The American Voice Institute of Public Policy presents
Personal Health
Joel P. Rutkowski, Ph. D., editor
July 9, 2005
PERSONAL HEALTH for the week of June 18-24
- Snuff, Chew Tobacco Raise Heart Death Risk
- Vegetarian women weigh less than meat-eaters
- Health Tip: Don't Let the Norovirus Get You
- Even Infants Can Suffer Strokes
- Dark chocolate seen healthy for arteries
- Study Points to Heart Disease Marker's Dark Side
- Heroin users show Alzheimer's-like brain changes
- Restoring Full Blood Flow Boosts Bypass Survival
- Serve kids more food, and they'll eat it
- Health Tip: Prevent Food Poisoning in Children
- Most U.S. Migraine Going Untreated
- U.S. clears Nitromed heart drug for blacks
- Triptan Nasal Spray Eased Migraines in Teens
- AMA to Seek Limits on Tanning, Video Games
- NSAIDs Appear to Ease Tough-to-Treat Migraine
- Western and Japanese diets up colon cancer risk
- High STD Rates Seen in Young Drug Users
- FDA Panel Rejects Artificial Heart
- Health Tip: Furthering Family Fitness
- Health Tip: When Your Mouth's on Fire
- Yes, bigger brains mean higher IQ, on average
- Radiation Frequency Questioned for Male Breast Cancer
- Survey: Most U.S. Doctors Believe in God
- Antibiotics No Good for Pinkeye
- Cardiac arrest response slow for hospital visitors
- Death Risk Higher Month After Heart Attack
- Steel workers at risk for kidney stones
- New Drug Shows Promise in Type 1 Diabetes
- Body fat pattern abnormal in recovered anorexics
- Post-Surgery Chemo Raises Lung Cancer Survival
- Cancer fear high among women having hysterectomy
- Public Hospitals Provide Good Diabetes Care
- Caffeine's blood pressure effect persists in some
- Way to Predict Stroke after 'Mini-Stroke' Found
- US docs' group wants package fixes for herbal meds
- Keyhole Surgery Works with Colon Cancer
- Plant chemical may harm male fertility – study
- Duke: Hydraulic Fluid Wash Doesn't Infect
- Common virus kills cancer, study finds
- Children Need an Hour of Exercise Per Day
- Heavy exercise may worsen arthritis damage
- Breast-Feeding Cuts Risk of Myopia
- Modest weight loss curbs high blood pressure risk
- Heart Condition Linked to Resistant Staph
- Combination of diabetes, depression ups death risk
- Bacteria a Key for Kids' Ear Infections
- Study finds racial disparity in lung cancer cases
- GERD May Be Linked to Cancers
- Polio still a threat but a fading one - officials
- Aging Stem Cells Linked to Leukemia in Elderly
- Study finds antibiotics rarely help deep cough
- Health Tip: Recognizing Generalized Anxiety Disorder
- Heavier heart-bypass patients fare somewhat better
- Study: Extra Folic Acid May Help Memory
- Nicotine affects brain like heroin: study
- Brain Exercise Is Key to Healthy Mind
- Overeating plus inactivity ups breast cancer risk
- Health Tip: Be Wise About Summertime Exercise
- Bacterial virus may underlie meningitis
- Deadliest Skin Cancer Often Missed
- Warning: Your job may give you asthma
- Worldwide Alzheimer's Care Carries Staggering Costs
- Twins Study Links Causes of Alzheimer's
- Studies Show Ways to Predict, Prevent Alzheimer's
- Experts Say Schizophrenia Drug Cures SARS
- Blood Protein Signals Heart Disease Risk
- MRI Can Identify Alzheimer's, Other Dementia
Friday, June 24, 2005
Snuff, Chew Tobacco Raise Heart Death Risk
By Randy Dotinga
HealthDay Reporter
HealthDay News
Friday, June 24, 2005
FRIDAY, June 24 (HealthDay News) -- Besides raising the risk of oral cancer, smokeless tobacco -- also known as snuff, dip or chewing tobacco -- appears to boost the odds male users will die from heart disease, according to the largest study of its kind ever conducted.
The findings contradict earlier research, finding instead that people who chew or "dip" tobacco are 20 percent more likely to be killed by a heart attack or stroke than nonusers.
It isn't clear why smokeless tobacco might contribute to cardiovascular problems, and the study isn't the final word on the issue, said co-author Jane Henley, an epidemiologist with the American Cancer Society. Even so, the research, released this month in the journal Cancer Causes and Control, should give users another reason to kick their habit, she said.
Some chew users are ex-smokers who turn to smokeless tobacco to "tide them over" as they try to kick the smoking habit. But "any form of tobacco is harmful to your health," Henley said. "We should be encouraging smokers who want to quit to use nicotine-replacement and other safe therapies."
In their study, Henley and her colleagues examined two U.S. surveys of American adults, one spanning the years 1959-1972 and another from 1982-2000. Together, nearly 1 million men filled out questionnaires, including almost 10,000 smokeless tobacco users.
The studies encompassed both chewing tobacco, found in pouches and kept between the cheek and gums, and "dip," also known as "snuff," which comes in small tins and is "pinched" between the lower lip and gums.
Those who reported using smokeless tobacco when first surveyed were 20 percent more likely to die of cardiovascular diseases compared to those who never used any form of tobacco. They were also 20 percent more likely to die from all diseases combined.
The researchers adjusted the statistics in the study in an attempt to remove the influence of other factors such as age, race, occupation and diet.
Previous studies have both supported and debunked the link between smokeless tobacco and heart disease, said Henley, who believes more research needs to be done to confirm the findings.
Why would smokeless tobacco pose a risk to the heart? According to Henley, oral use of tobacco may increase heart rate and contribute to clots, which can block blood flow in the body.
Since nicotine replacement therapy seems to be safe, "tobacco itself is probably more harmful than just pure nicotine," she said.
An estimated 7.7 Americans, almost all male, use smokeless tobacco, Henley said. Part of its appeal is the rush delivered to users.
Also, "it's really easy to get hold of, and it's often sold in convenience stores right by the candy," said Elizabeth Rogers, spokeswoman for Oral Health America.
Smokeless tobacco now comes in several flavors, like wintergreen and cherry, that attract children, she said. Another key to its appeal is the ease of hiding the habit from adults.
Cigarettes, of course, leave telltale signs of smoke, while smokeless tobacco can disappear in an instant. "If the kid is swallowing instead of spitting, they could get away with it a lot easier," Rogers said.
More information:
Learn more about the hazards of smokeless tobacco from kidshealth.org.
Vegetarian women weigh less than meat-eaters
By Amy Norton
Reuters Health
Friday, June 24, 2005
Women who eat little or no meat are less likely to be overweight than their more carnivorous peers, according to a new study.
The findings, say researchers, suggest that replacing some meat and other animal products with plant-based fare may help people control their weight.
The study of more than 55,000 Swedish women found that those who identified themselves as vegetarian or vegan tended to weigh less than meat-eaters, and were less likely to be overweight or obese.
The vegetarian group included women who ate no meat, fish or eggs but did consume dairy products (lactovegetarians), as well as "semivegetarians," who said they sometimes ate fish or eggs. Vegans eat no animal products, including dairy.
In the study, self-proclaimed vegans were two-thirds less likely than meat-eaters to be overweight or obese, while the two vegetarian groups were about half as likely as meat-eaters to be overweight -- even with other factors, such as age, exercise and total calorie intake, taken into account.
While this was not a weight-loss study, the findings do suggest that a plant-based diet may aid in weight control, according to P. Kirstin Newby, a researcher at Tufts University in Boston.
But that doesn't necessarily mean shunning meat and other animal products, she told Reuters Health, noting that semivegetarians in the study had a lower risk of being overweight.
The study, in the American Journal of Clinical Nutrition, included 55,459 healthy middle-aged and older women who were surveyed about their eating habits, weight and other health and lifestyle factors. A small percentage identified themselves as vegan or vegetarian.
Overall, vegans had the lowest average body mass index (BMI) -- a measure of weight in relation to height -- followed by vegetarians, then meat-eaters. While 40 percent of meat-eaters were overweight or obese, only 25 to 29 percent of vegetarians and vegans were, Newby and her colleagues report.
The findings, they point out, run counter to the current "fad" of high-protein, low-carbohydrate diets.
That vegetarians are leaner than meat-eaters, according to the researchers, highlights the fact that not all carbohydrates are equal. A diet of fiber-rich carbs like fruits, vegetables and whole grains, they note, differs from one loaded with refined carbohydrates such as those in white bread and snack foods.
"Plant foods are generally high-carb," Newby said, "but they also contain a lot of fiber -- which helps you to feel full -- and they also have other nutrients that are important to overall health."
Because these nutrients may help ward off heart disease and cancer, she noted, there are "lots of good reasons" besides weight control to eat a plant-based diet.
For people who do eat animal products, Newby added, it's important to limit saturated fat by choosing lean cuts of meat and low-fat dairy products.
Source: American Journal of Clinical Nutrition, June 2005.
Health Tip: Don't Let the Norovirus Get You
HealthDay News
Friday, June 24, 2005
(HealthDay News) -- Over the past couple of years, outbreaks of gastroenteritis or Norwalk-like viruses have afflicted hundreds of people.
The U.S. Centers for Disease Control and Prevention says at least 50 percent of all foodborne outbreaks of gastroenteritis may be attributed to these germs, called noroviruses.
Among the 232 outbreaks of norovirus illness reported to the CDC from July 1997 to June 2000, common settings for outbreaks include restaurants (36 percent), nursing homes (23 percent), schools (13 percent), and vacation settings or cruise ships (10 percent).
Whether you're at home or traveling, you can fend off the norovirus with these tips offered by the Johns Hopkins University Health After 50 medical letter:
Wash your hands frequently with soap and water, particularly before and after meals, and keep your hands away from your face and mouth. Every so often, use alcohol-based hand sanitizers. Don't share eating utensils or drinking glasses. Avoid eating uncooked food. If you're traveling, drink only bottled water. If you're planning a trip and are over 65 or have a weakened immune system, your doctor may suggest additional precautions.
Even Infants Can Suffer Strokes
By Kathleen Doheny
HealthDay Reporter
HealthDay News
Friday, June 24, 2005
FRIDAY, June 24 (HealthDay News) -- Parents of newborns often worry their babies may choke, or not feed well, or perhaps struggle with breathing problems.
Few consider the possibility their child may suffer a stroke.
But they need to be aware of that risk, neurologists say: Strokes are as common in newborns as they are in the elderly. In older children, strokes are far rarer, but they do occur.
"Most people are under the impression that babies and children don't have strokes. Part of what makes it surprising is that it can certainly happen in otherwise healthy babies," said Dr. Heather Fullerton, an assistant professor of pediatrics and neurology at the University of California, San Francisco, who has published research on the topic.
Experts are still trying to determine why strokes occur in the very young. Complicating matters, strokes in infants are often diagnosed late or not at all. And there are few well-accepted treatments for these little patients.
But children's brains are very "plastic," which means they have a great capacity to learn to compensate for the damage, experts say.
About one in 4,000 or 5,000 infants suffers a stroke sometime in the first month of life, according to Dr. John Kylan Lynch, a researcher at the National Institute of Neurological Disorders and Stroke.
"From age one month to 18 years, the rate is about 1 or 2 per 30,000," Lynch added.
About half of infant strokes are ischemic, which means a brain artery has become blocked. The other half are hemorrhagic, in which a blood vessel has burst, Fullerton said.
According to Lynch's research, up to 12 percent of newborns who suffer a stroke will die. Few newborns have a repeat stroke, he said. "The recurrence rate is up to 5 percent, although recent studies suggest rates less than 1 percent," Lynch said.
While strokes in infants often strike suddenly, there can sometimes be warning signs. "In infants, it could be seizures or sudden onset of weakness on one side of the body and usually involves the hands," Fullerton said. "Certainly if parents see an acute change like that, they should go to the emergency department."
Once there, the infant can be taken to the neonatal intensive care unit and a CT scan of the head performed, to rule in or out a stroke.
In his research, Lynch has found that black infants are twice as likely as white children to suffer a stroke. Part of that increased risk owes to the prevalence of sickle cell disease, an inherited disorder of the red blood cells. "Sickle cells over time damage the blood vessels to the brain," he said.
Infants who suffer stroke are often basically healthy babies, Lynch noted. So what goes wrong? "We don't really know. What we are finding is that many of these mothers have pregnancy complications, such as preeclampsia [in which the pregnant woman's blood pressure rises to abnormal levels] or maybe an infection during pregnancy," he said.
"Many of the mothers turn out to have blood clotting abnormalities, and somehow it is passed on to the baby," he added.
Sometimes, doctors can't determine exactly when the stroke occurred in a newborn. "A stroke around the newborn period can occur before the child is born, when coming down the birth canal or after the child is born," Lynch said.
While there is no specific treatment for newborn stroke, doctors recommend that if there is a fever, it be controlled and that infection be ruled out, since it can trigger a stroke, Lynch said. Seizures must be controlled, too.
There have been some pilot studies in adults that have shown cooling the body may protect the brain. A cooling cap may help in children, but that is yet to be proven, Lynch pointed out.
Parents shouldn't blame themselves if they don't recognize the warning signs of a stroke in their newborn, Lynch stressed. "Probably 30 percent go unrecognized" when they first occur, he said.
Part of the problem is that a baby can't tell a parent he or she has lost feeling in a hand, for instance. And their muscle coordination is just developing, so it's difficult to determine if there is muscle weakness.
The good news: "In general, children recover better than adults from stroke," Fullerton said. They may need extra help by the time they reach school age. And teachers should be told about their medical history, she advised.
That's why it's so critical to diagnose the stroke early. The sooner children begin physical, occupational or speech therapy, the better the chance they have at adapting, Fullerton said.
More information
To learn more, visit the Children's Hemiplegia and Stroke Association.
Dark chocolate seen healthy for arteries
Reuters Health
Friday, June 24, 2005
Eating dark chocolate may have a protective effect on the cardiovascular system in healthy people, the results of a new study suggest.
"Epidemiological studies suggest that high flavonoid intake confers a benefit on cardiovascular outcome," Dr. Charalambos Vlachopoulos, of Athens Medical School in Greece, and colleagues write in the American Journal of Hypertension.
They point out that the elasticity or stiffness of arteries "are important determinants of cardiovascular performance and are predictors of cardiovascular risk."
The researchers examined the effects of flavonoid-rich dark chocolate on blood-vessel function in 17 young, healthy volunteers over a 3-hour period after they consumed 100 grams of a commercially available dark chocolate.
The investigators saw that an artery in the arm dilated significantly more in response to an increase in bloodflow. Chocolate consumption also led to a significant 7-percent decrease in aortic stiffness.
"The predominant mechanism appears to be dilation of small and medium-sized peripheral arteries and arterioles," Vlachopoulos and colleagues suggest.
The team didn't detect any change in antioxidant levels, so they suggest other possible explanations. "The dilatory effect of chocolate under resting conditions can be attributed to improved nitric oxide bioavailability, prostacyclin increase, direct effect of chocolate in smooth muscle cells, or activation of central mechanisms," they write.
Source: American Journal of Hypertension, June 2005.
Study Points to Heart Disease Marker's Dark Side
By Amanda Gardner
HealthDay Reporter
HealthDay News
Friday, June 24, 2005
THURSDAY, June 23 (HealthDay News) -- Scientists have taken a small step in identifying an additional potential cause of heart disease.
Whether or not the possible culprit, C-reactive protein (CRP), actually does damage in humans is still an open question, however.
"The big prize is nailing [CRP] as a cause of heart disease and not just a marker," said Dr. Edward Fisher, a professor of medicine at New York University School of Medicine, and national spokesman for the American Heart Association. "A lot of people are working on it, and we're not there yet."
The study outlining the latest findings appears in the July issue of Arteriosclerosis, Thrombosis, and Vascular Biology.
CRP is established as a marker for heart disease, meaning it can identify people at high risk for heart attacks, strokes and other events. Proving a more active role has so far proved elusive.
Blood levels of the protein increase when parts of the body become inflamed. Inflammation, in turn, is key to the development of atherosclerosis. As such, CRP can foreshadow future cardiovascular problems.
But more recent research has some scientists guessing that CRP may be more than just a harbinger of disease.
Recently, researchers found that CRP could bind to Fc-gamma receptors on leukocytes or white blood cells. That means that "CRP will interact with the white cells and stimulate the production of a number of factors that are known to be inflammatory," Fisher explained. "Researchers have speculated that if this happens in the vessel wall, CRP can be a direct inflammatory molecule."
Earlier this year, researchers at the University of California, Davis (the same team that conducted this study) also found that CRP is produced by endothelial cells that line the artery walls (it was previously thought to be manufactured only by the liver).
Endothelial cells "are the critical cells that line the endothelial lining of coronary and cerebral arteries and participate in the first step of plaque formation," said Sridevi Devaraj, lead author of the current study and an associate professor of pathology. This brought CRP a little closer to the "ground zero" of heart disease, he said.
The question then became: How does CRP get into the endothelial cells?
"CRP promotes plaque formation so, obviously, the big question is 'How does it do this?'" Devaraj said. "It's a huge protein. Somehow it has to get into the cell."
This latest study, conducted by Devaraj and senior author Dr. Ishwarlal Jialal, showed that, in addition to binding to Fc-gamma receptors in white blood cells, CRP also binds to two members of the Fc-gamma receptor family found on endothelial cells.
And when those receptors were blocked with specific antibodies, CRP uptake was also blocked.
The key question for the future would be how to block CRP in the human body, although the scientists said they're still a long way from figuring that out.
These studies were conducted in the lab, and no one yet knows if the process works the same way in living, breathing people, Fisher said.
For one thing, it's not clear how CRP competes with the myriad other molecules that can also bind to Fc receptors. "What you don't know is how good is CRP at getting through the crowd of other things that will bind to Fc receptors and actually utilize this pathway?" Fisher said.
He cautioned that it is premature to draw any firm conclusions about these mechanisms. "Extrapolation at this point has to be somewhat limited," Fisher said. "No matter what we find in a cell model or in a mouse, what's going to trump all of that is what we find in people."
More information
The American Heart Association has more on CRP.
Heroin users show Alzheimer's-like brain changes
By Amy Norton
Reuters Health
Friday, June 24, 2005
Young people who abuse heroin may suffer brain damage similar to what's seen in the early stages of Alzheimer's disease, according to a new study.
Comparing autopsied brain tissue from young heroin abusers and non-drug users, UK researchers found that before they died, the drug users had begun to develop damage in brain areas involved in learning, memory and emotion.
Specifically, they had heightened levels of two proteins that contribute to the "plaques" and "tangles" that build up in the brains of people with Alzheimer's.
One of these proteins is called tau, and drug users in this study showed higher levels of an abnormal, insoluble form of tau that is seen the tangles that mark Alzheimer's and other forms of dementia.
"Since abnormal tau is clearly linked to dementia in a number of other conditions," senior study author Dr. Jeanne E. Bell told Reuters Health, "there is cause for worry about accelerated aging of the brain in people who start to abuse opiates at a young age."
It's unlikely that the protein levels seen in drug abusers' brains had already caused problems with thinking, memory or behavior, according to Bell, a professor of neuropathology at the University of Edinburgh.
"However," she added, "our findings do relate to areas of the brain involved in memory and emotional control, and if the process were to continue at an accelerated pace in opiate abusers compared with non-abusers, it seems likely that symptoms would follow."
The findings were published online this week by the journal Neuropathology and Applied Neurobiology.
For their study, Bell and her colleagues examined brain tissue from 34 intravenous drug users younger than 40 who had abused heroin or methadone. Most had died of a drug overdose; one committed suicide.
For comparison, the researchers also looked at tissue from 16 people in the same age range who had died suddenly and had no known history of drug abuse.
While none of the brain tissue contained Alzheimer's-like "plaques" -- deposits composed of a protein called beta-amyloid -- drug abusers were much more likely to show evidence of beta-amyloid precursor protein in two brain areas. This protein, when broken up by specific enzymes, forms the beta-amyloids that mark Alzheimer's plaques.
Drug abusers were also far more likely than the comparison group to have brain tangles composed of abnormal tau.
More than twice as many opiate users -- 44 percent versus 19 percent -- showed such protein deposits. And while the tangles were limited to one brain area in non-drug users, they were more widespread in drug abusers' brains.
The findings, Bell said, show only an association between drug abuse and abnormal protein deposits in the brain, and so cannot establish heroin or other opiates as the cause.
That means it's also impossible to say whether the brain damage could be reversed if the drug abuse were to stop, according to the researcher.
It will be important, Bell noted, to find out whether opiates in fact cause the abnormal protein deposits, and if they do, the mechanisms at work. Doing so, she said, could also yield clues to the early development of Alzheimer's and other forms of dementia.
Source: Neuropathology and Applied Neurobiology, online June 21, 2005.
Restoring Full Blood Flow Boosts Bypass Survival
HealthDay News
Friday, June 24, 2005
FRIDAY, June 24 (HealthDay News) -- In patients with multiple blocked arteries, restoring blood flow to all areas of the heart improves five-year survival, researchers report.
A team of experts at Cedars-Sinai Medical Center, Los Angeles, reviewed 1,034 patient cases and concluded that those who have complete revascularization -- the grafting of arteries to restore blood flow to all the affected areas of the heart -- have better long-term survival rates than patients who have incomplete revascularization.
"Our study centered on the various factors that make for the most successful coronary artery bypass operation, and we were looking not only at in-hospital survival by five-year survival," study leader and cardiothoracic surgeon Dr. Wen Cheng said in a prepared statement.
"Although most survival studies are based on immediate outcomes, this is not the whole picture," he added. "We should be emphasizing long-term survival. What are the results going to be after five years or more? Is the patient going to need another intervention? And the most important thing: is the patient going to be alive?"
Cheng and his colleagues also said that when doing complete revascularization, surgeons should use transplanted arteries, not veins, to restore blood flow throughout the heart.
"It is much easier to harvest and work with veins, but, unfortunately, veins do not last forever. Arteries are naturally better able to carry blood under arterial pressure than veins, and while arterial grafting is technically more difficult to accomplish, requiring a higher level of skill, it was the best choice for our patients," Cheng said.
The findings appear in the current issue of the Journal of Thoracic and Cardiovascular Surgery.
More information
The American Medical Association has information about coronary artery bypass surgery.
Serve kids more food, and they'll eat it
By Alison McCook
Reuters Health
Friday, June 24, 2005
When it comes to food, kids tend to eat what's put in front of them even if it exceeds their calorie needs, according to new study findings.
Researchers at Cornell University in Ithaca, New York found that if kids were served more food, they ate it, and did not adjust how much they ate according to what they'd already eaten earlier in the day.
For instance, kids didn't eat less if they had big breakfasts, and the more snacks they were given, the more calories they ate in one day.
These findings suggest that kids are no better than adults at listening to their bodies, and that parents can have a big influence on their children's health, study author Dr. David A. Levitsky told Reuters Health.
"The more opportunity you give them to eat, and the more food you put in front of them, the more they will eat," he said.
Consequently, Levitsky recommended that adults try to avoid overfeeding kids, perhaps by serving small portions. Give kids more food if they want it, "but don't put a lot on the plate," he said.
Levitsky and Gordana Mrdjenovic monitored the eating habits of 16 children ages 4 to 6 for up to 7 days in a row. The researchers tracked what children ate at day care centers, and asked parents to keep food diaries of what kids ate at home.
The team found that the biggest determinant of the amount kids ate was the amount they were served. What kids ate previously, and the fat, protein, or carbohydrate content of their food, did little to influence kids' intake, the investigators report in the journal Appetite.
Levitsky explained that previous studies have suggested that kids naturally adjust their intake based on what they've eaten before. For instance, earlier studies conducted in laboratories showed that infants appear to adjust their intake if scientists switched them to high-calorie formula.
However, Levitsky said that he and his colleagues reanalyzed this data, and found that kids don't "totally compensate" for changes in food content, and infants eventually got fatter if they consumed calorie-rich formula.
"I know of very little evidence supporting the idea that children are any better than adults" at listening to their bodies when it comes to food, Levitsky noted.
Source: Appetite, June 2005.
Health Tip: Prevent Food Poisoning in Children
HealthDay News
Friday, June 24, 2005
(HealthDayNews) -- Children under age five are especially susceptible to food poisoning because their immune systems aren't fully developed.
Help protect them with these tips from All Children's Hospital in St. Petersburg, Fla.:
Keep hot foods hot and cold foods cold. Wash your hands before preparing food, in between preparing different food courses, and after you've finished making the meal. When grilling chicken, beef or pork, ensure that it's fully cooked by making sure there are no pink juices coming from the meat. Buy pasteurized fruit juices.
Thursday, June 23, 2005
Most U.S. Migraine Going Untreated
By Randy Dotinga
HealthDay Reporter
HealthDay News
Thursday, June 23, 2005
THURSDAY, June 23 (HealthDay News) -- A new survey of more than 19,000 people with migraines suggests that a large number of American headache sufferers don't get proper preventive care.
Only about 5 percent of people with migraines reported taking drugs that could help stop the headaches, researchers found. "It means there's an intense degree of unnecessary suffering in the United States," said study investigator Dr. Stephen D. Silberstein, director of the Headache Center at Thomas Jefferson University Hospital in Philadelphia.
Migraine headaches, which affect an estimated 28 million Americans aged 12 and older, have long been notoriously difficult to treat. Doctors use a variety of drugs to prevent the headaches, including antidepressants, blood pressure medications and anticonvulsants.
Recently, neurologists have been turning to botulinum toxin type A (Botox), best known for its power to smooth wrinkles by paralyzing muscles in the face. Also, researchers report that new drugs known as triptans can ease symptoms in more than 80 percent of patients.
There are also a wide variety of alternative treatments for migraine headaches, which often start with changes in vision known as an "aura." Other migraine symptoms include nausea or vomiting, lightheadedness, tender scalp, sensitivity to light, and confusion, among others.
As part of the ongoing American Migraine Prevalence and Prevention study, researchers sent surveys to 120,000 households. Nearly 78,000 returned them and provided information about 162,576 people, of whom 19,018 -- or 12 percent -- appeared to suffer from migraines.
Researchers analyzed the survey results, and they were to report their findings Thursday at the American Headache Society annual meeting in Philadelphia.
Judging by the findings, an estimated 7.7 million Americans with the worst headaches should definitely take preventive drugs, while another 3.8 million should consider doing so, researchers reported. The other 16.3 million can get by with treatment as the headaches occur, they said.
But only one in 20 migraine sufferers reported taking such medications.
"Migraine is still under-diagnosed and under-treated," Silverstein said. "This means more with days with migraine, more disability."
Part of the problem is that many people, perhaps half, don't realize they have migraine headaches, said Dr. Frederick J. de la Vega, a neurologist with Scripps Memorial Hospital La Jolla in San Diego. "People will say they have a sinus headache, but that's basically just a layman's description of the headache they have."
While sinus problems may exacerbate migraines, often the sinuses have nothing to do with headaches, he said. But patients still try to treat themselves with drugs like Sudafed, he said. Other over-the-counter drugs, including common painkillers, can contribute to rebound effects, making headaches more frequent, according to de la Vega.
In some cases, patients resist getting medical help for migraines, he said. "A lot of people will say, 'I don't need to see a doctor, I only have them once a year, or a couple times a month, or around menstruation.' They don't see the need to go to an actual doctor to look at it."
The truth is that doctors can help just about everyone with migraines, although some patients won't get full relief, he said.
De la Vega's advice? If you think you have a migraine, "go to a doctor, preferably a neurologist, and have the headache evaluated completely, not only to confirm diagnosis of possible migraine, but also to rule out the possibility that the headache is the symptom of another underlying disease."
With proper treatment, he said, pain can be eliminated or reduced.
More information
Learn more about migraine headaches from the American Academy of Family Physicians.
U.S. clears Nitromed heart drug for blacks
By Lisa Richwine
Reuters
Thursday, June 23, 2005
U.S. officials approved on Thursday the first medicine for patients of one specific race, a heart-failure treatment that sharply reduced deaths among blacks.
Nitromed Inc.'s BiDil cut deaths by 43 percent in a company study, but the company's strategy of marketing it just for one race has generated controversy.
A Nitromed trial of 1,050 people "clearly showed that blacks suffering from heart failure will now have an additional safe and effective option for treating their condition," Dr. Robert Temple, the Food and Drug Administration's associate director of medical policy, said in a statement..
"In the future, we hope to discover characteristics that identify people of any race who might be helped by BiDil," Temple added.
BiDil is the first drug to reach the market for Lexington, Massachusetts-based Nitromed.
The FDA's clearance of the drug specifically for blacks benefits Nitromed because the company holds patent rights for that use until 2020. The patent for BiDil for general use expires in 2007, a fact that has prompted criticism.
"This approval of BiDil isn't about personalizing medicine. It's about exploiting race to make money by extending patent protection," said Jonathan Kahn, a law professor and ethicist at Hamline University in Minnesota who has studied BiDil's development.
Kahn and other critics argued BiDil should be approved for all patients, regardless of race, because there is no biological reason blacks should react differently than others.
Nitromed officials insist their effort is based on solid science and will address a major public health problem. African-Americans are more likely than others to develop heart failure and to die early from the disease, studies have found.
"FDA approval of BiDil represents an important leap forward in addressing this health disparity," said Dr. Anne Taylor, a NitroMed consultant and lead researcher on the BiDil study.
Future research may identify a genetic variation in people of different races that indicates a good outcome from BiDil, company officials have said.
The drug is a combination of two generic medicines -- isosorbide dinitrate and hydralazine -- that dilate blood vessels. It was designed to treat congestive heart failure, a progressive weakening that impairs the heart's ability to pump.
About 750,000 African-Americans have been diagnosed with heart failure, NitroMed said. Half the people with heart failure die within five years of diagnosis.
Tests of BiDil in the 1980s did not show a benefit for patients overall, but researchers said blacks fared better than others.
Nitromed and the Association of Black Cardiologists then studied 1,050 advanced heart failure patients who identified themselves as black, and gave them standard drug therapy plus either BiDil or a placebo.
Deaths were so much lower in the BiDil group that researchers ended the study early so all patients could take BiDil. Fifty-four patients, or 10.2 percent, died in the placebo group, compared with 32 deaths, or 6.2 percent, in the BiDil group. Hospitalizations from heart failure also were reduced.
Even with an approval for blacks only, doctors could prescribe BiDil for anyone they thought it might help.
Triptan Nasal Spray Eased Migraines in Teens
By Janice Billingsley
HealthDay Reporter
HealthDay News
Thursday, June 23, 2005
THURSDAY, June 23 (HealthDay News) -- A prescription nasal spray approved for adults with migraines also helps teens, offering potential relief for this underserved population, a Florida researcher reports.
Teens who took zolmitriptan nasal spray (Zomig) for their headache pain were nearly three times more likely to find relief from pain within an hour compared to those given a placebo, said study author Paul Winner, a neurologist and director of the Palm Beach Headache Center.
This is important preliminary research, Winner said, because while there are seven FDA-approved drugs to treat migraines in adults, there are none for teens, who currently rely on often ineffective over-the-counter medications for pain relief.
"There is a lack of awareness that kids have headaches at all, let alone migraines -- this is a dramatically under-diagnosed and under-treated population," Winner said, "and we need to more research to find appropriate FDA-approved, specific treatment for migraines for this population."
Winner was to present the findings Thursday at the American Headache Society's annual meeting in Philadelphia. The study was funded by a grant from AstraZeneca, the maker of Zomig.
The neurologist said that perhaps because most teen migraines are shorter in duration than those of adults -- four to six hours compared to headaches that last several days -- there has been a tendency to dismiss the severity of headaches in those between the ages of 12 and 17.
Another reason for neglect of this group, he said, is that their headaches don't mean they're missing work but rather a half day of school or after-school activities -- "it's a product of what their responsibilities are."
Yet more than one in 10 U.S. teens, an estimated 8 million to 12 million adolescents, get migraines, most during the day, and the headaches can severely impair their lives, Winner said.
The double-blind study included 171 adolescents with migraines who had received no relief from placebo nasal spray. Half then received zolmitriptan nasal spray and half more of the placebo nasal spray.
After an hour, 28 percent of those who had taken the prescription medicine while suffering an attack were pain-free compared to only 10 percent of the placebo group. Further, 51 percent of the children who took zolmitriptan were able to resume their normal activities, while 38 percent of the placebo group were comfortable doing so. Two hours after taking the spray, the 39 percent of the zolmitriptan were pain-free compared to 19 percent of the placebo group.
The adolescents who received the zolmitriptan experienced no serious side effects, Winner added.
Based on the results of this study, Winner said he would be comfortable prescribing the adult medication to teens under certain conditions, including occasional use for those who report a headache once a week --"We do not want it used every day."
However, most doctors and patients are reluctant to use FDA-approved medications for conditions that have not been indicated by the agency's review process, called "off-label" prescribing, so Winner hopes his research will spur others to continue testing triptans for use in adolescents.
"This study is not the first of its kind," said Alan Carver, an assistant professor of neurology at Mount Sinai School of Medicine in New York City, adding that the American Academy of Neurology has issued guidelines on the use of triptans for teens.
Those guidelines, issued in December 2004, included reports of small studies showing that sumatriptan nasal spray (Imitrex) was effective in reducing pain in adolescents and recommended its use for acute migraines in teens.
Carver added, however, that the new research is extremely welcome to doctors who are treating children with migraines.
"What we want is to practice evidence-based medicine to provide some evidence for our conviction that teens with migraines can be given triptans when they are really suffering, just as we treat adults," he said.
More information
Go to The American Academy of Neurology to read guidelines for migraine medicine use among teens.
AMA to Seek Limits on Tanning, Video Games
By Lindsey Tanner
AP Medical Writer
The Associated Press
Thursday, June 23, 2005
The American Medical Association voted Wednesday to take on indoor tanning, violent video games and drinking in an effort to promote healthier lifestyles among the young.
The nation's largest physicians' group also adopted new policies to strengthen its campaign against childhood obesity, including urging doctors to include waist measurements in children's routine exams.
The AMA's newly elected president, Dr. J. Edward Hill, suggested in his inaugural remarks Tuesday that doctors use the campaign "as a springboard to improve the health of our nation's most precious commodity, our children."
The measures adopted by AMA member-delegates Wednesday, the final day of the annual meeting, included a push for a federal ban on minors using tanning salons and more appropriate labeling so only adults would be able to buy violent video games.
States and cities have tried restricting the sale of violent video games to minors, but federal courts have declared the efforts violations of free speech.
Delegates also voted Wednesday to approve resolutions asking the AMA to lobby for higher alcohol taxes and for taxes to be based on the amount of alcohol per beverage, rather, rather than volume.
Evidence suggests "that tax increases lead to lower alcohol consumption rates among adults and youth, fewer binge-drinking episodes, and lower traffic fatality rates," a committee told the meeting delegates.
Dr. Ronald Davis, an AMA trustee, said it makes sense for a 120-proof beverage to have a higher tax than a 20-proof beverage because the higher alcohol content makes it more risky.
Interest groups say the AMA's new stance is misguided.
The Distilled Spirits Council of the United States says liquor excise taxes are discriminatory and backfire because by reducing demand, they also reduce tax revenue generated.
The Indoor Tanning Association similarly opposes the AMA push for federal legislation to prohibit anyone under age 18 from using indoor tanning equipment, a move that stemmed from concerns about skin cancer.
Several states have parental consent laws for teen indoor tanning but none have successfully banned it outright, said Melissa Haynes of the Indoor Tanning Association. She said her group believes "decisions on whether or not a teen gets tan should be left up to their parents and not the government."
During its annual meeting this week, the AMA also pledged to encourage medical schools to include ethics training on medical treatment of prisoners of war, but stopped short of acknowledging that any abuse involving U.S. doctors occurred in Iraq and elsewhere.
Some doctors branded as slander a proposed measure suggesting that has happened.
On the Net:
NSAIDs Appear to Ease Tough-to-Treat Migraine
By Amanda Gardner
HealthDay Reporter
HealthDay News
Thursday, June 23, 2005
THURSDAY, June 23 (HealthDay News) -- Delivered intravenously in an emergency-care setting, nonsteroidal anti-inflammatory drugs (NSAIDs) may be at least as effective as narcotics in treating late-stage migraines, a new study suggests.
Even better, the researchers add, they are much safer and non-habit forming.
Thus, NSAIDs should be considered first-line therapy for migraine sufferers showing up in emergency rooms, say the researchers, who are to present their findings Thursday at the American Headache Society annual meeting in Philadelphia.
"Patients who go to the emergency room because they cannot get rid of a migraine any other way should request that they be treated with intravenous NSAIDs rather than intravenous opioids," said study author Rami Burstein, an associate professor at Harvard Medical School and vice chairman of research of the department of anesthesia and critical care at Beth Israel Deaconess Medical Center.
"Intravenous NSAIDs are as effective, if not more, and they are not habit-forming drugs," he explained.
Migraines are particularly debilitating headaches plaguing about 28 million Americans. Some 800,000 of these sufferers end up in the emergency room each year seeking relief from hard-to-treat symptoms.
Burstein said that, according to one 1998 survey, about 51 percent of migraine sufferers showing up at ERs are given opioid narcotics, "basically without even being offered any other possibility."
What happens next, Burstein added, is that patients all too often return to their doctors and ask for a prescription for this "miracle drug" that banished their migraine. "This is the beginning of them going on opioid therapy, and once a patient gets on opioids, they basically stop responding to any other drugs for pain," Burstein said.
For this study, Burstein treated 32 people who had developed allodynia, a hypersensitivity of the skin that affects about two-thirds of people with advanced migraine.
Previous studies had indicated that once allodynia occurs, triptans, which are drugs commonly used to treat migraines, no longer work. This is when people typically end up in the emergency room hooked up to an IV drip filled with opioids.
But in this case, NSAIDs were chosen because previous research had shown that inflammatory molecules play a role in chronic pain, including frequent migraines.
"These inflammatory molecules are found in the periphery [of the body] but also in the central nervous system," Burstein explained.
While NSAIDs in pill form can block inflammation in the periphery, they "don't make it to high enough concentrations to block production in the central nervous system," he said. Delivered intravenously, however, NSAIDs can reach that highly effective concentration.
In the study, half of the participants received the NSAID ketorolac (brand name Toradol) delivered intravenously beginning four hours after the start of a migraine attack. The other 16 participants received an injection of one of the triptans (in this case, sumatriptan) four hours after the migraine began, followed by ketorolac two hours later if their pain refused to subside.
After receiving ketorolac, 64 percent of patients were pain-free one hour after infusion, with skin sensitivity returning to normal.
On the other hand, 32 percent received no benefit at all from ketorolac, the researchers said. All of these individuals had a previous history of using opioids.
"This immediately raised a red flag regarding treating migraine patients with opioids, which we believe is wrong practice," Burstein said.
"Patients don't go every day to the emergency room," he added, but the finding "really is a proof of concept of a new direction that we should develop to address migraines in late stages after onset."
More information
For more on migraines and their treatments, visit the Migraine Awareness Group.
Western and Japanese diets up colon cancer risk
Reuters Health
Thursday, June 23, 2005
Both the meat-laden "Western" diet and the traditional, salty diet of the Japanese apparently increase the risk of colon cancer -- at least for women -- findings from a large study suggest.
Researchers in Japan found that among more than 42,000 adults followed for 10 years, women (but not men) with either a Western pattern of eating or a diet heavy in traditional Japanese foods like salted fish and pickled vegetables had a higher risk of colon cancer compared with women who were deemed healthy eaters.
For their study, the investigators defined three different dietary patterns based on survey respondents' reported eating habits. One was dubbed the Western dietary pattern, and was marked by high intakes of meat, poultry, cheese and bread and butter. A second category, the "traditional" dietary pattern, was built around rice, miso soup, salted fish and pickled vegetables.
The third dietary pattern was the "healthy" one, and it included high amounts of fruits, vegetables, soy products, beans and dairy.
Overall, women whose diets were the most Western had more than double the risk of developing colon cancer as women with the least Westernized diets. Similarly, women who ate the most traditional foods were twice as likely as those who ate the fewest to be diagnosed with colon cancer.
The healthy eating pattern was not linked to colon cancer risk at all.
Dr. Mi Kyung Kim and colleagues at the National Cancer Center in Tokyo report the findings in the July 10th issue of the International Journal of Cancer.
A number of studies have suggested that diets high in animal products and saturated fat may raise the risk of colon cancer. A large European study published last week found that people who regularly ate hefty servings of red or processed meat had an elevated risk of the disease, as did people who got little fiber in their diets.
In that study, fish consumption in general was tied to a lower risk of colon cancer.
In addition, heavy consumption of salted fish and vegetables, staples of the traditional Japanese diet in the current study, has been tied to higher colon cancer risk. The reasons are unclear, but research in lab animals has shown that substances in salt-preserved foods called nitrosamines may promote cancerous changes in cells, Kim's team points out.
Why the various diets in their study were linked to colon cancer only among women is uncertain. It's possible, the team suggests, that smoking and habitual drinking -- two habits associated with colon cancer -- weighed more heavily than diet in men's risk of the disease.
The American Cancer Society recommends that people exercise regularly and follow a diet rich in fruits, vegetables and whole grains as one way to lower the risk of colon cancer.
Source: International Journal of Cancer, July 10, 2005.
High STD Rates Seen in Young Drug Users
HealthDay News
Thursday, June 23, 2005
THURSDAY, June 23 (HealthDay News) -- Young drug users have high rates of the sexually transmitted diseases herpes simplex virus 2 and syphilis, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health and other institutions.
The study of 543 heroin, cocaine and crack users, aged 18 to 30, in Baltimore found no difference in infection rates between injection and noninjection drug users, but did find that young female drug users had much higher infection rates than young male drug users. Only a few of the infected people were aware of their condition.
The findings appear in the June issue of Sexually Transmitted Infections.
"We found a high rate of sexually transmitted infections among the injection and noninjection drug users we recruited, which indicates the extent of sexual risk behaviors among both of these populations. Noninjection heroin and/or crack users are rarely the target of sexual or drug risk reduction interventions. Sexually transmitted infection prevention and treatment programs need to target drug users," corresponding author Susan G. Sherman, an assistant professor in the epidemiology department at Bloomberg, said in a prepared statement.
"The sexual behavior of both injection drug users and noninjection drug users is an important public health issue. Intervention and outreach programs for young drug users should offer sexually transmitted infection testing and education, as well as promote safe-sex messages in order to decrease the further spread of all sexually transmitted infections," Sherman said.
More information
The American Medical Association has more about screening and prevention of sexually transmitted diseases.
FDA Panel Rejects Artificial Heart
By Lauran Neergaard
AP Medical Writer
The Associated Press
Thursday, June 23, 2005
Government scientists on Thursday narrowly rejected the first fully implantable artificial heart, saying they were unsure if a few extra months of life outweighed the serious side effects.
The AbioCor artificial heart has been tested in only 14 patients. Two died immediately. The rest survived only about five months. Many patients had severe strokes that compromised their final days.
But one patient lived 17 months until the mechanical heart wore out. His family and one other told advisers to the Food and Drug Administration that the heart provided priceless extra time.
Yet the advisers wanted more testing to figure out just which dying patients should be offered a chance to try the heart.
While the panel deadlocked on whether to recommend sale of the device, it voted 7-6 that the probable benefit did not outweigh the risks.
"I voted against (this) with some angst," said Dr. Clyde Yancey of the University of Texas Southwestern Medical Center.
"The device has a clear level of promise," said Dr. Judah Weinberger of Columbia University.
Some panelists, after four separate votes failed to clear the device, urged the device's maker, Abiomed Inc. of Danvers, Mass., to study it more carefully.
The FDA is not bound by its advisers' recommendations, but usually follows them.
"This one, I think, is a real dilemma," said the FDA's chief reviewer, Dr. Julie Swain. She asked if, for most patients, the AbioCor was really "prolonging life, not prolonging death."
The AbioCor is a novel device, the first attempt at a mechanical heart that has no wire sticking through the skin. The battery that powers the softball-sized device is recharged by an electrical charge through the skin.
The heart is intended for patients who are dying from heart failure, who are not candidates for a transplant and who are not expected to live more than another month.
Only a very small subset of the 5 million heart-failure sufferers meet those criteria, and Abiomed had sought permission to sell under a "humanitarian device exemption."
That is a special program designed for devices that might help fewer than 4,000 people a year who have no other treatment options. The program requires only evidence of "probable benefit" without unreasonable risk.
Panelists wrestled all day with that question. They noted that more than half of AbioCor recipients had strokes and that some then lived their last weeks in a hospital and had little brain function.
One adviser, Dr. John Somberg of Rush University, said there is an "agonizingly thin" line between the possibility of benefit and harm.
Added Dr. Robert Nelson of the University of Pennsylvania: "Who should be the judge of that is an important question."
Abiomed said the strokes were caused by a design flaw that has been changed and by still unclear understanding of which patients were the best candidates and how much blood-thinning medication they needed.
Two families said that patients were helped.
The second recipient, Tom Christerson, 71, lived for 17 months, long enough to meet his first great-grandchild and spend another Thanksgiving with his family. The Central City, Ky., man was the only recipient able to move back home.
"Frankly, coming from this daddy's girl, each and every moment was priceless," said his daughter, Patti Pryor.
The first recipient was Robert Tools, 59, who lived with the heart for five months. "I wanted to tell you how important it was for him to have that implant," said his wife, Carol Tools. She recalled that he got to go fishing a last time.
But every family was not satisfied.
The advisory panel was not told that the widow of one recipient settled a lawsuit that claimed her husband was not adequately warned of what life with the mechanical heart would be like, and soon regretted taking part in the experiment.
Abiomed's chief scientific officer, Robert Kung, pledged that if it were authorized to sell the heart, the company would allow implants at only 10 hospitals where surgeons would get special training. He said the company also would continue studying how the next 20 patients fare.
If approved, the implant is expected to cost about $250,000. It is unclear if insurance would cover it.
On the Net:
Food and Drug Administration: http://www.fda.gov/
Abiomed: http://www.abiomed.com/
Health Tip: Furthering Family Fitness
HealthDay News
Thursday, June 23, 2005
(HealthDayNews) -- Get your family off the couch and onto its feet with these ideas from the National Association for Sport and Physical Education:
Run or walk through a family treasure hunt. Walk to visit friends, or when you dine at a local restaurant. Plant a garden and give each family member their own section. Visit a "u-pick-it" vegetable and fruit farm. Enter a family fun run, walk, bike-a-thon or triathlon. Put on some music and dance. Try something new like wall climbing, dance, yoga, or hip-hop.
Health Tip: When Your Mouth's on Fire
HealthDay News
Thursday, June 23, 2005
(HealthDayNews) -- If you accidentally bite into a chili pepper, water won't quench the fire in your mouth, according to the University of California, Berkeley.
Chili contains capsaicin, which irritates the pain receptors in the mouth, nose and stomach. And water won't work to neutralize the pain.
Instead, cool down your mouth with yogurt, milk, or ice cream. It's believed that casein, which is contained in dairy products, strips the capsaicin from the pain receptors.
Wednesday, June 22, 2005
Yes, bigger brains mean higher IQ, on average
By Alison McCook
Reuters Health
Wednesday, June 22, 2005
People with bigger brains tend to score higher on standardized tests of intelligence, according to new study findings.
However, study author Dr. Michael A. McDaniel of the Virginia Commonwealth University in Richmond emphasized that these findings represent a general trend, and people with small heads should not automatically believe they are less intelligent.
For instance, Albert Einstein's brain was "not particularly large," McDaniel noted.
"There's some relationship (between brain size and intelligence) on average, but there's plenty of room for exceptions," he told Reuters Health.
Interest in the relationship between brain size and intelligence grew in the 1830s, when German anatomist Frederick Tiedmann wrote that he believed there was "an indisputable connection between the size of the brain and the mental energy displayed by the individual man."
Since that statement, scientists have conducted numerous studies to determine if Tiedmann's assertion was, in fact, correct. Most studies have investigated the link between head size and intelligence. More recently, however, researchers have published additional studies on intelligence and brain size, measured using MRI scans.
For his study, McDaniel analyzed more than 20 studies that investigated the relationship between brain size and intelligence in a total of 1530 people.
The studies showed that on average, people with larger brain volumes tended to be more intelligent. The relationship between brain size was stronger in women than men, and in adults than children, McDaniel notes in the journal Intelligence.
In an interview, McDaniel noted that he's not sure why the relationship was stronger for adults and women. Previous research has shown that women, on average, tend to have smaller brains than men, but score just as well - if not higher - in tests of intelligence, he said.
McDaniel insisted that the relationship between brain size and intelligence is not a "perfect" one. "One can certainly find lots of examples of smaller-brained people who are highly intelligent," he said. "But, on average, the relationship holds."
Source: Intelligence, online June 16, 2005.
Radiation Frequency Questioned for Male Breast Cancer
HealthDay News
Wednesday, June 22, 2005
WEDNESDAY, June 22 (HealthDay News) -- Though rare, breast cancer in men can be deadly.
And a new study shows that men with a breast malignancy that has not spread beyond the breast are nearly six times more likely to undergo radiotherapy than women with the equivalent stage of the disease, suggesting that some male breast cancer patients may be receiving unnecessary radiation treatments.
Researchers reporting in the June 22 issue of the Annals of Oncology believe doctors treating male breast cancer patients should follow the same guidelines they use for their female patients.
"If we do have presumptions about prognosis purely on the basis of sex, we would do better to ditch them and apply the same guidelines for radiotherapy treatment to men as we do for women," study author Dr. Graham Macdonald, a consultant in clinical oncology at Aberdeen Royal Infirmary in Scotland, said in a prepared statement. Macdonald was a fellow in radiation oncology in Vancouver, Canada, at the time of the study.
The researchers found that radiotherapy is common among male breast cancer patients who have undergone mastectomy. That's because the smaller male breast makes it difficult for surgeons to leave a clear margin of healthy tissue after they remove the tumor. Because of this, there's a belief that men are at an increased risk of tumor recurrence, compared with women.
However, this study of 60 male and more than 4,000 female breast cancer patients concluded that gender was not a factor in either tumor recurrence, breast cancer survival or overall survival.
About 1,700 American men are diagnosed with breast cancer each year, according to the American Cancer Society.
More information
The American Cancer Society has more about male breast cancer.
Survey: Most U.S. Doctors Believe in God
By Lindsey Tanner
AP Medical Writer
The Associated Press
Wednesday, June 22, 2005
A survey examining religion in medicine found that most U.S. doctors believe in God and an afterlife — a surprising degree of spirituality in a science-based field, researchers say.
In the survey of 1,044 doctors nationwide, 76 percent said they believe in God, 59 percent said they believe in some sort of afterlife, and 55 percent said their religious beliefs influence how they practice medicine.
"We were surprised to find that physicians were as religious as they apparently are," said Dr. Farr Curlin, a researcher at the University of Chicago's MacLean Center for Clinical Medical Ethics.
"There's certainly a deep-seated cultural idea that science and religion are at odds," and previous studies have suggested that fewer than half of scientists believe in God, Curlin said Wednesday.
A previous survey showed about 83 percent of the general population believes in God.
But while medicine is science-based, doctors differ from scientists who work primarily in a laboratory setting, and their direct contact with patients in life-and-death situations may explain the differing views, Curlin said.
The study is based on responses to questionnaires mailed in 2003. It is to appear in an upcoming issue of the Journal of General Internal Medicine and was released online to subscribers earlier this month.
Dr. J. Edward Hill, president of the American Medical Association, said religion and medicine are completely compatible, as long as doctors do not force their own beliefs on patients.
Belief in "a supreme being ... is vitally important to physicians' ability to take care of patients, particularly the end-of-life issues that we deal with so often," said Hill, a family physician from Tupelo, Miss.
Religions among physicians are more varied than among the general population, the survey found. While more than 80 percent of the U.S. population is Protestant or Catholic, 60 percent of doctors said they were from either group.
Compared with the general population, more doctors were Jewish — 14 percent vs. 2 percent; Hindu — 5 percent vs. less than 1 percent; and Muslim — almost 3 percent vs. less than 1 percent.
Antibiotics No Good for Pinkeye
By Amanda Gardner
HealthDay Reporter
HealthDay News
Wednesday, June 22, 2005
WEDNESDAY, June 22 (HealthDay News) -- The common childhood infection known as pinkeye does not respond to antibiotics, a new British study finds.
Instead, parents should simply let conjunctivitis clear up on its own, the researchers report in the June 21 online issue of The Lancet.
"Conjunctivitis is a mild and self-limiting condition and does not need specific treatment, therefore it is wrong to continue to medicalize it," said study author Dr. Peter Rose, a university lecturer in the department of primary health care at the University of Oxford.
The findings, however, are probably not enough to change current practice, according to American experts.
"I don't think we should change our treatment parameters quite yet, but this is food for thought and further study," said Dr. Craig McKeown, a pediatric ophthalmologist at Bascom Palmer Eye Institute of the University of Miami School of Medicine.
Dr. Eduardo Alfonso, director of the ocular microbiology lab at Bascom, took issue with some aspects of the study.
"I have a problem with the placebo they used in this study because it is an antiseptic. They both kill organisms," he said. In other words, the placebo may have had an effect on the infection.
Also, many times an antibiotic will resolve conjunctivitis in one or two days, rather than seven.
"I would rather have a kid get over the infection in two days," Alfonso said. And kids still need to be seen by a doctor in case they have another related and more serious infection in other parts of their body.
Pinkeye is a common condition affecting about 5 million schoolchildren in the United States, or one in eight children annually. It's characterized by an inflammation of the conjunctiva, the clear membrane covering the white part of the eye.
Conjunctivitis can be caused either by bacteria or viruses, but doctors often have trouble differentiating the causes. Many will prescribe antibiotic eye drops, despite a lack of evidence to support this practice. Antibiotics are ineffective against viruses.
Antibiotic overuse can have serious consequences for public health, however. Overprescribing contributes to the development of resistant bacteria, and many experts are trying to find ways to cut down on the unnecessary use of these drugs.
The idea of whether or not to use antibiotics for conjunctivitis, McKeown said, "has been long questioned because there are other forms of conjunctivitis. It's been sort of a shotgun approach with antibiotics."
This trial was designed to compare the effectiveness of chloramphenicol eye drops -- the most commonly used prescription antibiotic for conjunctivitis in the United Kingdom -- with a placebo in children who had pinkeye.
Chloramphenicol eye drops will soon be available over-the-counter in the United Kingdom; it will be the first antibiotic to be available without a prescription in that country.
According to Alfonso, chloramphenicol is banned in the United States. "We would never think of treating a child with chloramphenicol," he said.
In all, 326 British children aged 6 months to 12 years with a clinical diagnosis of conjunctivitis were randomly assigned to either the treatment or a placebo.
After seven days, the researchers found no significant difference in the cure rate, with 86 percent of the children in the antibiotic group cured vs. 83 percent in the placebo group.
Findings were similar among children known to have a bacterial form of conjunctivitis: The researchers report a cure rate of 85 percent in the antibiotic group and 80 percent in the placebo group.
In other words, children taking the drops cut about half a day off their infection. But that small gain, the authors argued, is not enough to balance the health-care costs involved, including 1 million visits to primary-care physicians each year in the United Kingdom.
Although the researchers suggested that parents initially treat children themselves without seeing a doctor, such a tactic may be difficult to implement among school-age children in the United States, one expert said.
"There are usually nurses based in the school, but we don't diagnose. We have to send anyone with a true pinkeye to a doctor," said Lucille Golembiewski, a supervising registered nurse at the Block Institute preschool in New York City. "They decide how to treat the child."
What's more, Golembiewski said, the school cannot accept the child back unless the infection has cleared.
In the United Kingdom, Rose explained, many child-care facilities and schools exclude children with conjunctivitis even though the national public health service advises against this.
"The exclusion policy results in loss of schooling for children and loss of work for parents who have to care for their children," Rose said. "There may need to be education of children and schools to change this exclusion policy, so that parents do not feel pressured to seek antibiotic treatment."
More information
The Nemours Foundation has more on pinkeye.
Cardiac arrest response slow for hospital visitors
By Anthony J. Brown, MD
Reuters Health
Wednesday, June 22, 2005
You might think that, if it's going to happen, the best time for your heart to stop might be while you're in a hospital, visiting. That isn't necessarily so, according to a new study.
"As a public citizen, you're better off suffering a cardiac arrest in a casino or airport terminal than in a hospital lobby," Dr. Bruce D. Adams, from Brooke Army Medical Center in San Antonio, Texas, told Reuters Health. "The time to defibrillation in hospital lobbies appears to be much worse than what has been reported for casinos and airports."
This finding is concerning, given the critical role that timely defibrillation plays in survival.
In the study, in the American Journal of Cardiology, Adams and colleagues looked into 749 instances of cardiac arrest or respiratory arrest at one hospital over a 2-year period. Six of the arrests involved visitors, while the remainder involved patients.
It took 2.5 minutes for hospital patients to receive defibrillation, but 12.3 minutes elapsed before visitors in public areas of the hospital received defibrillation.
Resuscitation efforts were successful in 72 percent of the patients, but of the 4 visitors who had a cardiac arrest, only 1 (25 percent) survived.
Adams said the delay in defibrillation for hospital visitors "may stem from cardiac arrest teams not being used to codes called in public areas of the hospital."
He said that he's now "putting together a study to see if placement of automated external defibrillators can improve response times in public areas of the hospital, as it has in casinos and airport terminals."
Source: American Journal of Cardiology, June 1, 2005.
Death Risk Higher Month After Heart Attack
By Alicia Chang
AP Science Writer
The Associated Press
Wednesday, June 22, 2005
People are most at risk of dropping dead in the first month after a heart attack, a new study finds, but the most effective treatment to prevent this isn't done that early on because it, too, is considered riskiest then.
The new research should prompt doctors to rethink how patients are treated in those crucial early days. The rate of sudden death was 10 times higher in the first month after a heart attack compared to two years later, researchers report in Thursday's New England Journal of Medicine.
"We need to consider therapies and strategies ... that could protect patients during this early vulnerable period following a heart attack," said Dr. Scott Solomon, a cardiologist at Brigham and Women's Hospital in Boston, who led the study.
Most heart attacks are caused by blockages that deprive the pumping muscle of blood and oxygen. Treatments can clear these and restore blood flow, but damage from the heart attack can lead to abnormal rhythms that can stop the heart without warning.
The problem is becoming more common as heart attack treatment improves. Sudden death now accounts for 2 out of 3 heart deaths in the United States, about 450,000 cases each year.
Studies have shown that implanted defibrillators — like the one Vice President Dick Cheney has — can help prevent sudden death by shocking the heart back into a normal rhythm. But those studies were done in patients several years after a heart attack.
Last year, a study in the same journal reported that putting the pager-size devices in people just weeks after a heart attack does not improve survival, and guidelines by the American College of Cardiology and American Heart Association recommend that doctors wait one to three months before implanting the device.
The new study shows the dilemma that creates.
"This study shows that patients right after a heart attack perhaps have the highest risk of sudden cardiac death and those patients are deprived of getting a defibrillator. It's an area that we need to study more closely," said heart association spokesman Dr. Kenneth Ellenbogen, a professor at Medical College of Virginia who was not connected with the study.
Researchers studied 14,609 post-heart attack patients enrolled in a drug trial who suffered a muscle-damaging heart attack or heart failure between 1998 and 2001. Seven percent either died suddenly or were revived after cardiac arrest.
Researchers found 19 percent of all sudden deaths or cardiac arrests happened within a month of a heart attack. The rate of sudden death or cardiac arrest was highest in the first month after a heart attack — 1.4 percent compared to 0.14 after two years.
The study was funded by Novartis Pharmaceuticals, which makes several cholesterol and blood pressure-lowering drugs.
"The solution may be identifying the highest risk patients and employing short-term therapies that are not invasive," said Dr. Alfred Buxton, a cardiologist at Brown Medical School, who had no role in the study.
Recent heart attack victims at high risk of sudden death might consider alternatives such as a vest defibrillator or automated external defibrillator similar to those found in airports and other public venues to restart a stopped heart, Buxton wrote in an accompanying editorial.
The National Heart, Lung and Blood Institute is currently funding a study that looks at the effectiveness of automated external defibrillators on recent heart attack patients.
On the Net:
New England Journal: http://www.nejm.org
Brigham and Women's Hospital: http://www.brighamandwomens.org
Steel workers at risk for kidney stones
Reuters Health
Wednesday, June 22, 2005
Men who work in the steel industry and are exposed to high temperatures are prone to develop kidney or urinary stones, according to a report from researchers in Brazil.
Dr. Cassio Andreoni, and colleagues at the Federal University of Sao Paulo, analyzed the medical records of 10,326 men working in the steel industry.
The subjects were divided into two groups -- the 1289 who worked in areas with temperatures greater than 45 degrees C, and 9037 who worked at normal temperatures.
Overall, 181 men (2 percent) had at least one episode of urinary stones, the investigators report in the medical journal Urology. Of these, 103 worked hot areas (representing 8 percent of that group) and 78 were in the room-temperature group (0.9 percent).
The investigators then looked more closely at the body chemistry of 59 workers -- 34 hot-area workers and 25 normal-temperature workers.
The team found that low levels of citrate in urine occurred more often in men in the hot-area group than those in the room-temperature group (56 percent versus 28 percent). Men in the hot-area group were also twice as likely to have low urine volumes. Both these conditions are involved in stone formation.
To minimize the risk of kidney stones for people who work in a high-temperature environment, "it is important to encourage the workers to increase their ingestion of liquids during the period of heat exposure," Andreoni's team advises.
They also say that, to offset low citrate levels, "the use of diluted potassium citrate in the water the workers drink could be recommended; lemonade could represent another source of citrate."
Source: Urology, May 2005.
New Drug Shows Promise in Type 1 Diabetes
By Alicia Chang
AP Science Writer
The Associated Press
Wednesday, June 22, 2005
A novel experimental treatment showed promise in a small study for helping certain diabetics retain some ability to make insulin, potentially lessening their need for shots of the hormone to regulate blood sugar levels.
But the experiment raised safety concerns: Most who got the treatment had side effects that researchers said were temporary, but that theoretically might increase their risk of a blood disorder later on.
Nevertheless, the Juvenile Diabetes Research Foundation, which funded the work, considered the results encouraging enough to plan future large-scale studies, which would be needed before the experimental drug might be available.
"The results are very promising. There are not many instances where you can stop an autoimmune disease in its tracks," said Dr. Richard Insel, the foundation's executive vice president for research.
Results were published in Thursday's New England Journal of Medicine.
More than 18 million people in the United State have diabetes. The vast majority have Type 2, which is linked to obesity and occurs when the body can't effectively use the insulin it makes.
The new study involved the other 5 percent to 10 percent of diabetics who have Type 1, which occurs when the body's immune system attacks and destroys insulin-producing cells in the pancreas. They must get insulin through shots or a pump.
Researchers led by Dr. Lucienne Chatenoud of Necker Hospital in Paris tested the novel approach on 80 newly diagnosed diabetics who still had some insulin function left. The patients were given an experimental drug called anti-CD3 antibody to prevent the immune system attack.
Half of the patients received it and the other half got a dummy drug for a week after they were diagnosed as diabetics. Both groups also got at least three insulin shots a day to control blood sugar.
After 1 1/2 years, the placebo group lost an average one-third of its insulin production ability and needed 50 percent more insulin in shots to regulate blood sugar. The group that got the drug, on the other hand, lowered insulin dependence by 12 percent and increased insulin-making capability. The drug worked best in patients who still had about half of their insulin function remaining.
However, nearly all the people who took the drug had symptoms of mononucleosis, a white-blood-cell disorder caused by a virus, and flulike symptoms including fever and headache.
Researchers said the side effects were minor and short-lived. But Dr. Ake Lernmark, a professor of medicine at the University of Washington, Seattle, wrote in an accompanying editorial that more research is needed to address the drug's safety.
Lernmark, who had no role in the study, also noted that the drug's benefits might be limited in patients who already have greater insulin function than typical Type 1 patients. Most Type 1 diabetics are diagnosed when they have already lost 90 percent of their insulin-making ability.
The federal government is currently supporting two studies of the drug in Type 1 patients, said Dr. Judith Fradkin of the National Institute of Diabetes and Digestive and Kidney Diseases.
Several of the researchers in the study reported getting consulting fees and holding stocks options from TolerRx, Inc., a Cambridge, Mass., firm that developed the drug.
On the Net:
New England Journal: http://www.nejm.org
Juvenile Diabetes Research Foundation: http://www.jdrf.org
Body fat pattern abnormal in recovered anorexics
By Megan Rauscher
Reuters Health
Wednesday, June 22, 2005
Women suffering from anorexia but who successfully normalize their weight tend to deposit the added pounds around the abdomen, at least in the short term, a study shows.
Dr. Laurel Mayer from Columbia University in New York who led the study told Reuters Health that "the mechanism underlying this maldistribution of fat, the psychological effects of this truncally focused fat, and whether it is a temporary or permanent phenomenon are as yet unknown."
Mayer and her colleagues used a variety of measures to assess the distribution of body fat before and immediately after weight recovery in 29 women with anorexia.
"The important observations from the study are that when patients with anorexia nervosa normalize their weight, their body composition improves on all measures. That is, contrary to their fears, they don't gain only fat, but they gain fat-free mass (i.e., muscle, water) as well," Mayer commented.
However, there is "disproportionate central adipose tissue deposition with weight recovery," she and her associates report in the American Journal of Clinical Nutrition.
The disproportionate amount of abdominal fat might be an initial effect of weight gain that "redistributes with long-term maintenance of normal weight," the team suggests, in which case "supportive therapy might suffice to help the patient tolerate the body distortions until redistribution."
On the other hands, if the changes are more permanent, "a more targeted, cognitive approach might be necessary to promote self-acceptance," they note.
Source: American Journal of Clinical Nutrition, June 2005.
Post-Surgery Chemo Raises Lung Cancer Survival
By Serena Gordon
HealthDay Reporter
HealthDay News
Wednesday, June 22, 2005
WEDNESDAY, June 22 (HealthDay News) -- In one of the first real advances in lung cancer treatment in years, researchers report that chemotherapy after surgery to remove early-stage lung cancer can boost patient survival.
The study found the combination of two drugs, vinorelbine and cisplatin, initiated soon after surgery to remove non-small-cell lung cancer tumors, increased five-year survival rates by 15 percent and overall survival rates by 31 percent.
The findings were first presented at the American Society of Clinical Oncology's annual meeting last year, and have quickly become the standard of care for people with early-stage lung cancer. The full study now appears in the June 23 issue of the New England Journal of Medicine.
"Surgery is not the primary and only care any longer," explained study author Dr. Timothy Winton, an associate professor of surgery and division director of thoracic surgery at the University of Alberta in Edmonton, Canada. "A short course of chemotherapy led to significant improvements in survival and recurrence-free survival. This is extremely good news for lung cancer patients and is a major advance," he added.
Lung cancer is the leading cancer killer, causing more deaths than breast, prostate and colon cancer combined, according to the American Lung Association. More than 160,000 Americans will die of lung cancer this year, and 172,000 will be diagnosed with the disease.
In the past, the only treatment option for early-stage non-small-cell lung cancer -- the most common form of lung malignancy -- was surgical removal of the tumor. According to an accompanying editorial in the same issue of the journal, five-year survival rates after surgery alone range between 23 percent and 67 percent.
The problem with surgery alone is that it can leave traces of malignancy behind. Those hidden cancer cells can then travel and grow in other sites, such as the brain, where they become even more deadly.
Past studies on post-surgery chemotherapy had shown little or no benefit, or the benefit was so small that it didn't outweigh the risks of chemotherapy. But, according to editorial author Dr. Katherine Pisters, of the University of Texas M.D. Anderson Cancer Center in Houston, many of those studies were small and were done with older, less active drugs. Also, she said, diagnostic imaging wasn't as precise as it is today, so many cases in those older studies may not have been properly staged.
To try to correct for those limitations, Winton and his colleagues focused on people diagnosed with early Stage IB or Stage II lung cancer. They also began the chemotherapy regimen within six weeks of surgical tumor removal.
"We wanted to have a significant impact on microscopic, undetectable disease," Winton said.
The study included 482 patients. A total of 242 underwent four cycles of chemotherapy with vinorelbine and cisplatin over a 16-week period, while the remaining 240 patients had no additional treatment after the surgery.
The chemotherapy combination was generally well-tolerated, according to Winton, though two deaths were associated with the medications. The most common side effect, experienced by 88 percent of the treated group -- was neutropenia. Neutropenia is a decrease in the number of neutrophils, a type of white blood cell that helps fight infection. Other side effects included fatigue, nausea, vomiting and constipation.
Overall survival was increased 31 percent for the treated group, the researches report. Those treated lived an average of 94 months vs. 73 months for the surgery-alone group. No one in the surgery-alone group achieved relapse-free survival, while those in the treated group averaged nearly 47 months without a relapse.
Five-year survival rates were also up for those who received chemotherapy: 69 percent compared to 54 percent for the surgery alone group, according to the study.
"Up until now, chemotherapy after surgery was controversial," said Pisters, who noted that several additional studies have since confirmed this study's results. "This is the most encouraging news in lung cancer treatment in a long time."
This encouraging news comes on the heels of last week's disappointing news about the targeted lung cancer drug Iressa. That medication initially looked promising but, according to the FDA, it produced a response in just one in 10 patients. That suggests Iressa may only be effective for a select group of patients with a specific genetic mutation.
Winton said the vinorelbine/cisplatin combination doesn't appear to be that selective and should benefit a wide range of patients. However, he did add that researchers are creating a "biologic tumor bank" to determine whether patients with certain genetic markers benefit more or less from the treatment.
The bottom line, however, is that "we've never had anything in the lung cancer setting with this much benefit," said Pisters. "If you have surgery for lung cancer, you need to find out if you're a candidate for chemotherapy." She recommended that these patients discuss the findings with their physician.
More information
To learn more about lung cancer, visit LungCancer.org.
Cancer fear high among women having hysterectomy
By Amy Norton
Reuters Health
Wednesday, June 22, 2005
Many women who have their uterus removed for benign conditions may mistakenly believe that, unless they have the surgery, they're likely to develop cancer, a new study suggests.
Researchers found that among more than 1,100 women who underwent hysterectomy for non-cancerous conditions, 29 percent said they had "a lot" of fear that they would develop cancer, without the surgery. The large majority, 80 percent, reported at least "a little" fear.
This was despite the fact that the conditions the women had -- mostly fibroids, menstrual disorders or uterine prolapse -- did not put them at high risk of uterine cancer or other gynecologic cancers.>
The level of cancer anxiety in the study was surprising, according to lead study author Dr. Lisa Gallicchio of the Johns Hopkins University School of Public Health in Baltimore.
Given the benign nature of the women's conditions, she told Reuters Health, cancer fear should not have played a role in their decision to undergo hysterectomy -- which is only one of several treatment options for the conditions the patients had.
But the study, published in the journal Psychosomatic Medicine, did not look at whether concern about cancer was in fact a factor in the decision-making process.
"You could certainly suggest, due to the high levels of fear reported by some women in the study, that fear of cancer may have played a role in the decision to have a hysterectomy," Gallicchio said.
Exactly why many women overestimated their cancer risk is unknown, but a lack of clear communication from their doctors is a possibility, according to Gallicchio.
For example, about 60 percent of the 1,142 study participants had uterine fibroids, benign growths in the uterus that rarely become cancerous. In medical language, however, fibroids are often called "tumors." If a doctor uses that word, the study authors note in the report, a woman could mistakenly believe she has cancer or is at high risk of it.
"Physicians should make sure that women undergoing hysterectomy for benign conditions understand that they are not at higher risk of developing cancer if they do not undergo a hysterectomy," Gallicchio said.
She and her colleagues also found that certain hysterectomy patients -- including younger women, black women and those who had less education or low incomes -- had higher levels of cancer anxiety.
Women who are young or less educated, Gallicchio noted, may have relatively less understanding of their medical condition or its treatment options. It will be important, she said, to improve communication between women and their doctors so that patients can make a truly informed decision about treatment.
Source: Psychosomatic Medicine, June 2005.
Public Hospitals Provide Good Diabetes Care
HealthDay News
Wednesday, June 22, 2005
WEDNESDAY, June 22 (HealthDay News) -- Public hospitals in the United States do a good job of managing the care of diabetes patients, but there are still disparities in care for minority and uninsured patients, according to the results of a study of seven public hospital systems from across the nation.
The study found that even though public hospitals provide care to a very large volume of underserved patients, they are able to maintain quality care for diabetes patients. In fact, the seven public hospital systems included in the study had patient outcomes comparable to -- and in some cases, better than -- the national average for diabetes care.
Two-thirds of diabetes patients at these seven public hospitals maintained moderate control of their diabetes. Patients at these hospitals also had cholesterol levels that were similar to or better than those of patients in national surveys, the researchers found.
However, the study did find that Hispanic and black diabetes patients at public centers were less likely than white diabetics to have their disease under good control. It also found that uninsured diabetes patients received less care compared to their insured peers.
American Diabetes Association-related education programs and hospital pharmacy clinics were linked to better outcomes among diabetes patients at these hospitals, the study said.
The survey was conducted by the Consortium for Quality Improvement in Safety Net Hospitals and Health Systems. The study, convened by the National Public Health and Hospital Institute with support from The Commonwealth Fund, was released Wednesday.
"These findings show that public hospitals have established effective programs for patients with diabetes. While there is room for improvement, public hospital systems can effectively manage long-term chronic conditions," study author Marsha Regenstein, director of the National Public Health and Hospital Institute, said in a prepared statement.
More information
The National Diabetes Education Program outlines steps to control diabetes for life.
Caffeine's blood pressure effect persists in some
By Amy Norton
Reuters Health
Wednesday, June 22, 2005
Though some coffee drinkers develop a tolerance for caffeine, those who don't may be sending up their blood pressure with each cup, new research suggests.
In a study of regular caffeine consumers, researchers found that many persistently showed small blood pressure spikes shortly after a large dose of caffeine -- even when that dose came after several days of high caffeine intake.
The findings, according to the study authors, add to evidence that many people who regularly down caffeinated beverages do not develop a tolerance to caffeine's effects. If such a "low tolerance" person also has high blood pressure, it may be best to pass on that second cup of coffee, they say.
"My advice would be for individuals who have high blood pressure -- and particularly if their blood pressure is not easily controlled with medication -- to limit their caffeine intake," Dr. Noha H. Farag, a researcher at the VA Medical Center and University of Oklahoma Health Sciences Center in Oklahoma City, told Reuters Health.
He and his colleagues report the findings in the American Journal of Hypertension.
The role of caffeine in high blood pressure is not entirely clear. A key reason is that while lab experiments have found caffeine to trigger a short-term rise in blood pressure, studies of the general population have often failed to link caffeine intake with the risk of high blood pressure.
One explanation that has been given for this discrepancy is that in real life, people who regularly consume caffeine develop a tolerance for the stimulant and eventually fail to have a blood pressure response to their morning coffee.
However, Farag noted, a number of studies have suggested that while some people may indeed build up a tolerance to caffeine, others continue to have a blood pressure rise after their daily shot of java.
The current study is a continuation of an earlier lab experiment in which Farag's colleagues found that about half of regular caffeine consumers showed a small blood pressure spike after ingesting caffeine -- even after spending several days downing the equivalent of six cups of coffee per day.
In this latest study, the researchers used portable blood pressure monitors to follow blood pressure changes throughout the day in the same group of people. Such "ambulatory" blood pressure measurements, Farag noted, give a better idea of the effect caffeine may have in everyday life.
The study was conducted over 4 weeks. For one week, participants took placebo capsules, which contained no caffeine, for 5 days; on the sixth day, they were given a large dose of caffeine -- equivalent to about seven cups of coffee -- and had their blood pressure monitored for 24 hours. On other weeks, they consumed a moderate or high amount of caffeine for 5 days before having their large caffeine dose on test day.
Based on the previous study, the men and women were divided into "low" and "high" tolerance groups.
Farag's team found that participants with a high caffeine tolerance showed a blood pressure spike only during the week in which they consumed no caffeine for 5 days then had a big dose on test day.
In contrast, the low tolerance group still showed blood pressure elevations during the weeks in which they had caffeine for several days before testing -- indicating that they had not built up a tolerance to the stimulant's blood pressure effects.
For healthy people with normal blood pressure, the impact of caffeine may not pose a health risk, according to Farag. But for those with high blood pressure or risk factors for it, he said, caffeine intake could be a "significant factor" -- and stress could compound the blood pressure effect.
There is no easy way for people to tell whether they have high or low caffeine tolerance; systematic monitoring of a person's blood pressure response to various caffeine doses is the only route, according to Farag.
Given that, he advised that people with high blood pressure moderate their caffeine intake -- along with getting regular exercise and eating a healthful diet.
Source: American Journal of Hypertension, May 2005.
Way to Predict Stroke after 'Mini-Stroke' Found
By Steven Reinberg
HealthDay Reporter
HealthDay News
Wednesday, June 22, 2005
WEDNESDAY, June 22 (HealthDay News) -- A mini-stroke can signal the impending possibility of a full-blown stroke, but many are missed or not taken seriously by doctors and patients alike.
Now there is a simple risk score that doctors can use to predict whether a patient is likely to have a stroke in the week following a mini-stroke, or transient ischemic attack (TIA), British researchers report in the June 21 online issue of The Lancet.
A TIA occurs when a blood clot blocks an artery in the brain for a short time. The symptoms of a TIA are similar to the warning signs of a stroke, but they usually last only a few minutes.
According to the American Stroke Association, signs of a TIA can include all or some of the following: sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion; trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and sudden severe headache with no known cause.
"We looked at the characteristics of the event in patients who had a TIA, and predicted the risk of a major stroke within the next seven days," said study author Dr. Peter Rothwell, a professor of clinical neurology at the University of Oxford.
By studying 200 patients who had a TIA, Rothwell and his colleagues developed the simple score, which is based on age, blood pressure, clinical features and duration of symptoms.
The researchers tested the risk score in two separate groups of similar patients, and found they could predict the risk of stroke during the first seven days after TIA.
"People with a low score had no early recurrent stroke," Rothwell said. "People with the highest score had a risk of about 30 percent." The score is not a perfect predictor of stroke, but it can steer doctors to those patients whose risk for stroke is very high.
The main predictors of an early stroke are speech disturbance and weakness in one side of the body that lasts more than 10 minutes, Rothwell said.
Rothwell believes doctors can use the score to identify patients at a very high risk of having a stroke within a few days. "It can also be used to focus public education about TIA," he said.
One expert thinks the study is valuable. "I like this paper because it emphasizes how high the risk really is for a stroke after a TIA," said Dr. Lawrence M. Brass, a professor of neurology and epidemiology and public health at the Yale University School of Medicine.
In addition, using their simple score is a way to really identify the patients who are at high risk for a stroke after having had a TIA. "As much as I'd like everybody to be seen by a specialist within 12 hours of having their spell, it's not often practical," Brass said. "For me, this result is going to make me figure out the people who had better be seen tomorrow."
Brass believes TIAs should never be taken lightly. "TIAs are a really bad disease," he said. "Often patients will ignore them. These results, which show the very high risk of early recurrence, should prompt patients to get into the emergency room when they have these spells, even if they have gotten better, because the risk of having a stroke can be very high."
Moreover, "TIAs represent a window of opportunity for us to intervene to prevent a stroke," Brass said. "No TIA should be ignored, but there are some that require special urgency, with more aggressive therapy."
Brass also said that patients should ask their doctor about their risk of having a stroke, and what they and their doctor can do to reduce that risk. "The more patients become active partners in preventing stroke, the better it is for both the patient and the physician."
More information
The American Stroke Association can tell you more about stroke.
US docs' group wants package fixes for herbal meds
By M. Mary Conroy
Reuters Health
Wednesday, June 22, 2005
The American Medical Association says packaging of some herbal remedies is confusing and gives the impression that the supplements are pharmaceutical products. The group wants it stopped.
On Tuesday the AMA approved a resolution urging that supplement manufacturers be required to clearly name and label products in a way that would clearly differentiate the products from pharmaceuticals. For example, the AMA is suggesting that the word "herbal" be included in product names.
"This resolution addresses the potential for consumers to confuse dietary supplements that are marketed as herbal remedies with over-the-counter drugs," said Dr. Daniel van Heeckeren, a thoracic surgeon with University Hospitals, Cleveland, Ohio, and chair of an AMA reference committee that heard testimony on herbal packaging.
The herbal packaging policy, approved Tuesday by the AMA House of Delegates, directs AMA leadership to urge Congress to modify the Dietary Supplement Health and Education Act to require those promoting herbal remedies to prove their efficacy and safety and to force the herbal remedies to list product ingredients on packages.
Keyhole Surgery Works with Colon Cancer
HealthDay News
Wednesday, June 22, 2005
WEDNESDAY, June 22 (HealthDay News) -- Keyhole, or laparoscopic, surgery is a safe option for the removal of tumors from the colon, claims a study published online Tuesday by The Lancet Oncology.
The study included more than 1,200 colon cancer patients from 29 hospitals in seven European countries. Half the patients had keyhole surgery, and half had traditional open surgery.
While keyhole surgery took longer to perform than open surgery, patients who had keyhole surgery had less blood loss during surgery, earlier recovery of bowel function, required fewer painkillers and had shorter hospital stays than patients who had open surgery.
Death and illness rates in the two groups of patients were the same.
There's been extensive debate over the safety and short-term benefits of keyhole surgery. While this form of minimally invasive surgery reduces surgical trauma for colon cancer patients, there is some concern that keyhole surgery could lead to tumor recurrence.
"Laparoscopic [keyhole] surgery can be used for safe and radical resection of cancer in the right, left and sigmoid colon," study author Jaap Bonjer, of Dalhousie University in Halifax, Canada, said in a prepared statement. "Further studies of the current surgical approaches for colon cancer are warranted to establish the optimum procedure for the individual patient with colon cancer."
More information
The U.S. National Cancer Institute has more about colon cancer treatment.
Tuesday, June 21, 2005
Plant chemical may harm male fertility – study
By Patricia Reaney
Reuters
Tuesday, June 21, 2005
A plant chemical found in soya, tofu and legumes could potentially damage sperm and affect male fertility, a British researcher said on Wednesday.
Professor Lynn Fraser, of King's College London has shown that genistein, which can mimic the effect of the female hormone estrogen, affects sperm in mice.
But it seems to have an even stronger impact on human sperm.
In laboratory tests, Fraser found that small amounts of the chemical can cause human sperm to "burn out" and lose fertility.
"Human sperm proved to be even more responsive than mouse sperm to genistein," Fraser told a fertility meeting.
She added that if women eat soya and other foods high in genistein it might have a bigger impact on male fertility because the chemical is likely to affect sperm when it is in the female preparing to fertilize an egg.
"Maternal exposure to the compounds is probably more important than paternal exposure," Fraser explained.
Although it is very preliminary research, Fraser speculated that the findings could have an impact on women trying to conceive.
"On the basis of what we have seen, it might be a practical thing to do if you are in the habit of eating lots of soya-based products to restrict your diet for a short time over the window of ovulation," she told the European Society of Human Reproduction and Embryology meeting.
Professor Richard Sharpe, of Edinburgh University in Scotland, described the research as interesting and said the results were surprising.
"It could of course have human health/fertility implications as indicated by the authors," he said in a statement.
But Sharpe added that oriental societies that traditionally eat a soya-rich diet show no signs of reduced fertility that he is aware of.
The effects on sperm in the laboratory may also not be directly related to what may happens in real life.
Dr Allan Pacey, of the University of Sheffield in England, said it is worrying if these compounds affect mature sperm.
"It's early days, but clearly if what happens in the laboratory also occurs in the woman's fallopian tube as the sperm make their way to the egg, then there would be the potential for fertilization to fail," he explained.
Duke: Hydraulic Fluid Wash Doesn't Infect
The Associated Press
Tuesday, June 21, 2005
Duke University has told thousands of patients whose surgical instruments were mistakenly washed in hydraulic fluid before being sterilized that there's no risk of getting infections as a result.
The university hospital system did not address patients' fears that the mistake led to an increased risk of autoimmune or other noninfectious disorders.
In a letter sent this week to nearly 4,000 patients, the university cited a risk study done by an outside researcher it hired.
"We regret when any patient suffers," Duke said, adding that there is "always some risk of an undesirable outcome in any procedure."
For two months late last year, surgeons at Duke Health Raleigh Hospital and Durham Regional Hospital unknowingly used instruments that had been washed with hydraulic fluid instead of soap.
The error happened after elevator workers drained hydraulic fluid into empty soap containers without changing the labels.
Among the 4,000 patients was Shelley Bassett, who underwent a lumpectomy at the Raleigh hospital. Her husband, Kelley, said his wife soon developed gastrointestinal symptoms and lost 38 pounds.
"She was exposed to used hydraulic oil with cancer-causing agents and poisonous materials," he said, adding that infection was not a top concern.
The federal Centers for Medicare and Medicaid Services in a report earlier this year said the hospitals had put patients in "immediate jeopardy" by not detecting the problem, despite complaints from medical staff about slick tools.
Duke said its tests were conducted by scientists led by William Rutala, director of the Statewide Program in Infection Control and Epidemiology at the University of North Carolina School of Medicine.
"We found that replacing cleaning detergent with hydraulic fluid did not alter the effectiveness of the sterilization process as high numbers of clinically relevant bacteria and standard test spores ... were completely inactivated," the letter quoted Rutala as concluding.
Common virus kills cancer, study finds
Reuters
Tuesday, June 21, 2005
A common virus that is harmless to people can destroy cancerous cells in the body and might be developed into a new cancer therapy, U.S. researchers said on Tuesday.
The virus, called adeno-associated virus type 2, or AAV-2, infects an estimated 80 percent of the population.
"Our results suggest that adeno-associated virus type 2, which infects the majority of the population but has no known ill effects, kills multiple types of cancer cells yet has no effect on healthy cells," said Craig Meyers, a professor of microbiology and immunology at the Penn State College of Medicine in Pennsylvania.
"We believe that AAV-2 recognizes that the cancer cells are abnormal and destroys them. This suggests that AAV-2 has great potential to be developed as an anti-cancer agent," Meyers said in a statement.
He said at a meeting of the American Society for Virology that studies have shown women infected with AAV-2 who are also infected with a cancer-causing wart virus called HPV develop cervical cancer less frequently than uninfected women do.
AAV-2 is a small virus that cannot replicate itself without the help of another virus. But with the help of a second virus it kills cells.
For their study, Meyers and colleagues first infected a batch of human cells with HPV, some strains of which cause cervical cancer.
They then infected these cells and normal cells with AAV-2.
After six days, all the HPV-infected cells died.
The same thing happened with cervical, breast, prostate and squamous cell tumor cells.
All are cancers of the epithelial cells, which include skin cells and other cells that line the insides and outsides of organs.
"One of the most compelling findings is that AAV-2 appears to have no pathologic effects on healthy cells," Meyers said.
"So many cancer therapies are as poisonous to healthy cells as they are to cancer cells. A therapy that is able to distinguish between healthy and cancer cells could be less difficult to endure for those with cancer."
AAV-2 is being studied intensively as a gene therapy vector -- a virus modified to carry disease-correcting genes into the body. Gene therapy researchers favor it because it does not seem to cause disease or immune system reaction on its own.
Children Need an Hour of Exercise Per Day
By Daniel Yee
Associated Press Writer
The Associated Press
Tuesday, June 21, 2005
Children should get an hour of exercise over the course of each day, a panel of national obesity experts has concluded, seeking to end confusion on the matter.
"Physical activity is essential for health. This just puts a number on the amount of physical activity children should receive or shoot for," said Dr. William Dietz, director of nutrition and physical activity for the Centers for Disease Control and Prevention, which funded the panel. The recommendation was made earlier this month.
The committee was created to cut through conflicting advice on children's exercise — 27 different groups have their own recommendations.
"People get confused about what they should do," Dietz said. Federal health officials hopes the different organizations will adopt the panel's advice so parents will get a unified message from the health community.
The panel reviewed more than 850 existing studies on child physical activity and found that most recommended 30 to 45 minutes of continuous activity.
But the panel decided that 60 minutes of exercise was more appropriate because children typically are active in "fits and spurts" rather than in a continuous manner, said Dr. William Strong, a co-chairman of the panel.
"What we're trying to say is that you accumulate this over the day — it doesn't have to be in one particular spurt of activity," said Strong, a retired professor of medicine at the Medical College of Georgia.
Children should be given the chance to take part in a variety of physical activity, from walking to jumping rope to competitive sports.
"The reality is children aren't going to be physically active unless it's fun," Dietz said.
It's an important issue because besides helping control weight, regular exercise reduces the risk for heart attack, colon cancer, diabetes and high blood pressure, and may reduce their risk for stroke.
"The real issue is not that children are having immediate problems, but that if we don't do something about this now, 20 to 30 years from now we'll have a severe epidemic of cardiovascular disease and metabolic syndrome," Strong said.
The CDC previously said that more than a third of high school students nationwide do not engage in vigorous physical activity, such as running or playing sports like basketball or soccer.
Daily participation in high school physical education classes dropped from 42 percent in 1991 to 32 percent in 2001, according to the latest data from the CDC.
Dietz said that in Atlanta, where the health agency is based, children have "substantial difficulties" in being active.
"Most children (in Atlanta) can't walk to school because of traffic and because of the way communities are designed," he said. "Part of the challenge in today's world is finding opportunities to make physical activity fun."
On the Net:
CDC info: http://www.cdc.gov
Medical College of Georgia: http://www.mcg.edu
Heavy exercise may worsen arthritis damage
Reuters Health
Tuesday, June 21, 2005
For people with extensive damage in large joints from rheumatoid arthritis, high-intensity, weight-bearing exercise apparently accelerates the progression of joint damage, Dutch investigators report.
However, intensive exercise appears to be safe for arthritis patients with little or no joint damage.
Previous studies have shown that exercise programs to improve muscle strength and aerobic capacity are beneficial for people with rheumatoid arthritis. However, one study did uncover a trend toward more damage within large joints after high-intensity exercise.
In the current report, published in the journal Arthritis Care and Research, Dr. Marten Munneke, from Leiden University Medical Center, and his colleagues investigated outcomes after two years for 277 participants in the Rheumatoid Arthritis Patients in Training (RAPIT) study -- 140 assigned to usual care, and 137 to the exercise program.
The amount of joint damage at the start of the study was a significant factor in effects of exercise, the investigators found.
For the 218 patients with a low initial joint-damage score, the exercise program had no effect on joint damage. For the 59 others with higher initial scores, there was a faster rate of damage in the exercise group.
Shoulder and ankle joints were particularly affected.
"Rheumatologists and physiotherapists should advise patients with rheumatoid arthritis to be cautious with excessive loading of extensively damaged joints," Munneke's group advises. They recommend that individualized exercise program should be designed for people with already extensively damaged large joints.
Source: Arthritis Care and Research, June 15, 2005.
Breast-Feeding Cuts Risk of Myopia
By Kathleen Doheny
HealthDay Reporter
HealthDay News
Tuesday, June 21, 2005
TUESDAY, June 21 (HealthDay News) -- Here's yet another reason to breast-feed babies: a new study finds it may reduce a child's likelihood of growing up to need eyeglasses.
Researchers who compared a group of breast-fed infants with formula-fed babies found that breast-fed infants were a bit less likely to be nearsighted at ages 10 to 12.
"It may have to do with some constituents in breast milk, but we can't be sure," said Dr. Richard Stone, an ophthalmologist at the University of Pennsylvania and a co-author of a research letter on the study in the June 22/29 issue of the Journal of the American Medical Association.
Stone and his colleagues, led by Dr. Yap-Seng Chong of the National University of Singapore, evaluated 797 Singapore children at ages 10 to 12, including 418 who had been exclusively breast-fed and 379 who had not been.
While 62 percent of the breast-fed children had myopia, or nearsightedness, 69 percent of those not breast-fed did. "It's really a modest effect," Stone said.
Even after the researchers controlled for factors such as the parents' nearsightedness, maternal age at delivery and birth weight, the association still held.
In developed countries, nearsightedness is the leading cause of visual impairment, the authors noted, and in the United States, more than 30 million adults are nearsighted. The prevalence of myopia has been increasing among urban Asian children, they added.
While the study is believed to be the first to observe an association between breast-feeding and myopia, other studies have found that breast-feeding is good for the development of children's eyes and is associated with better school performance by children.
Several of these studies have been conducted by scientists at the Retina Foundation of the Southwest in Dallas, Texas.
Dennis Hoffman, director of the visual biochemistry laboratory at the foundation said the new study findings are consistent with those done by his group.
"We've shown that breast-fed infants have improved visual maturation at one and a half years, compared to those fed formula," he added.
Stone and his colleagues speculate that a substance in breast milk, docosahexaenoic acid or DHA, may underlie the decreased risk of myopia. DHA is a fatty acid crucial for the growth and functional brain development in infants and it's also required for maintenance of normal brain functioning in adults.
It is also important, the study authors noted, for the development of photoreceptor cells in the retina, which play a major role in whether children become nearsighted.
The retina lines the inner eyeball and is connected by the optic nerve to the brain. The eye's lens focuses light on the retina, which then converts this light into signals sent to the brain. In nearsightedness, the eyeball is too long and light rays focus in front of the retina, rather than on it, causing the person to be able to see objects up close but not at a distance.
While the effect of breast-feeding on nearsightedness was modest, "on this basis, it seems sensible to breast-feed," said Stone, citing the numerous other benefits attributed to the practice.
Modest weight loss curbs high blood pressure risk
Reuters Health
Tuesday, June 21, 2005
Overweight middle-aged and older adults who lose 6.8 kilograms (15 pounds) or more decrease their long-term risk of developing high blood pressure, investigators report. Loss of less weight, if sustained, can also reduce risk.
Though the effects of weight loss on blood pressure are well known, there are few studies that have looked into the long-term results of weight loss on the development of hypertension among adults who start out with normal blood pressure, Dr. Lynn L. Moore, from the Boston University School of Medicine and associates note in the Archives of Internal Medicine.
The researchers' data come from the Framingham Study, in which participants were examined every 2 years since 1948. The team focused on 623 middle-aged disease-free but overweight adults (ages 30 to 49 years) and 605 older adults (ages 50 to 65 years) whose weight remained stable or declined over the ensuing 4 years.
Eight years after the baseline weight measurement, middle-aged adults who lost 6.8 kg or more reduced their long-term risk of becoming hypertensive by 21 percent, while older adults reduced their risk by 29 percent.
Sustained weight loss of as little as 1.8 kg (4 pounds) was associated with a 22 percent reduction in risk among middle-aged subjects and 26 percent among older subjects.
Moreover, Moore's group notes, "There is no evidence that regaining weight has an adverse effect on hypertension." There was a trend toward lower risk if subjects lost weight even when it was not sustained.
Given these findings, the team believes that reducing weight, "even for a few years, may have beneficial physiological effects."
Source: Archives of Internal Medicine, June 13, 2005.
Heart Condition Linked to Resistant Staph
By Ed Edelson
HealthDay Reporter
HealthDay News
Tuesday, June 21, 2005
TUESDAY, June 21 (HealthDay News) -- For years, doctors have associated the inflammatory heart valve condition infective endocarditis with risk factors such as injection drug use and infection with the streptococcus family of bacteria.
But a new international study points to infection with the much harder-to-treat Staphylococcus aureus bacteria as an increasing cause of infective endocarditis, much to the researchers' alarm. It also found that many of these infections may be occurring in hospitals, nursing homes and other health-care settings.
"The face of endocarditis, a potentially lethal infection of the heart, has changed fundamentally, in terms of the organism responsible," said lead researcher Dr. Vance G. Fowler Jr., an assistant professor of medicine at Duke University Medical Center. His team published their findings in the June 22/29 issue of the Journal of the American Medical Association.
Staphylococcus aureus was found to be the most common cause of infection among the 1,779 patients in the 16 countries covered by the study, the report found.
That change has important implications for medical practice, since more and more strains of staph are resistant to the most widely used antibiotics, Fowler said.
"S. aureus is a highly virulent pathogen," he explained. "The pipeline of effective antibiotics against S. aureus is dwindling, leaving us with less therapeutic options in a setting of greater clinical need."
Another report in the same issue of the journal was at odds with Fowler's study, however.
Physicians at the Mayo Clinic looked at all 102 cases of infectious endocarditis occurring in Olmsted County, Minn., between 1970 and 2000. They concluded that there has been no increase in staph infections at their center.
The study found the incidence of the infection had not increased over the decades, said Dr. Imad M. Tleyjeh, an instructor in medicine at the Mayo and lead author of the report. "The second finding is that streptococcus infections remain more common than staph infection," he said. But he acknowledged that "other studies say that staph is taking over."
The finding that endocarditis infections can result from medical care and yet often occur to people who are not hospitalized is a result in a change in medical practice, said Dr. Vincent Quagliarello, a professor of medicine at Yale University, who wrote an accompanying editorial on the studies
"What has happened over the past couple of decades is that more and more people are being treated in an ambulatory setting," Quagliarello said. "They may be in a nursing home, getting chemotherapy, on dialysis. They may not be in a hospital, but they have a lot of contact with the hospital system."
Doctors need to recognize the change in the pattern of these infections, Quagliarello said. "They used to be seen almost exclusively in the hospital," he said. "Now, you see patients arriving with it in the emergency room. If there is a suspicion of bacterial infection, there should be recognition that it may be a resistant infection."
More information
For more on resistant staph, visit the CDC.
Combination of diabetes, depression ups death risk
By Amy Norton
Reuters Health
Tuesday, June 21, 2005
The combination of diabetes and depression increases a person's risk of dying early, beyond that linked to either condition alone, a new study suggests.
The implication, according to researchers, is that patients with diabetes should be routinely screened for depression.
They found that among more than 10,000 U.S. adults in a national health survey, those who had both diabetes and depression were more likely than those with either disorder alone to die over the next 8 years. They were 2.5 times more likely to die during the study period than were men and women without diabetes or depression.
The findings are published in the June issue of the journal Diabetes Care.
Diabetes is well known to increase the risk of heart disease, stroke and other ills, and a number of studies have linked depression to a heightened risk of death from any cause. What has been unclear is whether the combination of the two illnesses may be deadlier than either alone.
The new findings suggest that this is the case, according to study leader Dr. Leonard E. Egede, an assistant professor of medicine at the Medical University of South Carolina in Charleston.
The reason is unclear, but Egede said it's possible that depression makes it harder to manage diabetes -- which requires regular blood sugar monitoring, sticking to a medication regimen, regular exercise and a healthful diet.
Studies have shown that people with diabetes have a higher-than-average rate of depression, which may, according to Egede, be related to the stress of dealing with a chronic disease. But, he told Reuters Health, the problem may often go unrecognized.
"We believe that all patients with diabetes should be screened for depression at least once a year," Egede said. Depression screening, which can be done with a short questionnaire, could be part of routine diabetes care, according to the researcher -- similar to blood pressure and cholesterol check-ups.
Source: Diabetes Care, June 2005.
Bacteria a Key for Kids' Ear Infections
HealthDay News
Tuesday, June 21, 2005
TUESDAY, June 21 (HealthDay News) -- Children who suffer frequent ear infections have more potentially infectious bacteria and fewer protective bacteria in their noses than other children, says a Georgetown University School of Medicine study.
Researchers compared the presence of potentially infectious bacteria and protective bacteria in samples taken from the back of the noses of 20 ear infection-prone children and their nonsmoking parents, and 20 ear infection-prone children and their smoking parents.
The study found that smoking parents had 14 potential pathogens and their children had 17, while nonsmoking parents had three potential pathogens and their children had 16 potential pathogens. The researchers noted 58 instances of bacterial interference against potential pathogens in smoking parents and 55 instances in their children, compared to 129 instances in nonsmoking parents and 55 instances in their children.
"A high recovery rate of potential pathogens and a low number of interfering organisms were observed in OMP [otitis media-prone] children," the study authors wrote.
"This was not related to their parents' smoking habits. The posterior nasopharynx flora of smoking parents contained more pathogens similar to the ones recovered from OMP children and fewer interfering organisms than nonsmoking parents," the authors wrote.
The study appears in the June issue of the journal Archives of Otolaryngology - Head & Neck Surgery.
More information
The Nemours Foundation has more about ear infections.
Study finds racial disparity in lung cancer cases
Reuters
Tuesday, June 21, 2005
Black cigarette smokers with a parent or sibling who developed lung cancer at an early age are more likely to get the disease themselves than white smokers with the same family history, researchers reported Tuesday.
The reason for the racial disparity is not clear, but it could be that blacks are more susceptible to lung cancer or there may be some other risk factor that is not yet understood, the report from Detroit's Wayne State University said.
The finding came from a study of more than 7,500 smokers who were lung cancer victims in the Detroit area between 1990 and 2003, one third of whom were black.
Across the board there was "approximately a twofold increase in risk" for cigarette smokers getting lung cancer after age 60 if they were closely related to someone who got the disease before the age of 50, said Michele Cote, the study's lead author.
But about 25 percent of blacks in that category developed lung cancer later on compared to 17 percent of similar whites, the study found.
Less than 7 percent of U.S. lung cancer cases show up before age 50.
The report, published in this week's Journal of the American Medical Association, said that cigarette smoking is the prime risk factor for developing lung cancer and is the source of most of the disease, but a genetic component has also been recognized.
John Ruckdeschel, another researcher involved in the study, said doctors should take thorough family histories from smokers and advise those who have a close relative with the disease to undergo annual imaging scans.
HealthDay News
Tuesday, June 21, 2005
TUESDAY, June 21 (HealthDay News) -- Gastroesophageal reflux disease (GERD) may be linked with more cancers than previously believed, new research suggests.
The University of Southern California study authors noted that there's a clear relationship between GERD and adenocarcinoma of the esophagus, which features tumors along the tubular portion of the esophagus.
However, the origin of tumors located at the far end of the esophagus where it connects to the stomach is the subject of debate. There are two distinct cancer types found there. One of those cancers is associated with Barrett mucosa -- a condition in which the cellular lining of the esophagus has been changed by reflux.
The second type of cancer that occurs at this location has no associated Barrett mucosa, and it's been suggested that these tumors have a different origin.
In their study, researchers examined data from 215 people who had surgery for cancer of the lining of the far end of the esophagus. Patients with Barrett mucosa had tumors that were diagnosed earlier, were smaller in size, earlier in stage, and less metastases than patients without detectable Barrett mucosa. The patients with Barrett mucosa also had a better five-year survival rate.
"Although overall survival in the two groups was significantly different, survival by tumor stage was similar," the study authors wrote in a prepared statement.
"This suggests that adenocarcinomas without detectable Barrett epithelium [Barrett mucosa] may not be a different type of tumor but rather a more advanced stage of the same disease. It is likely that these larger, more aggressive tumors have overgrown the Barrett epithelium in which they arose," the authors wrote.
If that's the case, that would double the number of deaths due to cancer caused by GERD, the authors said.
The study appears in the June issue of the journal Archives of Surgery.
More information
The American Society for Gastrointestinal Endoscopy has more about GERD and esophageal cancer.
Polio still a threat but a fading one - officials
By Michael Conlon
Reuters
Tuesday, June 21, 2005
With more than 500 new polio cases worldwide so far this year, the disease is still a threat but the goal of eradicating it globally is within reach, top health officials said on Tuesday.
"As long as there is polio anywhere in the world it's just really one traveler from being elsewhere in the world," said Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention.
"We want a polio-free world" and that is possible, she added.
Lee Jong-wook, director-general of the World Health Organization, said most of this year's problem can be traced to the fact that Nigeria suspended vaccinations for a year, and by the time it resumed them 10 other countries had become infected.
But going from 350,000 cases a year in the mid-1980s to a slightly more than 1,000 in 2004 and less than that so far this year indicates that what's left in ending the disease is really just a "clean-up job," he said.
Endemic, wild polio virus has been eliminated from all but six countries -- Nigeria, India, Pakistan, Niger, Afghanistan and Egypt -- and the incidence of the disease has been reduced by more than 99 percent, according to the World Health Organization.
Travelers visiting areas where the disease is endemic are responsible for the reintroduction of it in places where it was thought to have been eradicated. The 50 cases reported recently in Indonesia, for example, may have come from a returning pilgrim.
Polio is a viral disease that attacks the central nervous system, causing paralysis and death in some cases.
Lee and Gerberding spoke at a briefing during Rotary International's annual convention. The service club group along with the WHO, CDC and UNICEF, have for the past 10 years been working to eradicate the disease in what has been termed the largest global health initiative under way.
If no new cases are reported for three years it would be considered eradicated, as is already the case with small pox.
To accomplish the goal of eradicating polio, the groups need to raise $250 million for vaccinations this year and in 2006, Lee said, adding that "the last countries are always the most difficult."
"We are confident we will end polio very soon," said Carlo Ravizza, Rotary Foundation trustee chairman. Many believe, he added, that this is the best year to accomplish the goal. But he and others at the briefing declined to name a specific date by which they hope to see it happen.
Aging Stem Cells Linked to Leukemia in Elderly
HealthDay News
Tuesday, June 21, 2005
TUESDAY, June 21 (HealthDay News) -- Aging stem cells may be behind an increased risk of infection and leukemia in older people, according to a Stanford University School of Medicine study.
The report appears in this week's issue of the Proceedings of the National Academy of Sciences.
The Stanford team found that in older mice, bone marrow stem cells that create new blood cells produce fewer immune cells. That means the bodies of older mice are less able to fight infection.
As well as producing fewer immune cells, the aging blood-forming stem cells use genes known to be involved in leukemia -- cancers that affect blood cells. This may be one reason why older people have an increased risk of developing certain kinds of leukemia, the study authors said.
The findings provide more evidence that aging stem cells or stem cells responding to conditions in an aging body may be the source of a number of age-related health problems.
"Aging results in a diminished capacity of the body to maintain tissue and organ function. Since we know the cells mediating this maintenance are stem cells, it doesn't take a great leap of faith to think that stem cells are at the heart of that failure," study co-author and postdoctoral scholar Derrick Rossi said in a prepared statement.
The researchers said this finding could lead to ways to improve immune function or prevent leukemia in older people.
More information
The Alliance for Aging Research has more about aging.
Study finds antibiotics rarely help deep cough
Reuters
Tuesday, June 21, 2005
Lower respiratory tract infections that trigger coughing fits and fever usually clear up on their own, yet millions of dollars are wasted prescribing antibiotics to hacking patients, researchers said Tuesday.
A study of more than 500 patients suffering from acute bronchitis or pharyngitis found the irritating bouts of coughing lasted an average of nearly 12 days after the doctor visit whether antibiotics were prescribed immediately or not.
Overuse of antibiotics has become a worrisome trend because it renders some drugs ineffective as infections mutate, requiring doctors to deploy stronger and stronger antibiotics.
Antibiotic prescriptions for lower respiratory tract infections account for 55 percent of excess prescriptions in the United States, wasting some $726 million a year, wrote study author Dr. Paul Little of the University of Southampton, England. A typical prescription can cost $50 to $100.
There are still some more severe infections where antibiotics can help, but the drugs are routinely overprescribed for deep coughs and flu associated with lower respiratory infections because patients often ask for them, the researchers said.
Previously only small studies had been performed examining the drugs' effectiveness for patients with coughs bad enough to go the doctor, which account for 3 percent of outpatient doctor visits.
"The challenge now is for clinicians and researchers to determine which groups are at risk of adverse outcomes and identify those patients who might selectively benefit from immediate antibiotic prescription," Little wrote in the Journal of the American Medical Association.
In a few patients in the study, the illness lasted 17 days or longer after the doctor visit. Prior to the visit, the average duration of the illness was nine days. Pneumonia patients, for whom antibiotics use is well established, were excluded from the study.
In an effort to determine if informed patients would be less demanding of antibiotics, the researchers gave half the participants leaflets explaining the issues involved but the information had little impact on patients' attitudes.
However, patients who recovered without the drugs were more likely to become disenchanted with antibiotics. More than half the study participants not given antibiotics decided they would be ineffective anyway. In contrast, three quarters of those who took the drugs continued to believe in their effectiveness.
Health Tip: Recognizing Generalized Anxiety Disorder
HealthDay News
Tuesday, June 21, 2005
(HealthDay News) -- Are you constantly worrying about your health, finances, family or career?
If you've spent at least six months fretting excessively about a number of everyday problems, you may be experiencing Generalized Anxiety Disorder (GAD), says the National Institute of Mental Health. It's a condition that affects about 4 million American adults.
People with GAD are consumed with worry, even when there's no apparent trigger. It's much more than the normal anxiety associated with daily life. People with GAD find it hard to dismiss their worry, even when they know it's more than the situation warrants.
GAD is often accompanied by physical symptoms such as headaches, fatigue, muscle tension and muscle aches. You may also find you have difficultly relaxing, concentrating or sleeping, and you may startle more easily than others.
But constant worry needn't be a way of life. GAD is often treated with medication. The condition typically occurs in conjunction with another anxiety disorder, depression or substance abuse, which will need treatment, as well.
Monday, June 20, 2005
Heavier heart-bypass patients fare somewhat better
Reuters Health
Monday, June 20, 2005
From a statistical viewpoint, a person's weight does not affect his or her risk of dying in the hospital after undergoing coronary artery bypass grafting. However, overweight patients and those with high-normal weights do fare slightly better in this regard than underweight or obese patients, new research shows.
"A little extra body fat apparently provides patients a needed source of glucose ... to help them recover from surgery," Dr. Ruyun Jin, from the Providence Health System in Portland, Oregon, said in a statement.
Previous studies investigating the impact of obesity on death rates following coronary bypass -- which is performed to get around blocked arteries supplying blood to the muscle of the heart -- have yielded conflicting results, according to the report in the American Heart Association's journal Circulation. Of the 17 studies that specifically addressed this topic, only the one found obesity to be a significant risk factor.
To sort out these previous findings, Jin's team analyzed data from 16,218 patients who underwent coronary bypass at one of nine Providence Health System hospitals between 1997 and 2003.
The subjects were divided into one of six groups based on their body mass index (BMI), a measure of weight in relation to height: underweight, normal weight, overweight, mildly obese, moderately obese, and extremely obese.
In agreement with 12 previous reports, the team found no significant correlation between BMI and in-hospital mortality rates after coronary bypass. Still, as noted, the lowest mortality rates were seen in overweight patients or those of high-normal weight.
Dr. Robert Eckel, president-elect of the AHA, doesn't find this an argument for putting on some extra pounds. As he pointed out in a statement, the findings "may be explained by the fact that those with higher BMIs were younger when they needed surgery and thus had the advantage of youth to help them get through the surgery."
He cautioned that excess weight in the long run is undesirable, being associated with high blood pressure, diabetes, and heart disease.
Source: Circulation, June 28, 2005.
Study: Extra Folic Acid May Help Memory
By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, June 20, 2005
Taking large amounts of folic acid improved the memory of older adults, Dutch scientists reported Monday in the first study to show a vitamin pill might slow the mental decline of aging.
The research adds to mounting evidence that a diet higher in folate — a B vitamin found in grains and certain dark-colored fruits and vegetables — is important for a variety of diseases. It's proven to lower women's risk of devastating birth defects of the brain and spinal cord, and research suggests it helps ward off heart disease and strokes, too.
As people age, some decline in brain function is inevitable. The Dutch study tested whether otherwise healthy people could slow that brain drain by taking double the recommended daily U.S. dose of folic acid — the amount in 2.5 pounds of strawberries.
The study divided 818 people ages 50 to 75 to take either a vitamin containing 800 micrograms of folic acid a day, or a dummy pill, for three years.
The folic acid protected users' brains, lead researcher Jane Durga of Wageningen University reported Monday at a meeting of the Alzheimer's Association.
On memory tests, the supplement users had scores comparable to people 5.5 years younger, Durga said. On tests of cognitive speed, the folic acid helped users perform as well as people 1.9 years younger.
The study involved healthy older people, not those with Alzheimer's symptoms, so it doesn't show if folic acid might ward off that disease.
"That's the key question," Durga said.
Still, folic acid offered significant brain protection, said Johns Hopkins University neuroscientist Marilyn Albert, who chairs the Alzheimer's Association's science advisory council.
Scientists have long thought that folic acid might play a role in dementia. Previous studies have shown people with low folate levels are more at risk for both heart disease and diminished cognitive function; clogged arteries slow blood flow in the brain.
"I think I would take folic acid, assuming my doctor said it was OK," Albert said, noting that long study of folic acid shows these levels are safe.
"We know Alzheimer's disease, the pathology, begins many, many years before the symptoms. We ought to be thinking about the health of our brain the same way we think about the health of our heart," she added.
Folate is found in such foods as oranges and strawberries, dark green leafy vegetables and beans. In the United States, it also is added to cereal and flour products. The recommended daily dose here is 400 micrograms; doctors advise women of childbearing age to take a supplement to ensure they get that much.
Durga said it's not clear how folic acid might work to protect the brain. Some studies suggest folate lowers inflammation; others suggest it may play a role in expression of dementia-related genes.
Nicotine affects brain like heroin: study
Reuters Health
Monday, June 20, 2005
New research hints at why it's so hard to quit smoking. In a mouse study, Pennsylvania researchers found that nicotine affects the brain through the same mechanism as heroin and other opiate drugs.
What's more, when nicotine-addicted mice were placed in the same cage where they had received nicotine before, the same signals in the brain were set off as when mice were actually given nicotine -- showing that certain cues reinforce the addiction.
But a drug that reverses the effects of narcotic drugs blocked both the effect of nicotine in the brain and the similar effect set off when mice were in the cage they associated with nicotine.
Anyone who has tried to quit smoking knows that nicotine is extremely addictive, and that certain situations trigger the desire to smoke.
Part of nicotine's hold on smokers is believed to be due to its effect on brain levels of dopamine, which is associated with feelings of well-being. But there is evidence from several studies that nicotine also causes a rise in levels of opioids -- naturally occurring chemicals that are similar to opiate drugs.
Now, Dr. Julie A. Blendy and colleagues at the University of Pennsylvania in Philadelphia indeed found that nicotine affects the brain pathway activated by heroin and other opiate drugs, at least in mice.
In the experiments, mice that were given nicotine showed a rise in levels of a protein called CREB. This protein is thought to be involved in the brain's response to many drugs of abuse.
But levels of this protein rose not only when mice were given nicotine but also when they were in placed in a location where they had previously received nicotine, Blendy and her colleagues report in the journal Neuron.
These effects were absent in mice that lacked opioid receptors, which respond to the body's natural painkillers as well as to drugs such as heroin and morphine.
A single dose of the drug naloxone, which reverses the effect of heroin and other similar drugs, blocked both responses -- to nicotine and to being in a place associated with nicotine.
The results raise the possibility of using opioid-blocking drugs to treat nicotine addiction.
In past studies, opioid-blocking drugs have not been effective at helping people quit smoking. But Blendy and her colleagues note that these studies were carried out in hospitals or in labs, not in places where people normally light up. It might make more sense, according to the researchers, to study the effects of these drugs when taken just before people are placed in situations when they may be tempted to smoke.
Source: Neuron, June 16, 2005.
Brain Exercise Is Key to Healthy Mind
By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, June 20, 2005
Exercise your brain. Nourish it well. And the earlier you start, the better. That's the best advice doctors can yet offer to ward off Alzheimer's disease.
There's no guarantee. But more and more research shows that some fairly simple steps can truly lower your risk of the deadly dementia.
Also, if Alzheimer's strikes anyway, people who have followed this advice tend to do better — their brains withstand the attack longer before symptoms become obvious.
The goal: build up what's called a "cognitive reserve."
"Cognitive reserve is not something you're born with," Dr. Yaakov Stern of Columbia University told a meeting of Alzheimer's researchers Monday. "It's something that changes, and can be modified over time."
In fact, there's now enough research backing this theory that the Alzheimer's Association is offering free classes around the country to teach people — of any age, but especially baby boomers — just how to do it. They call it "maintain your brain."
"There is tremendous interest in making sure that by the time you're 80, your brain is there with you," explains California psychologist Elizabeth Edgerly, who leads the program.
A healthy brain weighs about 2 pounds, roughly the size of a cauliflower. Networks of blood vessels keep oxygen flowing to 100 billion brain cells.
Branch-like tentacles extend from the ends of those cells, the brain's own specialized wiring to communicate. Under a microscope, they look like bushy hairs. A healthy brain can continue to grow new neurons and rewire and adapt itself throughout old age — and you want your brain to be as bushy as possible.
That growth starts in childhood, when parents read to tots, and depends heavily on getting lots of education. The less educated have double the risk of getting Alzheimer's decades later than people with a college education. Likewise, people who are less educated and have a not-so-challenging job have three to four times the risk of getting Alzheimer's, Stern says.
If you're already 40, don't despair. What's the advice?
·
Your brain is like a muscle — use it or lose it. Brain scans show that when people use their brains in unusual ways, more blood flows into different neural regions and new connections form. Do a new type of puzzle, learn to play chess, take a foreign language class or solve a vexing problem at work. Try to challenge your brain daily, Edgerly advises.
·
A healthy brain isn't just an intellectual one. Social stimulation is crucial, too. Don't sit in front of the television. People who are part of a group, whether it's a church or a book club, age healthier. Declining social interaction predicts declining cognitive function, new government research shows.
·
So do stress and anxiety. People who have what's called chronic distress — extreme worriers — are twice as likely to develop some form of dementia, reports Dr. Robert Wilson of Rush University Medical Center. Why? Autopsies show these people actually had fewer bush-like tentacles, or dendrites, linking their brain cells, meaning their brains were more vulnerable when disease struck.
It's not clear if someone can reverse a lifetime of worry and anxiety, but animal studies suggest exercise eases the effects of this kind of stress.
·
Getting physical is crucial also. Bad memory is linked to heart disease and diabetes, because clogged arteries slow blood flow in the brain. Elderly people who were less mentally and physically active in middle age are about three times as likely to get Alzheimer's as they gray. A study from Sweden found the obese are twice as likely to get Alzheimer's.
Go for the triple-whammy of something mentally, physically and socially stimulating all at once: Coach your child's ball team. Take a dance class. Strategize a round of golf.
·
And don't forget diet. The same foods that are heart-healthy are brain-healthy, so avoid artery-clogging saturated fat and try for omega-3 fatty acids, found in fish and nuts.
Eat dark-skinned fruits and vegetables, which are particularly high in brain-healthy vitamins E and C. Harvard researchers found eating dark green leafy vegetables like spinach improves cognitive function. Also, B vitamins and folic acid, found in cereals, breads and fruits like strawberries, are important for brain health.
Editor's Note: Lauran Neergaard covers health and medical issues for The Associated Press.
On the Net:
Alzheimer's Association: http://www.alz.org
Overeating plus inactivity ups breast cancer risk
By Alison McCook
Reuters Health
Monday, June 20, 2005
The combination of eating too much and exercising too little appears to significantly increase the risk of breast cancer, particularly in postmenopausal women, according to new study findings.
Investigators in the U.S. and China found that women who had an unhealthy energy balance -- meaning they weren't working off the calories they consumed -- were more than twice as likely as lean and active women to develop breast cancer. After menopause, both unhealthy habits appeared to up the risk of the cancer by nearly five-fold.
In contrast, simply overeating appeared to do little to increase breast cancer risk, the authors report in the journal Cancer Epidemiology, Biomarkers & Prevention.
"It's both (eating poorly and not exercising) together that really magnifies the risk, and makes it worse," Dr. Alecia S. Malin of Meharry Medical College in Nashville, Tennessee, told Reuters Health.
During the study, Malin and her team interviewed 1,459 women diagnosed with breast cancer, and 1,556 women of similar age without breast cancer, and asked them to recall their activity levels in recent years. All women were living in Shanghai.
Women who were relatively overweight appeared to have no higher risk of breast cancer if they also exercised, while inactive women appeared to escape the disease if they stayed lean.
Women who consistently showed the highest risk of cancer were those who were relatively inactive, heavier, and followed a higher-calorie diet.
These findings suggest that it's the combination of the two unhealthy habits -- overeating and inactivity -- that appear to put women at risk, Malin said in an interview. "Women who didn't work out, who had zero activity, and ate more than 2100 calories were at risk," she said.
She added that these findings serve as another "warning" for women about how they put their health at risk if they don't eat right and exercise.
"These are the healthy things to do, and here's what happens if you don't do them," Malin noted.
The researcher said that one of her co-authors, Charles E. Matthews, has also found that women who eat more than they work off are also at higher risk of endometrial cancer.
To investigate the relationship between energy balance and cancer, she and her colleagues plan to study how the body changes with an unhealthy energy balance, and if those changes can trigger cancer.
Source: Cancer Epidemiology, Biomarkers & Prevention, June 2005.
Health Tip: Be Wise About Summertime Exercise
HealthDay News
Monday, June 20, 2005
(HealthDay News) -- A pickup game of basketball or an afternoon jog on a sultry summer day could put your health at risk. Under normal conditions, your body is able to adjust to the heat. However, prolonged exposure to rising temperatures makes it harder for your body to keep cool, which puts you at risk for heat cramps, dehydration, heat exhaustion or heat stroke.
The Mayo Clinic offers these guidelines for warm-weather workouts:
Drink plenty of fluids, such as water, sports drinks and diluted fruit juices. Skip caffeinated drinks, such as coffee, tea and cola, which increase the rate that water is excreted from your body. Apply sunscreen before working out. Sunburn decreases your body's ability to cool itself. Take time to get acclimated to the increased temperature. If you're of an average fitness level, allow four to five days. If you're older or have a chronic health condition, it could take you 10 to 12 days. Wear loose-fitting, light-colored clothing constructed of breathable fabrics. Roomier garments allow air to pass over your body, which aids sweat evaporation and cooling. Items made of polypropylene wick moisture away from your skin. Work out early in the morning or late in the evening when temperatures are typically cooler. If you have a chronic medical condition or take medications, consult your doctor to learn if these will impact your ability to work out in hot weather.
The Mayo Clinic also notes that young children and older adults should be closely monitored for signs of distress, as they are at greater risk of heat-related illness.
Bacterial virus may underlie meningitis
Reuters Health
Monday, June 20, 2005
The cause of bacterial meningitis is, by definition, a bacterial infection -- but it may not be quite that simple. The true culprit may be a virus that infects the bacteria.
Bacteria and viruses are very different organisms. Basically, bacteria are self-sufficient when it comes to replication, but viruses need to infect a host cell and highjack its genetic machinery in order to reproduce.
Some viruses, called bacteriophages, specialize in infecting bacterial cells.
Now European researchers report that a bacteriophage may be the trigger that makes the common and generally harmless bacterium, Neisseria meningitidis, invade the blood stream and cross the blood-brain barrier, leading to meningitis.
"We have shown that a bacteriophage increases the ability of N. meningitidis, a (harmless) bacterium, to become pathogenic," investigator Dr. Xavier Nassif told Reuters Health.
Most cases of illness due to N. meningitidis are caused by a small number of "hyperinvasive" types of the microbe, Nassif of the National Institute of Health and Medical Research, Paris, and colleagues note in the Journal of Experimental Medicine.
To investigate further, the researchers analyzed genetic material from hyperinvasive organisms and from organisms not associated with disease. They found that a "prophage" -- the early stage of a bacteriophage -- was present in disease-casing bacteria.
The team points out that "the carriage of virulence determinants by phages is not an uncommon situation in bacterial pathogens." This is the case in both cholera and diphtheria.
The findings "may help to design a better strategy to fight cerebrospinal meningitis by pinpointing strains at higher risk of being pathogenic," Nassif concluded.
Source: Journal of Experimental Medicine, June 20, 2005.
Deadliest Skin Cancer Often Missed
By Steven Reinberg
HealthDay Reporter
HealthDay News
Monday, June 20, 2005
MONDAY, June 20 (HealthDayNews) -- While people have become aware of the dangers of skin cancer, the most serious type of melanoma is often missed in its early stages, researchers report.
Nodular melanoma, the most aggressive type of skin cancer, makes up 9 percent of all cases and 34 percent of thick melanoma cases. In contrast, the most common melanoma, superficial spreading melanoma, is usually diagnosed early and typically is a thin melanoma.
The difference between thick and thin melanomas is simply that thin melanomas tend to spread out over the surface of the skin, while thick melanomas grow down into the skin.
The incidence of melanoma in the United States has risen sharply from 1969 to 1999, and that increase is disproportionately greater in men 65 and older. Deaths from melanoma are strongly associated with the thickness of the primary lesion, according to the report in the June issue of the Archives of Dermatology.
"When we look at melanoma, the percentage of nodular melanomas has not moved over 12 years," said study author Dr. Marie-France Demierre, director of the Skin Oncology Program at Boston University School of Medicine.
To determine trends in distribution of thin and thick melanomas from 1988 to 1999, Demierre and her colleagues looked at skin cancer data from the Surveillance, Epidemiology, and End Results (SEER) database.
The researchers found the number of new melanoma cases increased 60 percent during that time. From 1988 to 1991, there were 9,132 cases, and from 1996 to 1999, there were 14,575. Meanwhile, the proportion of thick melanomas (at least 2 millimeters thick) remained practically unchanged during the 12 years of the study.
Demierre believes the reason many of the thick, nodular melanomas are missed is that they don't fit the criteria that many people and their doctors have learned to recognize as skin cancer. People have been taught to identify skin cancer by using the ABCD criteria: A for asymmetry; B for border irregularity; C for color change; and D for diameter change.
"Really, a lot of melanomas present without any of the ABCD," Demierre said. "The moles become itchy, the changes are small, and those turn out to be the thicker melanoma, often the nodular melanoma," she added.
To deal with this problem, Demierre said that people need to be more aware of the changes in any mole.
"If you have a lesion that you are concerned about, you should have it checked," she advised.
On expert agrees that more needs to be done to get people to recognize the thick, nodular melanomas.
"We have done a pretty good job on getting people to identify superficial spreading lesions," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. "But we really haven't really done as good a job on the nodular side."
Just because a lesion doesn't meet the ABCD rule doesn't mean you shouldn't get it checked, Lichtenfeld said.
"The bottom line is, if you have a lesion on your skin, and it's changing -- that is, it's getting larger, changing color, appears to be raising -- go see your doctor and get it checked. And you need to get there quickly, because this lesion grows fast," he stressed.
Three other reports in the same issue of the journal shed light on several aspects of melanoma.
In the first report, researchers looked at microsatellites to see if their presence was predictive of survival after being treated for skin cancer. Microsatellites are nodules of melanoma cells that are away from the main body of the tumor.
The research team led by Dr. Mohammed Kashani-Sabet, from the Melanoma Center at the University of California, San Francisco, found that microsatellites do predict that cancer is likely to recur in the same area as the initial tumor, and that this recurrence does negatively affect survival.
In the second report, Case Western University researchers found that when sampling a melanoma for analysis, taking several samples of different thickness appears to be the best way to accurately classify the melanoma and guide doctors in their treatment choices.
In the third report, a survey of 1,200 dermatologists, researchers led by Dr. Allan C. Halpern, a dermatologist at Memorial Sloan-Kettering Cancer Center, found there are no standards among dermatologists for how wide an area around a melanoma should be removed. In addition, most dermatologists didn't know which melanomas were likely to progress and which weren't.
"Further research in the specific area of melanomas is warranted to develop clear guidelines in the management and prevention of further disease," Halpern's team concluded.
More information
The American Cancer Society can tell you more about skin cancer.
Warning: Your job may give you asthma
By Charnicia Huggins
Reuters Health
Monday, June 20, 2005
Work-related asthma is fast becoming one of the most commonly diagnosed occupational respiratory diseases in this country, and people who work in certain industries may run a higher risk than others, new study findings show.
An analysis of survey responses from nearly 21,000 adults revealed that men and women who work in printing or publishing, furniture or lumber, health care, and entertainment and recreation, may be most likely to be diagnosed with asthma, as are those who work for automobile dealers and gas stations.
"This study stresses that workers employed in these industries need to be informed by the employer and aware that they are potentially exposed to asthmagens and the seriousness of their effect," study author Dr. Ki Moon Bang, of the West Virginia-based National Institute for Occupational Safety and Health, told Reuters Health.
In their study, Bang and colleagues reviewed information from 20,991 men and women who participated in the 2001 National Health Interview survey, to identify the industries associated with an increased risk of asthma.
Overall, 6.5 percent of survey respondents reported having been diagnosed with asthma. This represents about 8.6 million individuals among 133 million adult workers in the United States, the researchers report in this month's issue of the American Journal of Industrial Medicine.
Asthma was most prevalent among whites and females, and among automobile dealers, gasoline station workers and those in the durable goods field.
The industries associated with a greater risk of asthma varied by race, the report indicates.
White men who worked in printing, publishing and allied industries, were 2.4 times more likely to be diagnosed with asthma than those in the comparison group who worked in finance, public administration, communication and other office-related industries. The increased risk of asthma was possibly due to the men's exposure to acrylic resins, dyes, glues and sealants at their workplace, the report indicates.
White women who worked in the health care industry were 30 percent more likely than their peers in the comparison group to be diagnosed with asthma, possibly due to their exposure to certain detergents, latex and other agents.
On the other hand, black women who worked in the furniture, lumber and wood industry had a nearly six-fold increased risk of being diagnosed with asthma in comparison to their peers, potentially due to their exposure to formaldehyde, wood dust and other agents. Those who worked in the entertainment and recreation industry were four times more likely to be diagnosed with asthma, possibly because of their exposure to certain art materials, cleaning chemicals, and photographic development chemicals.
Black men who worked in the construction industry or in chemicals and allied products had a more than five-fold increased of being diagnosed with the condition, while those who worked in durable goods; furniture, lumber and wood; eating and drinking places; and other personal services, respectively, were up to four times more likely to be diagnosed with asthma than were their peers.
Men and women who worked in elementary, secondary schools, and colleges and those who worked in the utilities and sanitary industry were also at an increased risk for asthma, the researchers note.
According to the American Thoracic Society, an estimated 15 percent of all adult cases of asthma may be related to the workplace. Based on this estimate, Bang and colleagues write, approximately 1.3 million adult asthma cases could be attributed to occupational exposure.
"This article should increase awareness among employers and workers about increased risk of asthma in specific industries," Bang told Reuters Health.
The team concludes that "this information helps to target workplaces where detailed investigations for prevention and control may be appropriate."
Source: American Journal of Industrial Medicine, June 2005.
Worldwide Alzheimer's Care Carries Staggering Costs
By Alan Mozes
HealthDay Reporter
HealthDay News
Monday, June 20, 2005
MONDAY, June 20 (HealthDay News) -- Providing medical care for the nearly 28 million men and women who now suffer from Alzheimer's-related dementia costs an estimated $156 billion per year worldwide, a team of Swedish scientists reports.
The findings stem from the first study ever conducted to specifically assess the disease's overall financial impact on health care systems across the globe.
The researchers, who were to present their findings Monday at the Alzheimer's Association International Conference on Prevention of Dementia, in Washington, D.C., emphasized that their tabulations were based solely on such direct medical care costs as hospitalization, drugs, clinic visits, diagnostics, nursing care and social services.
They stressed, therefore, that significant indirect costs -- such as the time and effort provided by a patient's spouse, friends and/or neighbors -- would only augment the already monumental direct-care costs involved in treating Alzheimer's-related dementia.
Dementia is characterized as a severely disabling disorder in which brain function progressively deteriorates over time, resulting in a significant loss of short and/or long-term memory, the inability to communicate or reason properly, and confusion.
The authors caution that their global Alzheimer's cost tally was based on 2003 data and included some source information that was, at times, difficult to verify and categorize. In that light, they provided a supplementary number crunch, which suggested that global cost figures might in fact range from a low of $129 billion to a high of $159 billion.
Any way you calculate it, they stressed, the financial drain posed by Alzheimer's is universally striking and substantial.
And this is nowhere more true, they said, than in the United States where about one-third of the global annual medical expense figure -- or $50 billion -- is spent on caring for what they calculate are approximately 3 million Alzheimer's patients.
"This is the most costly disease for our society," said study lead author Dr. Bengt Winblad, chief physician at the Karolinska Institutet in Stockholm and the Karolinska University Hospital in Huddinge. "It's more costly than both cardiovascular disease and cancer put together."
Winblad and his colleagues utilized the United Nations population data base to calculate the prevalence of Alzheimer's in different regions of the world. In addition, prior studies exploring the cost of illness in certain sample countries were used as a base upon which to model the expenses entailed in providing direct medical care for dementia.
The researchers arrived at their final figures by further stacking such direct-care costs against every country's gross domestic product per capita -- a method that they said is routinely used in health care cost analyses. Using this approach, richer countries typically demonstrated the highest Alzheimer's-related health care costs.
In fact, the Swedish team found that the "advanced economies" as a whole represented 38 percent of the world's Alzheimer's patients, but they also accounted for 92 percent of Alzheimer's-related direct health care costs.
The United States and Canada, Winblad noted, currently spend about $16,000 in direct medical care per Alzheimer's patient each year. By contrast, $8,500 annually is spent on per-patient care in Europe, while roughly $400 is spent per patient across the African continent.
Against this stark financial snap-shot, Winblad suggested that spending more money on Alzheimer's research today will ultimately help to significantly curtail medical care costs down the road.
In that vein, he acknowledged the potential benefits that new legislation, like the Ronald Reagan Alzheimer's Breakthrough Act, may provide for ratcheting up American investment in Alzheimer's research.
The bill -- currently under consideration by Congress -- would double federal funding for Alzheimer's research to $1.4 billion per year, while providing family caregivers with a tax credit of up to $3,000 per year to help cover expenses related to medication, home health care and day care.
"The amount we now spend on research is very low compared to the societal costs," said Winblad. "And I think even a small step forward in increasing research has an enormous impact -- because it improves patient care and it improves the relationship between caregivers and patients. And more research may lead to better drugs, which will allow patients to stay home longer. And perhaps, in the long run, it will lead to a cure -- although we are not there yet. But it's now we have to do it, because it takes time."
Steve McConnell, senior vice president for advocacy and public policy for the Alzheimer's Association, agreed.
"The good thing is that we know that we don't even have to cure this disease to see a significant impact on the cost," said McConnell. "If we can simply delay the onset of Alzheimer's by just a few years and slow its progression, we can show enormous savings to health care programs. And the reason is that if the patients are quite elderly, they will die of something else and they won't have to experience this disease."
McConnell noted that in the United States, in particular, a rapidly aging population will translate into a rapid increase in the country's Alzheimer patient pool -- expanding to include as many as 16 million Americans by the middle of the century.
And he noted that the U.S. figures outlined in the Swedish study were actually "very conservative." According to the Alzheimer's Association, there are 4.5 million Americans with Alzheimer's disease.
McConnell said research-funding increases are urgently needed to address a looming Alzheimer's health care crisis.
"If you factor in the informal care of family members and the costs to business of lost productivity and absenteeism, you just see the numbers go higher and higher," McConnell said. "If we don't get this disease under control, the impact on worldwide economies will be back-breaking."
More information
For more on Alzheimer's disease, check out The Alzheimer's Association.
Sunday, June 19, 2005
Twins Study Links Causes of Alzheimer's
By Lauran Neergaard
AP Medical Writer
The Associated Press
Sunday, June 19, 2005
Education and a healthy youth may override genes in determining who gets Alzheimer's disease, says a provocative new study of dementia patients and their healthy identical twins.
Researchers combed Sweden's twin registry to find 109 identical twins where one had Alzheimer's or another form of dementia but the other remained healthy. Then they checked the twins' medical histories.
Having had a stroke increased the chances of dementia six-fold, not surprising as cardiovascular disease has long been considered a risk factor, scientists reported at an Alzheimer's Association conference on the quest to prevent the disease.
More surprising were two early-in-life factors:
·
Twins who had had early periodontal disease — leading to loose or lost teeth by age 35 — had a fourfold increased risk of dementia. Gum disease is a sign of poor child health in general. It's also an inflammatory disease; inflammation increases the risks of numerous disorders later in life.
·
Those with less high school and college education had 1.6 times the risk of dementia. Mental stimulation throughout life is thought to be brain-protective.
"I'd thought at first the story would be in the genes," said lead researcher Dr. Margaret Gatz of the University of Southern California, who was surprised to find education's role.
In interviews, surviving twins spoke about how a sibling was never as interested in school or struggled with it. Gatz immediately wondered if childhood infections played some role in their early brain development, which led to the gum disease finding. Now she's exploring other factors.
The bottom line: "Good brain health ... in old age reflects influences that begin much earlier in the life span," she said.
By Maggie Fox, Health and Science Correspondent
Reuters
Sunday, June 19, 2005
Painless brain scans and simple blood tests may offer ways to predict who has the highest risk of Alzheimer's disease, and it may be possible to lower risks by drinking juice daily, researchers said on Sunday.
The occasional alcoholic drink may also help, researchers told a prevention conference sponsored by the Alzheimer's Association.
"There is increasing evidence that we can do something for ourselves in terms of preventing this disease," Dr. Ron Peterson of the Mayo Clinic in Rochester, Minnesota, told a news conference.
It is important to act early, before symptoms such a memory loss begin, the researchers added.
The Alzheimer's Association estimates 4.5 million Americans have the incurable, fatal brain disease. It begins with mild memory loss and confusion and progresses gradually to a complete inability to care for oneself.
As many as 25 million people globally may have dementia, and those numbers will rise as the population ages.
"We need to be able to identify people at high risk as soon as possible," said Dr. Marilyn Alberts of Johns Hopkins University. Several studies presented on Sunday offered the possibility of predicting risk years before the disease develops.
Lisa Mosconi and colleagues at the New York University School of Medicine used positron emission tomography, or PET, scans to look at the brains of 53 normal elderly people.
They then watched for as long as 24 years to see who developed Alzheimer's. Nine did, while 19 developed mild cognitive impairment, which can worsen into Alzheimer's.
The PET scans detected reduced activity in an area of the brain called the hippocampus, which is known to be damaged in Alzheimer's. A 15- to 40-percent reduction in activity in the hippocampus, as measured by PET, predicted 85 percent of the Alzheimer's patients nine years in advance, Mosconi said.
It predicted 71 percent of the cognitive-impairment cases.
Alison Godbolt of the Institute of Neurology in London used a different brain scan called magnetic resonance spectroscopy in people who have a genetic flaw that makes them almost 100 percent certain to develop Alzheimer's, as well as people without the mutation.
The test looked for two compounds -- N-acetyl aspartate and myo-inositol and found their levels could predict which patients developed Alzheimer's.
Vaccine Hopes
Dr. Neil Graff-Radford of the Mayo Clinic in Jacksonville and colleagues found that blood levels of a protein called amyloid beta 42 plunged three to five years before a patient was diagnosed with Alzheimer's. This is presumably because the protein, which makes up the brain-clogging fibers associated with Alzheimer's, is staying in the brain instead of circulating in the blood, Graff-Radford said.
Companies are already targeting the protein with a vaccine in the hope of preventing Alzheimer's.
So far, drugs can temporarily slow Alzheimer's progression, but there is no cure. So experts are looking for ways to prevent it.
Amy Borenstein of the University of South Florida and colleagues found Japanese-Americans who drank the most fruit and vegetable juice had a fourfold lower risk of developing Alzheimer's than similar people who drank little or none.
Their study of 1,800 people covered 30 years.
Mark Sager of the University of Wisconsin and colleagues recruited people whose parents had Alzheimer's and found one clear way to predict who would also get the disease -- how much alcohol they drank.
He found that moderate drinkers had a lower risk of Alzheimer's than either non-drinkers or heavy drinkers.
"It is truly moderate intake that is protective," he said.
Experts Say Schizophrenia Drug Cures SARS
The Associated Press
Sunday, June 19, 2005
A drug used to treat schizophrenia has been shown to prevent and treat severe acute respiratory syndrome, according to Chinese and European experts at a conference in China, the government said Sunday.
Cinanserin was found to inhibit the coronavirus that causes the deadly flu-like SARS, which first emerged in the country's south in late 2002, the official Xinhua News Agency reported. The finding was announced by experts attending a meeting of the Sino-European Project on SARS Diagnostics and Antivirals in the coastal city of Hangzhou.
The report said cinanserin was among 15 drugs that appeared effective in preventing SARS but that the other 14 had yet to undergo sufficient testing.
"Cinanserin could be directly prescribed to prevent the SARS disease or treat SARS patients if the fatal epidemic mounts a comeback," Peter Kristensen, an expert from Denmark's University of Aarhus, was quoted as saying.
The disease killed 349 people in mainland China and sickened thousands worldwide before subsiding in July 2003. Another person died in April in China during a brief outbreak traced to a Beijing laboratory that handled the virus.
Saturday, June 18, 2005
Blood Protein Signals Heart Disease Risk
By E.J. Mundell
HealthDay Reporter
HealthDay News
Saturday, June 18, 2005
SATURDAY, June 18 (HealthDay News) -- As cholesterol builds up on artery walls, blood vessels shrink and blood pressure goes up. Now, there's a new test to help predict dangerous ruptures in those clogged arteries -- ruptures that can lead to heart attack or stroke.
The cheap, easy blood test measures circulating levels of an inflammation-linked compound called C-reactive protein (CRP), and it's becoming increasingly popular in doctor's offices nationwide.
"Even people with relatively low cholesterol levels, if they have a high CRP they may still be at high risk for heart trouble," said Dr. James O'Keefe, a spokesman for the American College of Cardiology and director of preventive cardiology at the Mid-America Heart Institute in Kansas City.
Another expert, former American Heart Association president Dr. Sidney Smith, stressed that the CRP screen should complement -- not replace -- traditional diagnostic tests such as screens for cholesterol and high blood pressure.
"At this point in time, it looks as if it will provide important additive information -- additional data that will be very helpful," he said.
Smith, director of cardiovascular science and medicine at the University of North Carolina at Chapel Hill, was also a co-author of heart association recommendations on CRP screening, issued in 2003. At that time, the group advised "against screening of the entire adult population for [CRP]." Instead, it recommended doctors use the test at their own discretion, noting that it is probably most useful in patients already diagnosed with various risk factors for heart disease.
CRP is a marker of inflammation, the process by which the body responds to injury and disease. As arteries get clogged with cholesterol and placed under increasing strain, inflammation often occurs.
"It may be that CRP helps cause the inflammation, but mostly it's a marker for it," O'Keefe said. CRP isn't restricted to heart disease -- in fact, it's found at relatively high levels in people with chronic inflammatory illnesses such as rheumatoid arthritis or inflammatory bowel disease.
However, "we've learned over the past decade that the process of atherosclerosis [hardening of the arteries] develops over years, and that inflammation seems to be a very important part of causing the atherosclerotic lesion to ulcerate and then 'clot off,' " Smith said. "So it's this combination of the atherosclerotic process and the presence of an active inflammatory state that seems to identify people that are at higher risk."
O'Keefe agreed. "I like to use the analogy of a pimple on your skin," he said. In pimples, as in diseased arteries, inflammation swells the affected tissue -- often to the bursting point.
Of course, when pimples burst, the effects are mostly cosmetic and fleeting. But when inflamed arteries burst, "it exposes [fatty] material and sends it into the bloodstream, making the blood more likely to clot -- and that's how a heart attack happens," O'Keefe said.
That's why the CRP test -- which costs about $12 -- may be especially helpful for patients already at high cardiovascular risk due to factors such as high blood cholesterol, hypertension, obesity, smoking, or a family history of heart disease.
Like the heart association, the American College of Cardiology has yet to designate the CRP test as a standard, first-line screen for heart disease, but O'Keefe said that "as more and more information comes out, I'm sure they will in the near future."
He pointed to two separate articles, published this January in the New England Journal of Medicine. Both studies found that "elevated CRP is as strong a predictor as LDL 'bad' cholesterol, in predicting who's going to get heart trouble," O'Keefe said.
Even individuals with low cholesterol might benefit from the CRP test, O'Keefe added.
"There's data to suggest that [patients with high CRP] can reduce their risk for heart attack by treating their already low cholesterol with a statin drug, to lower it further. Because statins also lower inflammation, as well," he said.
Most Americans may not need to turn to drugs to lower arterial inflammation, however, since the very behaviors that drive up cholesterol and high blood pressure -- smoking, lack of exercise and poor diet -- appear to send CRP skyward, too.
"The most important risk factor of all is obesity," O"Keefe warned. "Chronic excess weight, especially around the midsection, increases C-reactive protein. Lean people tend to have lower CRP, so my advice is to exercise more, lose weight, and eat a healthy diet."
More information
To learn more about CRP, visit the American Heart Association.
MRI Can Identify Alzheimer's, Other Dementia
HealthDay News
Saturday, June 18, 2005
SATURDAY, June 18 (HealthDay News) -- Researchers say an MRI technology called arterial spin labeling can distinguish between Alzheimer's disease and frontotemporal dementia (FTD), another common form of cognitive decline that's often confused with Alzheimer's.
Investigators at the San Francisco VA Medical Center (SFVAMC) used arterial spin labeling to measure blood flow in the brains of people with Alzheimer's and FTD. The study was presented Saturday at the Alzheimer's Association International Conference on Prevention of Dementia in Washington, D.C.
"Blood flow indicates brain activation. So the area with less blood flow is the area affected by disease," study leader Norbert Schuff, a principal investigator at SFVAMC and an associate professor of radiology at the University of California, San Francisco, said in a prepared statement.
Arterial spin labeling successfully distinguished between FTD patients, Alzheimer's patients and people with no dementia.
FTD, the second most common dementia after Alzheimer's disease, affects the front part of the brain. Alzheimer's mainly affects other brain areas, such as the temporal lobe and hippocampus. People in the early stages of both diseases display similar symptoms.
"Progression of frontotemporal dementia is usually faster than Alzheimer's, and the underlying pathology is different, so it is important to know the difference," Schuff said.
Currently, positron emission tomography (PET) and single proton emission computerized tomography (SPECT) can be used to measure brain blood flow. But these techniques require that patients be injected with radioactive tracers. They are also expensive, can take up to half a day to perform, and are not widely available.
"So if you can acquire blood flow information with MRI, that would be very beneficial. MRI is totally noninvasive, making it much safer for patients. It's more widely available, it's cheaper, and arterial spin labeling can be done in 10 minutes together with a conventional MRI scan," Schuff said.
More information
The American Medical Association has more about dementia.