail to communicate with patients has increased by 200 percent in less than one year. According to the study, 10 percent of physicians use e-mail on a daily or weekly basis to communicate quickly with their patients.

Tired of always losing your glasses? Laser eye surgery has been successful in recent years in nearsighted people, often improving their vision so that wearing eyeglasses may not be necessary. Now, according to a recent issue of Health Tips, published by Stanford University Medical Center, laser eye surgery can offer clear vision without eyeglasses in select patients with farsightedness and astigmatism. The article suggests that patients should talk to prospective surgeons to determine which system of laser devices might best suit their needs and cautions that the procedure is not appropriate in children or in people whose prescriptions are changing actively. In addition, people with certain eye diseases may not be good candidates for the procedure, especially if they expect to have 20/20 vision after surgery.

What a pill! In a report published by the AARP, the average American 65 years or older spent nearly one fifth of his or her annual income, about $2,400, on health care last year. According to American Demographics magazine, that amount represents Medicare premiums and deductibles, as well as expenses not covered by Medicare. The article reports that seniors spend as much for their prescription drugs (about 17 percent of their health care budget) as they do for physician services, vision services and medical supplies combined. And these figures don't even take into account the enormous costs of home health care and long-term nursing care.

Lost in space? According to a recent study reported in Lancet, 22 cosmonauts (2 female, 20 male) were studied to determine the effects of microgravity on the skeletal structure. When the skeleton is not exposed to the continuous effect of gravity, about 1 to 2 percent of the bone mineral density (BMD) is lost at various skeletal sites each month. The authors conclude that more studies are necessary to investigate the effects not only on different bones, but also on different areas of the same bone, because not all sites of the skeleton are similarly affected by space conditions.

Is it age or is it stress? Research on stress now includes looking at the negative effects of stress on the hippocampus and subsequent memory loss. The Harvard Health Letter recently reported on studies showing that cortisol, a hormone released by the adrenal glands during stress, has adverse effects on the hippocampus. High levels of cortisol (as well as other glucocorticoids) damage neurons of the hippocampus. Those damaged neurons stimulate production of more glucocorticoids, causing even more damage to the hippocampus. Science is rethinking the theory that aging automatically affects the hippocampus and causes memory loss, and stress is now considered a primary culprit.

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