Joel P. Rutkowski, Ph.D., Editor
May 19, 2003
By David B. Caruso
PHILADELPHIA - Some of the nation's leading medical schools have abandoned a little-known, decades-old practice of letting students perform pelvic exams on women without their consent while they are under anesthesia.
The schools are asking permission first.
Previously, these institutions had routinely brought in students — sometimes as many as three or four — to conduct pelvic exams on unconscious women just before their gynecological surgeries and often without their consent.
Changes in that practice have taken place over the past five years after complaints from students who felt the exams without consent were unethical.
"My problem was that if they found out about it, they might be really upset, and it was really only being done for my benefit," said Dr. Ari Silver-Isenstadt, who refused to examine anesthetized women as a student at the University of Pennsylvania.
"I felt like I would be violating their trust," he said.
Dr. Daniel Federman, senior dean for clinical teaching at Harvard, said the complaints led to a new policy under which surgical patients had to give consent for a pelvic exam for training purposes. In addition, the students had to be part of the medical team.
"Very few patients decline. And when they do, we honor it," Federman said.
At the University of California, San Francisco, School of Medicine, complaints by students in the late 1990s led to a line being added to patient consent forms, specifically noting that women having gynecological surgery may be given a pelvic exam while they are under anesthesia.
Typically, the surgeon performing the operation conducts an exam to confirm the problem to be corrected by surgery.
Dr. Patricia Robertson, director of UCSF's obstetrics and gynecology clerkship, said students have also been directed to meet with the patient before each operation and explain how they will be involved in their care.
"The students, I think, were most upset because they felt there were students lining up in the operating room doing pelvic exams, who really had nothing to do with the patient," she said.
Most medical students today learn the basics of the pelvic exam by practicing on paid volunteers but eventually need to move on to real patients.
Anesthetized women are the perfect subjects, doctors said, because they are relaxed and unable to feel the sometimes painful mistakes of novice examiners.
Consent is still far from a universal practice.
At the Washington University School of Medicine in St. Louis, patients are told that students will be part of their care team, but aren't specifically told the treatment could include a pelvic exam for educational purposes.
There are similar policies at the University of Pennsylvania and the Johns Hopkins School of Medicine.
"I don't think any of us even think about it. It's just so standard as to how you train medical students," said Dr. Jessica Bienstock, residency program director at Johns Hopkins.
Many students, however, appear to disagree: 70 percent surveyed at Philadelphia-area hospitals in 1995 before they completed an obstetrics and gynecology clerkship said it was important to ask women for consent, according to a study published last month in the American Journal of Obstetrics and Gynecology (news - web sites).
Silver-Isenstadt, one of the study's authors, said that number dropped to 51 percent among students who had completed a clerkship, which he views as evidence of a cavalier attitude toward patient privacy.
Dr. Michael Gregory, a Boston public (news - Y! TV) health physician who objected to the exams when he was a third-year student at Tufts University School of Medicine, said that while studies show most women will give their consent, doctors are afraid to ask.
"It's this paternalistic, patronizing view that the doctors know best ... We underestimate people's incredible charity, and their willingness to let us train," he said. "But I think that at a gut level, doctors understand that if they actually told patients that this was happening without their consent, people would be outraged."
On the Net:
American Journal of Obstetrics and Gynecology: http://www.mosby.com/ajog
By Keith Mulvihill
NEW YORK (Reuters Health) - For decades, men have routinely been advised to "exercise" their prostate--that is, to ejaculate on a regular basis--to ward off common problems associated with benign enlargement of the prostate.
But a new study finds no scientific support for such advice, suggesting the notion is nothing more than a modern medical myth.
The advice is not harmful, but probably pointless, study author Dr. Michael Lieber explained in an interview with Reuters Health.
Non-cancerous prostate enlargement, also known as benign prostatic hyperplasia (BPH), is common in men older than 50. While it is not dangerous, the swollen gland can block urine flow through the urethra, leading to urinary problems.
BPH symptoms include incomplete bladder emptying, weak urine stream, trouble getting urination started, frequent urination day and night, urgency and complete urinary retention, according to Lieber.
To learn whether BPH symptoms are made worse by infrequent sex, Lieber's team evaluated 2,115 Minnesota men between the ages of 40 and 79. The researchers asked the men about lower urinary tract symptoms and their frequency of ejaculation.
While men in their 40s and 50s had a "pretty good" frequency of ejaculation, Lieber said, this frequency dropped for men in their 60s and 70s. Older men also tended to have more BPH symptoms, larger prostates and a low urine flow rate.
"If you just compared the frequency of ejaculation with a man's urinary status, it looked like there was an association," said Lieber, who is with the Mayo Clinic in Rochester, Minnesota.
But after age was accounted for, "there was no association between the number of times a man ejaculated per week or per month and their urinary symptom score or their prostate size or their urine flow rate," he added.
The findings are published in the March issue of the journal Urology.
The apparent tie between age and ejaculation frequency may be the source of the "exercising the prostate" myth, Lieber and colleagues note.
But men who ejaculated more often, even after correcting for age, reported much better overall health and much higher sexual satisfaction, according to Lieber.
When asked why the apparent myth came to be, Lieber said that "all the prostate does is make seminal fluid, it has no other role...and I think people just thought, well if that is what your prostate does, it's better for it to be used."
But the bottom line, according to Lieber, is that his team couldn't substantiate the common physician recommendation that the more a man ejaculates, the better it is for his prostate health.
Source: Urology 2003;61:348-353.
TUESDAY, March 11 (HealthScoutNews) -- Individualized programs are the best way to make nursing home residents feel truly at home, says a geriatrics expert at the Saint Louis University School of Medicine.
Research by Dr. William Banks suggests that one-size-fits-all programs -- games, pet interaction, music therapies, holiday celebrations -- don't necessarily make nursing home life more enjoyable for everyone. What one person loves, another may hate.
His findings appear in the current issue of Geriatrics and Aging.
One of Banks' studies examined whether visits by dogs and other animals -- called animal-assisted therapy -- makes nursing home residents feel less lonely. It does, but only for people who like animals.
For people who don't like animals, forcing this type of therapy on them would hardly make living in the nursing home more pleasant.
In the same way, people who love music would be soothed and fulfilled taking part in music therapy. However, people who dislike music would find that form of therapy more punishment than pleasure.
Banks' research also suggests that more isn't necessarily better. Even the nursing home residents who loved dogs felt overwhelmed by multiple animal therapy sessions each week. Banks found that a single 30-minute animal therapy session a week was sufficient to combat loneliness in nursing home residents.
Here's where you can find more about all kinds of senior health issues.
By Alison McCook
NEW YORK (Reuters Health) - Secondhand smoke is linked to a variety of health risks. On Tuesday, researchers added another one to the list: tooth decay.
Dr. C. Andrew Aligne and his colleagues discovered that kids between the ages of 4 and 11 who were exposed to a large amount of secondhand smoke were more than twice as likely to show signs of tooth decay as were kids with little to no secondhand smoke exposure.
"This is one more piece of evidence that smoking harms children," Aligne told Reuters Health. "And children should grow up in a tobacco-free environment."
He added that while the connection between secondhand smoke and breathing problems in children makes sense, some people--including doctors, dentists and caregivers--may be surprised to see the health effects of the habit extend to teeth, as well.
"This is not the kind of thing that people think of" in the context of the dangers of secondhand smoke, Aligne said.
"I think this finding is going to be surprising to just about everybody," he added.
Aligne is associated with Pediathink, a think tank that advises organizations about child health.
This is not the first study to show that the harms of smoking can extend to the teeth and gums, however. For example, researchers have shown that exposure to secondhand smoke increases the risk of gum disease in adults.
Working in the lab, investigators have also found that nicotine can increase the growth of the cavity-causing bacterium that lives in the human mouth.
In the current study, published in the March 12th issue of the Journal of the American Medical Association (news - web sites), Aligne and his colleagues from the University of Rochester in New York reviewed national data collected between 1988 and 1994 on 3,531 children.
The authors noted whether the children showed signs of tooth decay, and if they had elevated levels of cotinine, a byproduct of nicotine, in their blood.
More than half of the children had levels of cotinine in their bodies that suggested they had been exposed to secondhand smoke. Children with the highest cotinine levels also had twice the risk of cavities in their baby teeth.
This relationship persisted even when the researchers accounted for the influence of family income, the region where the children lived and how often they visited the dentist.
In an interview, Aligne said he suspected secondhand smoking exposure could make a child more cavity-prone because women who smoke while pregnant increase their child's risk of a number of health problems, including prematurity, low birthweight and chronic illness.
All of these health problems, in turn, can increase the risk of cavities in young children, Aligne said.
The study did not find any relationship between body levels of cotinine and the risk of cavities in adult teeth, a finding that suggests the effects of secondhand smoke on teeth likely occur when a child is very young, Aligne added.
And the large proportion of children exposed to secondhand smoke in the current study suggests that more needs to be done to protect children from this health risk, the researcher noted.
"We should be doing more to help parents who smoke...quit smoking," Aligne said.
Source: Journal of the American Medical Association 2003;289:1258-1264.
By Colette Bouchez
TUESDAY, March 11 (HealthScoutNews) -- Even if parents who smoke step out of the house to have a puff, they are still putting their children's health at risk, particularly if those children already suffer from asthma.
That's the finding of the first study ever to measure the dose-related effects of parents' cigarette smoke on their children.
"We've known for a long time that secondhand smoke is harmful to children with asthma, but what we didn't know was whether that harm was dose-related. We now know that it is," says study author Dr. Nathan Rabinovitch, an allergist at the National Jewish Medical Center in Denver.
Rabinovitch presented his findings at the annual meeting of the American Academy of Allergy, Asthma and Immunology now underway in Denver.
What made the study possible is a newly developed portable monitor capable of registering air pollutants in levels less than 2.5 microns in size. That's a microscopic 1/12,700 of an inch. The monitor was also small enough for the 40 children in the study, all of whom had moderate to severe asthma, to wear daily for four months.
Over the course of the study, the children took a twice-daily lung function test. After comparing lung function tests of all the children, the result was clear: "Children who lived in a smoking household registered significantly higher levels of 'particulate matter' in their lungs -- a measure of pollution-related damage -- than children of non-smoking parents," Rabinovitch says.
Further, he says, children whose parents step out of the house to smoke were exposed to 30 percent less damaging lung particles than those whose families smoked indoors.
But, he adds, their rate of exposure was still significantly higher than that of nonsmokers -- up to 70 percent more.
While there clearly is a dose-dependant effect to secondhand smoke, experts say parents should not take this to mean that a little smoke exposure is OK.
"Just because the damage was less if parents smoked outdoors doesn't mean there wasn't damage. And parents of children with asthma who continue to smoke in any capacity, even outside the home, have to realize they are purposefully putting their children in harm's way," says Dr. Zab Mohsenifar, executive vice chairman of pulmonary and critical care medicine at Cedars Sinai Medical Center in Los Angeles.
The truth is, Mohsenifar adds, exposure to even one cigarette is one exposure too many for a child with asthma.
According to Mohsenifar, the take-home message is clear: "Even if you limit your smoking to outdoors, you are still exposing your child to significant damage. If you love your child, you must stop smoking; there is no other answer," Mohsenifar says.
To learn more about asthma and secondhand smoke, visit The U.S. Environmental Protection Agency. To learn more about allergies visit the American Academy of Allergy, Asthma and Immunology.
NEW YORK (Reuters Health) - Black Americans are at greater risk of dangerous high blood pressure than whites, and should be treated earlier to help prevent heart attack or stroke, according to a new set of expert guidelines released Monday.
The International Society on Hypertension in Blacks (ISHIB) now recommends that African-American patients begin anti-hypertensive treatments when their blood pressure reaches 130/80 mm Hg--a full 10 points lower than the previous standard of 140/90 mm Hg, recommended by the federal government in 1997.
Blood pressures below 120/80 mm Hg are considered within a normal, healthy range.
"On average, one African American dies from high blood pressure every hour, yet barely a quarter of hypertensive African Americans has the disease under control," ISHIB president Dr. John Flack said in a statement.
Experts now estimate that one in every three African Americans is hypertensive, with blacks more likely to develop the condition earlier and progress more rapidly to severe high blood pressure than their white peers.
With this in mind, drug interventions aimed at black Americans should be administered "early and persistently," the ISHIB experts say. Their consensus statement is published this week in the journal Archives of Internal Medicine (news - web sites).
While combination drug therapy may be required to push blood pressure to manageable levels, doctors should also urge patients to take up heart-healthy lifestyles, such as diets high in fruits and vegetables and low in salt and fat, daily exercise and quitting smoking, the experts say.
According to Flack, his group issued the guidelines "to give health care providers the tools to manage high blood pressure appropriately in African Americans and save lives."
The recommendations are endorsed by the American Heart Association (news - web sites), the Association of Black Cardiologists, the Consortium for Southeastern Hypertension Control and the National Medical Association.
Source: Archives of Internal Medicine 2003;163:521-524,525-541.
By Shirley Mathews
TUESDAY, March 11 (HealthScoutNews) -- People who starve themselves in the pursuit of super-thinness are no more likely to die than others of the same age and sex, claims new research.
This finding, in the March issue of Mayo Clinic Proceedings, seems to fly in the face of previous studies that have shown those who have anorexia nervosa (news - web sites) have much higher death rates.
About one in 100 girls and one in 1,000 boys have the eating disorder, and up to 20 percent of anorexics starve themselves to death, according to the National Eating Disorders Association.
The difference in the latest research: The 208 people studied were in the general population and not in special care, explains study co-author Dr. Alexander R. Lucas, emeritus professor of psychiatry at the Mayo Medical School.
"What [this study] says is that in the community, you have a whole spectrum of people, and many of them get well," Lucas says. On the other hand, he stresses, that should not minimize the risks of severe anorexia.
"I don't want the study to be misinterpreted to seem that this is a benign disorder," he says.
Dr. L. Joseph Melton III, an epidemiologist at the Mayo Clinic and a study co-author, adds that hospitals or referral centers see "the severest patient" and "almost all of the [research] comes from referral centers."
However, Douglas W. Bunnell, president-elect of the National Eating Disorders Association, fears this study may be used by some patients to avoid dealing with the risks of their behavior.
"Patients with this disease often will minimalize the potential impact on their health," Bunnell says.
In the study, the researchers looked at the patient records of primary-care doctors in Rochester, Minn., from 1935 through 1989. If the patients met at least two of four criteria, they were classified as "definite," "probable" or "possible" cases of anorexia. The 193 women and 15 men who met the criteria were followed for up to 63 years and their survival rates were compared with white Minnesota residents of like age and sex.
More than 90 percent of the people the researchers diagnosed as anorexic were still alive 30 years after they first went to a doctor with symptoms of the disorder.
During the period of the study, 17 of the 208 people died; one died from complications of anorexia, two committed suicide and six died of complications of alcoholism. Other causes of death, such as heart attack, were normal for age and sex. The expected number of deaths in the other group was 23.7, according to the study.
Deaths due to alcoholism are common among people with eating disorders but have not been studied much, despite the fact the alcohol dependence is "over-represented among patients with anorexia nervosa," says the study.
Lucas says the medical records, in fact, showed only 39 percent of the group had defined anorexia, but he stands behind his diagnoses.
"The information may not have been on the charts for some of them," he says, noting, for instance, that one of the criteria was a fear of fatness or loss of control of eating. "I'm quite confident that they all had at least a mild form of anorexia nervosa." Few of the people studied were hospitalized or treated in a specialized outpatient center, and most of them recovered during the study period.
Lucas says he is not telling people they shouldn't get formal treatment, and he is advising doctors and people in general not to get complacent about this disease just because his study seems to say it's not as harmful as some other researchers have found.
Bunnell adds much larger studies are needed to prove these results before the findings can be generalized across the population.
"Culturally, these [eating disorder] diseases are seen as fairly frilly -- not all that important," Bunnell adds. "[But] these are very serious illnesses with serious long-term effects."
NEW YORK (Reuters Health) - Male firefighters may be more than four times more likely to develop testicular cancer than men in the general population, according to the results of a German study.
Testicular cancer is rare, but is the most common cancer in men ages 15 to 40.
The new findings are based on only a small number of testicular cancer patients who had ever worked as firefighters.
Still, the results echo those of a recent study from New Zealand that found a three-fold higher risk of the cancer among firefighters, according to Dr. Andreas Stang of the University Hospital of Essen and his colleagues.
They report the latest findings in the March issue of the American Journal of Industrial Medicine.
Stang's team looked at occupational exposures among 269 men with a history of testicular cancer and nearly 800 "controls" of the same age and region, but no history of the disease.
Three of the controls (0.4 percent) and four men with testicular cancer (1.5 percent) reported that they had ever worked as firefighters.
Firefighters had a roughly four-times greater risk of testicular cancer, even after accounting for other factors such as family history of the disease, according to the researchers.
"Although the association between firefighting and testicular cancer risk is based on only small numbers of exposed subjects in our study, the finding is consistent with a recent cohort study from New Zealand," Stang's team notes.
In that study, published in 2001, researchers found that firefighters may be three times more likely to develop testicular cancer than men in the general population. Their findings were based on cancer statistics from a group of 4,221 male firefighters.
The reason for the association remains unclear, but Stang and his colleagues point out that firefighters are exposed to a number of potentially cancer-causing substances in smoke, soot and the "combustion products" of burning synthetic materials.
Source: American Journal of Industrial Medicine 2003;43:291-294.
By Ed Edelson
TUESDAY, March 11 (HealthScoutNews) -- A new study finds high blood levels of the protein homocysteine are associated with congestive heart failure, and there are strong hints in the report that they cause the deadly condition.
That last point is crucial. The American Heart Association (news - web sites)'s official stand is that while several studies have established an association, high homocysteine levels "are not yet called a major risk factor for cardiovascular disease. We don't recommend widespread use of folic acid and vitamin B supplements to reduce the risk of heart disease and stroke."
But several aspects of the study, reported in the March 12 issue of the Journal of the American Medical Association (news - web sites), point toward a causal link, says study author Dr. Ramachandran S. Vasan, a senior investigator with the Framingham Heart Study in Boston.
First, measurements of homocysteine levels were taken before the participants, 2,491 men and women in the long-running study, began to develop heart disease. "Readings of high levels were obtained before the onset of heart failure, thus establishing a sequence," Vasan says.
And the association was strong, he says. The risk was double for people in the upper 50 percent of blood homocysteine levels than for those in the lower half, and quadruple for those in the upper 25 percent, compared to those in the lowest 25 percent, Vasan says. The risk was elevated even for women whose homocysteine levels are in the range now regarded as normal.
Finally, there is "biological plausibility" to back the belief that high homocysteine levels can cause cardiovascular disease, he says. For example, laboratory studies have shown that homocysteine can have adverse effects on the endothelium, the delicate tissue that lines arteries.
However, the key bit of evidence, a study showing that lowering blood levels of homocysteine will reduce the risk of heart disease, is missing, Vasan says, and that evidence will not be available for some time. There are studies designed to see if lowering homocysteine levels will reduce the incidence of stroke, but none aimed at heart disease, he says.
The new study is interesting because it is the first to link high homocysteine levels with heart failure, rather than heart attacks and other cardiovascular diseases, says Dr. Nieca Goldberg, chief of cardiac rehabilitation at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. She, too, points out "there is no data available saying that reducing blood homocysteine levels actually reduces the incidence of heart attacks or heart failure."
It is premature to tell people to take vitamin supplements to lower blood homocysteine levels, Goldberg says. She recommends that "people look at the vitamin B content of a lot of foods, particularly green, leafy vegetables."
"I do prescribe B vitamins in appropriate patients," Goldberg says. She explains she will prescribe them for some patients with elevated homocysteine levels even if they do not have the traditional risk factors for cardiovascular disease, such as high blood pressure or obesity.
However, this is a decision that must be made for each individual patient, Goldberg says. There is a chance that taking too much vitamin B can cause damage in some people, she says, so the thing to do is to "ask your doctor about it."
NEW YORK (Reuters Health) - Eating whole-grain foods such as fiber-rich breakfast cereals, brown rice, barley and oatmeal may cut a person's risk of type 2 diabetes, new study findings from Finland suggest.
The study of more than 4,300 adults found that those reporting the highest intake of whole grains were 35 percent less likely to develop type 2 diabetes than those with the lowest intake.
Much of this reduced risk seemed to stem from the whole-grain eaters' intake of fiber-rich cereals, researchers found.
Participants with the highest cereal-fiber intake were 61 percent less likely to develop type 2 diabetes during the 10-year study than were those with the lowest intake.
The findings, reported in the March issue of the American Journal of Clinical Nutrition (news - web sites), are based on an analysis of dietary and lifestyle habits of men and women ages 40 to 69. During the 10-year follow-up, 156 developed type 2 diabetes.
"We found a reduced risk of type 2 diabetes in persons with high whole-grain intake. This reduced risk was apparently due to cereal fiber intake," Jukka Montonen and colleagues at the National Public Health Institute in Helsinki report.
Type 2 diabetes, the most common form of diabetes, is often linked to obesity. Once seen almost exclusively in older adults, type 2 is on the rise among US adults and children, as is obesity.
Cutting overall calories, exercising and maintaining a healthy weight can prevent type 2 diabetes, but the effects of specific dietary components has been unclear, according to Montonen's team.
Type 2 diabetes arises when the body loses its sensitivity to insulin, a hormone that shuttles sugar from the blood and into cells to be used for energy. People with the disorder see their blood sugar levels soar, which over time can lead to complications such as heart and kidney disease and nerve damage.
It's thought that fiber might help combat type 2 diabetes in a couple of ways. Compared with simple carbohydrates like white bread, fiber-rich carbs are slowly digested and absorbed, leading to less insulin demand. And insoluble fiber speeds through the intestines, leaving less time for carbohydrates to be absorbed, the Finnish researchers explain.
However, they also point out that whole-grain foods contain a host of components other than fiber that might contribute to the lower diabetes risk they found.
Source: American Journal of Clinical Nutrition 2003;77:622-629.
TUESDAY, March 11 (HealthScoutNews) -- Researchers at the University of Pittsburgh Cancer Institute plan to study whether acupuncture can relieve symptoms and improve quality of life for people with advanced, terminal colorectal cancer.
They'll be randomly assigned to one of three groups. The first group will receive true acupuncture in which needles will be inserted at acupoints associated with emotional well-being.
The second group will be given sham acupuncture, receiving needles in areas of the body that aren't actual acupoints. The third group will receive the standard cancer care without acupuncture.
The final months of life for many people with terminal colorectal cancer can include many distressing physical symptoms such as pain, appetite loss, shortness of breath, nausea and vomiting. These physical symptoms can cause psychological distress and frequent hospitalization and can result in poor quality of life.
In acupuncture theory, disruptions in energy flow within the body or an imbalance between the complementary life energies known as Yin and Yang cause illness and disease. Acupuncture is used to correct these energy flow imbalances and to promote optimal health.
This is done by inserting thin surgical needles into specific points close to the surface of the skin to stimulate energy flow.
Here's where you can learn more about acupuncture.
LONDON (Reuters Health) - People with the immune disorder lupus might be able to reduce their symptoms with the fatty acids found in fish such as tuna and salmon, researchers in Northern Ireland said on Tuesday.
In what the scientists call the largest study of its kind, Dr. Emeir Duffy and colleagues studied the effect of fish oil supplements in 52 patients with active lupus over six months.
All the participants who took the fish oil saw improvements in quality of life, inflammation and fatigue, which is the most debilitating symptom of lupus, said Duffy, a biomedical scientist from the University of Ulster.
"Some found it fantastic, and they went from being severely affected in their daily life to actually joining the gym and having a huge difference in what they could do," she told Reuters Health.
"Others saw a mild improvement, being able to go out and do the shopping which is a big bonus to some people who can't even leave the house."
Systemic lupus erythematosus--commonly referred to as lupus--is a disorder in which the immune system attacks healthy tissue throughout the body, causing painful or swollen joints, unexplained fever, skin rashes, kidney problems, cardiovascular complications and extreme fatigue.
Lupus is a complex disease and the exact cause is unclear. There is currently no effective treatment to stop its progression, although steroids and other drugs are used to manage symptoms.
Recently, researchers have been looking at managing the disease through diet. The omega-3 fatty acids found in fish oils and some other foods have raised particular interest because they are thought to fight inflammation and affect immune function.
"We found that some patients taking steroids and taking the fish oils actually reduced their dose (of steroids) toward the end of the study," Duffy said.
Participants took either fish-oil supplements three times per day, a copper supplement, copper plus fish oil or a placebo. The copper was of no benefit, Duffy's team found.
She said people with lupus could get the benefits seen in her study by increasing their intake of fatty fish such as mackerel, lake trout, herring, sardines, tuna and salmon.
By Gary Gately
TUESDAY, March 11 (HealthScoutNews) -- Children who suffer depression and anxiety are likely to underestimate their abilities, says a new study.
And the effects are not fleeting: Even a year after suffering emotional distress, children were likely to view themselves and the world in a negative light, researchers report in the March/April issue of Child Development. Even if moods remained stable, the children's views of their abilities continued to slide, the study found.
The study tracked 932 Illinois elementary schoolchildren -- half boys, half girls -- for a year through three detailed tests given six months apart. The tests were designed to measure depression and anxiety levels as well the children's views of themselves and the world and their perceptions of their competency.
Researchers compared the children's perceptions of their academic competence with reality by assessing grades in all subjects.
Eva M. Pomerantz, the study's lead author, says children who suffer emotional distress typically blame themselves for failures, while attributing success to factors beyond themselves. For instance, a child might assume he got a good grade because his teacher was in a good mood.
These children also harbor uncertainty about whether they can meet established standards and suffer low self-esteem about their social skills, says Pomerantz, an associate professor of psychology at the University of Illinois at Urbana-Champaign.
"You hear about people wearing rose-colored glasses; well, this is sort of the reverse of wearing rose-colored glasses," Pomerantz says.
Children with depression or anxiety may be more vulnerable to feelings of inadequacy than adults with the conditions because kids are less likely to realize how moods influence thinking, Pomerantz says.
"Because children have not had the same experience as adults with managing their moods, they may not be as good at discounting the influence their moods have on them," she says. "Kids might be less likely than adults to say, 'It's not that I am bad; it's just that I am in a bad mood.'"
Beset by doubts about their abilities, such children tend to avoid pursuing challenging tasks.
"We think that once kids start to have these views of themselves, they pursue easy tasks and they say, 'Oh yeah, I succeeded at an easy task, but anybody could do that,'" Pomerantz says.
Such thought patterns can spiral, putting children at risk for "lifetime difficulties," she says. "They think, 'I don't have the ability to do well in school, I don't have the skills. I'm not even going to apply to college; nobody would accept me.'"
The study, focusing on children between grades 4 through 6, found girls more vulnerable to emotional distress than boys. Girls, in turn, were more likely to underestimate their abilities -- except in social situations because communication skills may keep girls from underestimating their social skills, the authors say.
The study cited earlier research suggesting that for some children, low self-esteem may lead to emotional distress, while for others, emotional distress may contribute to low self-esteem.
James E. Maddux, a clinical psychologist at George Mason University in Virginia, says the study establishes how lasting the effects of depression and anxiety in children can be.
"What's important to me is this idea that the experience of depression and anxiety apparently had an impact a year later on their beliefs about their ability to do very important things in life," Maddux says.
Self-doubt stemming from emotional distress can set the stage for a vicious cycle, he says. "If someone doesn't believe he or she can accomplish something," Maddux explains, "he or she gives up easily in the face of challenges and says, 'See, I failed.' So what you have is a self-fulfilling prophecy."
Maddux says parents should recognize that emotional distress can affect children's views of their abilities and look for signs that their children have lost some self-confidence or seem be falling short of their potential.
Parents can help by offering reassurance -- for instance, by telling their children mood can contribute to self-doubt, but their feelings aren't grounded in reality, and they haven't really lost any of their ability.
Most children who have brief or mild depression or anxiety will regain their confidence in their abilities, Maddux says. However, he says if a lack of confidence, lower grades, or social isolation persists for more than six months or a year, it might be time to consider counseling for the child and parents.
Visit the American Academy of Child and Adolescent Psychiatry for more on childhood depression and anxiety. Or read about about the prevalence of childhood anxiety disorders.
By Alison McCook
Among men younger than 55 who'd had their prostates removed due to cancer, researchers found that current smokers were more than three times as likely as non-smokers to be diagnosed with an advanced form of the disease.
The risk of advanced disease was also increased for men who had smoked during the 10 years before surgery, the authors note--suggesting the risks of smoking may persist for many years.
What's more, the longer the men had smoked before surgery, the more likely they were to have higher-risk prostate cancer, Dr. William W. Roberts and colleagues at Johns Hopkins University in Baltimore, Maryland, report in the Journal of Urology.
"It's another reason why people shouldn't smoke," Roberts told Reuters Health.
Roberts and his team surveyed 498 men who had undergone surgery to remove their prostates between 1992 and 1999. Respondents gave information about their health habits, including whether they smoked before or during the year of their surgery.
The information was compared with analyzes of their prostates, completed after the tissue was removed, to determine whether patients had a form of the disease that was at risk of recurring.
High-risk cases were those that were graded highly on a scale of disease severity, or those that were deemed "extraprostatic," meaning they had spread outside the prostate, but not to distant sites in the body.
According to Roberts, extraprostatic prostate cancer is considered an advanced form of the disease because the cancer is more likely to recur once the prostate has been removed.
Despite the new findings, though, Roberts cautioned that the study is based on the men's ability to recall how much they had smoked in the past, a method that is often unreliable.
As such, he said the findings are only "suggestive" that smoking ups the odds of higher-risk prostate cancer, and further research is needed.
Still, there is reason to believe smoking could directly promote more-advanced disease, according to the researchers.
For example, a protein called GSTP1 appears critical in eliminating certain tobacco-smoke toxins from the body, and one of the hallmarks of prostate cancer involves the inactivation of this protein.
So in theory, Roberts said, men who have prostate cancer and also smoke might experience an increase in toxic compounds in their bodies, which could, in turn, render their cancer more advanced.
Source: Journal of Urology 2003;169:512-516.
(HealthScoutNews) -- Fitness balls are the latest hot exercise tool, and for good reason: they make you work muscles that are otherwise easy to neglect.
Fitness balls place the emphasis on the muscles in the trunk -- including the abdominal, chest and back muscles -- according to the Mayo Clinic. They work by constantly changing the base of your body's support. So by challenging your balance, just sitting on the ball becomes an exercise.
Use the ball for abdominal curls, modified push-ups or other exercises you normally do on a gym mat. A slightly deflated 55- or 65-centimeter ball works best for most people.
LOS ANGELES (Reuters) - Zapping tumors with high-heat microwaves before a lumpectomy may sharply reduce the chance that a woman with early-stage breast cancer (news - web sites) will need disfiguring surgery, according to preliminary research.
In an early-stage study, 24 out of 25 patients treated with the experimental microwave therapy had no remaining cancer cells in the affected area, said Dr. Hernan Vargas, chief of surgical oncology at the University of California at Los Angeles Harbor Medical Center and the study's lead investigator.
With a standard lumpectomy, only 20 percent to 25 percent of patients get that result and many of the remaining patients will need further surgery, Vargas said in a statement.
The Phase 1 trial results were presented in Los Angeles on Saturday at a meeting of the Society of Surgical Oncology.
"The theory is, why bother to cut out a cancer if you can destroy it with heat? ... the big problem is that with invasive breast cancer about one out of every five patients will still have cancer that's not detectable without a tissue sample for a pathologist to analyze," said Dr. Scott Karlan, a breast surgeon at Cedars Sinai Medical Center in Los Angeles.
Typically, when a woman has breast cancer, she undergoes a lumpectomy to excise the cancer. Women with more advanced tumors need to have the entire breast removed in a mastectomy.
The focused microwave technology is designed to work by heating and destroying cancer cells, while not harming healthy cells, which contain far less water and are therefore less susceptible to damage from heat.
The most common side effects of the treatment were pain, redness and swelling, but one patient was burned and had skin necrosis.
"If proven effective, this treatment would mark a significant step forward in the treatment of breast cancer and breast conservation," Vargas said.
Karlan said the technology would offer a lot of promise in terms of simplifying treatment of breast cancer, but it is not designed to improve cure rates.
The system was developed by Celsion Corp. using microwave technology licensed from the Massachusetts Institute of Technology (news - web sites) and derived from "Star Wars" defense technology for detecting and destroying missiles.
The software used to focus microwaves for tracking the trajectory of missiles was reconfigured to aim the electromagnetic waves directly at malignant tumor cells.
A fully randomized Phase II clinical trial is currently under way comparing the microwave heat therapy and lumpectomy with lumpectomy alone for early-phase breast cancer.
Celsion is also conducting a study using a combination of its microwave technology and chemotherapy to shrink large, advanced-stage breast tumors, currently indicated for radical mastectomy, with the goal of shrinking the breast cancer lesion so that a breast-conserving partial mastectomy or lumpectomy can be performed instead.
Here are some items to include:
to the Top
By Paula Moyer
DENVER (Reuters Health) - Even well-informed parents of children who have suffered severe allergic reactions may not use the antidote when such life-threatening reactions reoccur, according to Canadian researchers.
This may be because parents don't appreciate the danger of these allergic reactions, known as anaphylaxis, or because they deny this danger, the researchers reported here Saturday at the American Academy of Allergy, Asthma and Immunology's annual meeting.
"The challenge facing parents of these children is to accept the severity of the child's illness," study author Dr. Janet Roberts of the University of Manitoba Children's Hospital told Reuters Health.
"Parents have to act against their instincts," she said. "When a child with this history has any symptoms in addition to hives, parents need to make themselves use the medication immediately and then seek medical care."
Anaphylaxis can involve blood pressure drops, difficulty breathing and nausea and vomiting. Because such reactions can progress rapidly and may be fatal, people who have had them are advised to keep the antidote, a preloaded injection of epinephrine (EpiPen), on hand at all times, to use it immediately if a reaction occurs and then to seek emergency medical care.
Roberts and her colleague Dr. D. J. Delay noted that even well-informed parents often fail to use the EpiPen when needed. To investigate why, they mailed a questionnaire to members of a support group for parents of children with anaphylaxis.
Among the 75 respondents, 41 reported that their children had had a severe allergic reaction since they had received an epinephrine prescription. But 30, or 72 percent, of these parents did not use the EpiPen to treat the reaction. Seventy-two percent said they didn't use the drug because they felt their child's reaction wasn't serious enough.
Eight went immediately to the hospital, which was near their home. In six cases, a new substance had caused the reaction, and the parent did not understand that the treatment was to be used for all such reactions, regardless of the cause.
In other cases parents were concerned about the drug's side effects or the pain of the injection. Some reported that the syringe was not accessible, that medical personnel had advised them not to use it, that the child was frightened or that they were uncertain whether the child's symptoms were allergic in nature.
Despite the parents' perception that the reactions were too mild to warrant treatment, 22 (73 percent) of the children had symptoms such as respiratory distress, difficulty talking or swallowing, vomiting or abdominal pain or lethargy, all of which indicate a severe allergic reaction, Roberts said.
In other research presented at the meeting, investigators found differences between adolescents and their parents in their attitudes toward the child's food allergies.
Sally A. Noone of Mount Sinai Hospital in New York and colleagues surveyed 37 adolescents with food allergies, and their parents.
While all parents reported that their children had epinephrine prescriptions, parents were less likely than the teens themselves to say that a child would self-administer the treatment when needed.
Half of the teens said that they had been harassed about their allergies, and nearly half said that their social activities were curtailed due to their allergies.
The teens said that the hardest part of their disease was the social isolation; for parents, the hardest part was fear and worry that their child could die.
By Lindsey Tanner
CHICAGO - Most blacks with high blood pressure need aggressive treatment, including at least two drugs to effectively control hypertension, new guidelines say.
The recommendations from the International Society on Hypertension in Blacks are billed as the first-ever high blood pressure guidelines specifically for blacks, who are disproportionately affected by hypertension and related complications.
But the new guidelines could be applied to anyone with hypertension and high-risk conditions including diabetes and kidney disease, said Dr. John Flack of Wayne State University, the society's president.
"Good hypertension treatment is good hypertension treatment, irrespective of race," Flack said.
The guidelines appear in Monday's Archives of Internal Medicine (news - web sites). They have been endorsed by several medical groups, including the American Heart Association (news - web sites)'s Council on High Blood Pressure Research.
"This represents a huge problem, and we believe that the recommendations ... will result in a reduction of this huge burden of disease on African-Americans," said Dr. Ernesto Schiffrin, chairman of the AHA council.
About 50 million Americans have high blood pressure, including more than a third of black men, compared with about one-fourth of white and Mexican-American men. Black women are also disproportionately affected.
Blacks in general are more likely than whites to suffer related complications. They face nearly double the risk of fatal strokes and a four times higher risk of severe kidney disease.
The reasons for the disparities are uncertain, though some researchers think genetics and lack of access to health care may play a role.
Doctors generally recommend that otherwise healthy patients keep their blood pressure under 140 over 90. This can often be achieved through diet and exercise.
The new guidelines say blacks with diabetes, heart disease or mild kidney disease should strive for a reading lower than 130 over 80, and most will not be able to achieve that without taking at least two blood pressure-lowering medications, Schiffrin said.
The guidelines say two medications should be used when hypertension significantly exceeds those target levels. That involves levels at least 15 points above the desired top reading (systolic pressure) and 10 points higher than the bottom reading (diastolic) pressure. For example, black diabetics (news - web sites) should use two medications if their blood pressure is 145 over 90 or higher.
Flack said about 70 percent of blacks with hypertension, compared with about half of whites, would require at least two drugs to lower blood pressure. The recommended drug combinations include diuretics with beta blockers or ACE inhibitors, he said.
On the Net:
American Heart Association: http://www.americanheart.org
By Maggie Fox
WASHINGTON (Reuters) - If people would quit smoking, eat more healthily and exercise, cancer deaths could be cut by nearly a third, a report issued on Monday said.
It said the biggest cuts would come in lung cancer, the No. 1 cancer killer in the United States and many other countries, and colon cancer, the No. 3 killer.
"What's new here is the growing body of evidence confirming that interventions that get people to change their behaviors do work," Susan Curry of the University of Illinois at Chicago, who helped write the report, said in a statement.
The American Cancer Society (news - web sites) says nearly 1.3 million Americans were diagnosed with cancer and 500,000 died from cancer in 2002. Cancer is the second leading cause of death in the United States, after heart disease.
Curry noted it is very difficult to make the changes needed to lower cancer rates. The American Cancer Society and other groups focused on cancer prevention recommend a diet based on plant foods such as fruits and vegetables and whole grains, which many Americans are reluctant to adopt.
Colon cancer, for example, which kills 57,000 Americans a year, is linked to a diet rich in fat and red meat, as well as to smoking. Colonoscopies and other methods of cancer screening can catch colon cancer early, while it is still easy to cure.
Quitting smoking could prevent virtually all cases of lung cancer, which was a relatively uncommon disease before cigarettes became popular. Deaths among men from lung cancer have dropped markedly, although rates among women, who started smoking more in recent decades, are still rising.
"Although personal experience illustrates for most people the great difficulty of achieving sustained behavioral change, Americans have made substantial improvements in their health habits in the past few decades," the report said.
The institute, which advises the federal government on health issues such as vitamin intake and health insurance, recommends stricter enforcement of tobacco laws--especially sales on the Internet, where minors can easily obtain products.
Taxes on tobacco are "the single most effective method for reducing the demand for tobacco," the report said.
Health and Human Services (news - web sites) Secretary Tommy Thompson earlier this month rejected an HHS committee's recommendation to raise federal cigarette taxes by $2 a pack to discourage smoking and fund stop-smoking programs.
The report also recommended that insurers--including Medicare and Medicaid--pay for cancer prevention and detection services that have been shown to work, such as nicotine replacement therapy, breast cancer (news - web sites) screening for women age 50 and older, cervical cancer screening for all sexually active women and colon cancer screening.
By DeeAnn Durbin
WASHINGTON - Black Americans are buckling their seat belts at the highest rate ever, the government says, after years of using them less than drivers in general.
Blacks were using seat belts in 2002 about three-fourths, or 77 percent, of the time, according to a report released Monday by the National Highway Traffic Safety Administration (news - web sites). Overall, the U.S. population is buckled up 75 percent of the time.
NHTSA administrator Dr. Jeffrey Runge released the data at a highway safety conference in Chicago on Monday. Runge said the increase is the result of years of work in the black community.
"This is extremely heartening and will quickly result in fewer deaths to our citizens," Runge said. The numbers were the highest for black drivers since NHTSA's traffic surveys began nine years ago.
Joseph Akers, director of special projects for the National Organization of Black Law Enforcement Executives, said NHTSA reached out to a number of black groups in 2000 after it found blacks were buckling up 69 percent of the time.
Akers said many blacks have been reluctant to support tougher seat-belt laws because they felt they would be used for racial profiling. But he said statistics about accident fatalities among blacks have changed many peoples' minds.
In its latest report, NHTSA also found that the gender gap is closing, but that females still buckle up more often than males. About eight in 10 females used seat belts in the 2002 survey, while about seven in 10 males were wearing them.
About two-thirds, or 65 percent, of males riding in pickup trucks were buckled up. Females were buckled up 80 percent of the time in cars, 82 percent of the time in vans and sport utility vehicles and 71 percent of the time in pickups.
NHTSA found that seat belt use was rising in rural areas, to 73 percent. That was a five percentage point gain from 2000.
Last month, NHTSA reported that 99 percent of infants, 94 percent of 1- to 3-year-olds and 83 percent of 4- to 7-year-olds were riding with seat belts. That was higher than 2000 levels, when 95 percent of infants and 91 percent of toddlers were buckled up. The agency didn't measure seat belt use among children ages 4 to 7 in 2000.
Belt use among 8- to 15-year-olds was at 82 percent in 2002. But belt use dropped off among 16- to 24-year-olds, where the rate was 69 percent in both 2000 and 2002. That age group had the lowest level of seat belt use of any group.
NHTSA observed drivers and passengers during a 20-day period beginning June 3, 2002. Observers collected data on 37,900 vehicles at 1,100 intersections throughout the nation. They observed 37,900 drivers and 11,600 passengers, including 38,100 whites, 6,000 blacks and 5,400 other individuals.
Runge has said that the best way to increase seat belt use is to pass primary enforcement laws in all 50 states. Eighteen states and the District of Columbia now have primary enforcement laws, which allow officers to ticket people who aren't wearing seat belts. Most other states allow police to issue seat belt citations only when drivers are pulled over for other offenses.
On the Net: NHTSA: http://www.nhtsa.dot.gov
By Gene Emery
BOSTON (Reuters) - Life-threatening reactions to peanuts may soon be a thing of the past for millions of people around the world who are allergic to the legume, researchers said on Monday in a finding that may also help prevent allergic reactions to other foods.
An experimental treatment that involved monthly injections successfully muted the severe reactions of people who risk death if they ingest the slightest amount of peanut protein, according to a study this week in the New England Journal of Medicine (news - web sites).
"This is a huge advance for patients. Now they have something they can do in advance to protect themselves from accidental exposure," Hugh Sampson, one of the study's authors, told Reuters. "It allows them to go around and not be scared of their food. It really lifts a cloud."
Approximately 1.5 million Americans are allergic to peanuts, and 50 to 100 people in the United States die each year from anaphylactic shock after being exposed to the legume.
Peanut allergy can be so severe that people have been known to develop symptoms after eating just 1/2,000th of one peanut or kissing someone who has eaten peanuts.
Scientists who released the results of the study at the American Academy of Allergy, Asthma and Immunology conference in Denver said the medicine is not be a green light to eating peanuts.
"It increases the threshold of sensitivity to the peanut from accidental ingestion," said another of the study's authors, Donald Leung, head of pediatric allergy-immunology at the National Jewish Medical and Research Center in Denver.
Even if people with the allergy do all they can to avoid peanuts, it's not always enough. Schools or day care centers may not be fully aware of the problem and waiters may not have enough information about ingredients.
"Peanuts can be used to thicken brown gravy, or in pie crusts or even to hold an egg roll together," said Anne Munoz-Furlong, founder of the non-profit awareness group Food Allergy & Anaphylaxis Network. In some cases youngsters are teased about the allergy, she said.
The study will appear in Thursday's New England Journal of Medicine.
The treatment allowed volunteers who would normally develop symptoms after consuming a single peanut to eat an average of eight peanuts before experiencing nausea, pain, vomiting, hives, throat tightness or other symptoms.
And because the shots block the chemical pathway responsible for other types of food allergies, the treatment may help people allergic to eggs, cats, dogs and other types of nuts, according to the study.
However, the treatments didn't work for everyone and it may take a while for the therapy to get to consumers. Final testing has been halted because three companies are in court squabbling over rights to the treatment.
The study, which looked at the reactions of more than 80 volunteers who received four monthly shots, focused on peanuts because the legume is the leading cause of fatal and near-fatal reactions in the United States, said Sampson, of the Mount Sinai School of Medicine in New York.
In the study, only the patients who got the highest dose of the antibody showed significant improvement, and the treatment cut sensitivity to peanuts in 76 percent of those volunteers.
But in 24 percent of those cases, the volunteers were able to consume the equivalent of 24 peanuts before showing signs of a reaction.
Scientists have experimented with traditional allergy shots in the past, but the rate of side effects has been too high.
The drug would have to be taken throughout a person's life because it doesn't completely block the allergic reaction. The next round of tests could help researchers develop a better dose that makes the injections even more effective, according to Sampson.
But those tests, expected to lead to Food and Drug Administration (news - web sites) approval in three or four years, are now even farther off because of U.S. litigation that pits Tanox Inc. against Novartis Pharma AG and Genentech Inc. over development rights for the treatment.
Tanox paid for the study and three Tanox researchers are among the study's authors.
By Ira Dreyfuss
WASHINGTON - For older exercisers, effort counts.
At least that's what a large Harvard study of heart disease in older men showed.
It found that those who thought their workouts were hard had a lower risk of coronary heart disease, even though the amount of energy they burned was below minimum federal guidelines.
"Are they getting any benefit? The bottom line is yes, they are," said researcher I-Min Lee of the Harvard School of Public Health. Even though the study involved only men, Lee said the study could be applied to women as well.
The study suggests that older people may be able to do less exercise and get heart health benefits — provided they feel they are working hard. The findings were published in February in the American Heart Association (news - web sites) journal Circulation.
Researchers looked at 7,337 men in the long-running Harvard Alumni Health study. The scientists examined questionnaires from 1988-95 from men who had an average age of 66. In the study period, 551 developed coronary heart disease, a narrowing of the small blood vessels that feed the heart.
In the questionnaires, the alumni listed their physical activities. The researchers then estimated how much energy the men probably used in doing them. Those results were tallied in METs — multiples of resting metabolic rate, or the amount of energy a person uses just to sit quietly.
Sitting quietly is 1 MET; walking briskly would be about 4 METs, and jogging a mile in 12 minutes would be 6 METs.
The men rated the difficulty levels of the exercise on a 1-10 scale with 10 being the most difficult.
Researchers focused on the men whose workouts were at or below 3 METs, because the 3-to-6 MET range is the minimum energy expenditure that federal exercise recommendations consider healthful, Lee said.
Looking at this low-MET group, the scientists compared men whose activities felt hard to those who felt their activities were easy.
The ones who rated their intensity at 5 on the 10-point scale had a 31 percent lower rate of coronary heart disease than did men who rated their intensity at .5.
"The ones who felt they were exercising hard did better than ones who felt nothing," said Lee.
The results make sense because the cardiovascular system is sensitive to increased effort, said scientist William Haskell of Stanford University, who was not part of the research team.
If a person's fitness level is low at the start, then a strong effort can create a training effect, he said. Training that feels hard can be enough to increase the heart's ability to pump more blood with each beat, and also could reduce cholesterol levels, he said.
Lee said she did the study to see if people who do less than the METs targeted in the recommendations would still get some benefit. However, neither she nor Haskell believe people should try to get by on less. For one thing, a higher metabolic rate means more calories are burned — and weight can be lost.
But current MET standards don't adequately account for the slowing of metabolism that comes with age, Lee said. The guidelines are based on the bodies of younger adults who have higher metabolic rates that could run at 3 to 6 METs in moderate exercise, she said.
Lee said older people would feel they are working just as hard at lower METs.
Although the science behind the exercise recommendations is based in part on METs, the guidelines themselves are written in language based on ratings of perceived exertion. Because people can't keep track of their METs, the guidelines call for at least moderate exercise for a minimum of 30 minutes on most days of the week.
Lee would not change the wording. The recommendations are easy to understand and widely applicable — and even older exercisers who won't reach 3 to 6 METs still could find their efforts rewarded, she said.
On the Net
Federal guidelines http://www.cdc.gov/nccdphp/sgr/sgr.htm
Abstract of Circulation article: http://circ.ahajournals.org/cgi/content/abstract/107/8/1110
LONDON (Reuters) - A high-fat, low carbohydrate diet can drastically cut seizures in children with severe epilepsy and could reduce the need for medication if it was used more widely, British doctors said on Monday.
After three months on the diet, Dr. Helen Cross and researchers at Great Ormond Street Hospital in London said there was a 50 percent reduction in seizures in half the 14 children following the diet and a 75 percent drop in four youngsters.
"The early findings of this study and others demonstrate that the diet does actually work, with often dramatic effect, in reducing seizures," Cross said in a statement.
"If this diet was introduced more widely across the UK it could have widespread benefits in the future by reducing the need for medications," she added.
But Cross said that only a handful of dietitians in Britain have the expertise and resources to provide the diet, which was first developed in the 1920s and is individually calculated for each child.
The diet alters the body's metabolism by replacing glucose with fats as a major energy source. When the fat is broken down it produces ketone bodies that help to reduce seizures.
Most of the parents of the children in the study reported an improvement in the awareness and responsiveness of the youngsters.
Cross and her colleagues plan to recruit 120 children for the study, which will be the biggest of its kind in Britain, and will compare two different ways of giving the diet to determine if one if better than the other.
Half of the children will be given the classic ketogenic diet, in which the fat comes from cream, butter and oil. The remainder will have a slightly altered version that includes some fat from foods and some from a supplement.
The researchers said the effect of the diet varies among children, but it appears to work in a significant proportion of kids.
"It should be established as a recognized alternative treatment for any child with challenging and resistant epilepsy," Cross added.
Epilepsy is a disorder of the central nervous system caused by excessive local stimulation in the brain that leads to recurrent seizures.
By Lindsey Tanner
CHICAGO - Disabling chronic health conditions are more prevalent and have risen at a faster rate in black children than in whites nationwide, a disparity largely explained by poverty, a study suggests.
The results are based on annual national health surveys from 1979 to 2000 that asked parents whether their children had chronic ailments that interfered with daily life. Data on 419,843 children were analyzed, including 22,758 identified by their parents as having a disability.
The ailments were not identified but would include any chronic condition that is physically or mentally disabling, such as asthma, diabetes, mental retardation and learning difficulties, said researcher Paul Newacheck of the University of California at San Francisco.
The prevalence of disabling conditions increased 47 percent over the years in whites and 77 percent in blacks. By 1999-2000, 67 out of 1,000 black youngsters and about 60 out of 1,000 whites had disabling conditions, and blacks were 13 percent more likely to be afflicted.
In 1979, the rate was about 40 out of 1,000 for both blacks and whites.
In the new survey, poor children were twice as likely to have reported disabilities. Lack of access to health care and treatment probably contribute to the disparity, Newacheck said.
The researchers did not determine why disability rates appeared to increase in both blacks and whites. But the reasons could include increased awareness about some conditions or changes in parents' attitudes about their children's health, Newacheck said.
The researchers acknowledged several limitations in the study, including the survey's subjective nature and the possibility that black and white parents have differing perceptions about the effect of chronic conditions on their children's lives.
The study appears in the March issue of Archives of Pediatrics and Adolescent Medicine, published Monday.
Differing parents' perceptions would probably result in underreporting, not overstating, of health disabilities by black parents, said Gregg Haifley, deputy director of health at the Children's Defense Fund
Poorer children with disabling conditions are less likely to have been diagnosed or treated, and their parents probably would not label them disabled without a diagnosis, Haifley said.
Newacheck said the poverty link shows "that's really where we ought to be focusing our efforts, limiting those disparities by income, if we really care about the health of children."
Dr. Michael Macknin, head of general pediatrics at the Cleveland Clinic, said the findings echo other research suggesting that blacks are disproportionately affected by some chronic conditions such as asthma and obesity.
Whether genetics and other factors might also affect racial health disparities needs more study, but there is no question that poverty contributes, said Steve Hornberger, director of behavioral health at the Child Welfare League of America, a nonprofit advocacy group.
"Poverty means that children and families are living with the least that this society has to offer — the least good housing, the least good access to public services, the least economic resources," he said.
Blacks living in poverty tend not to use preventive health care services or to have regular doctors, he said.
On the Net:
By Jesse J. Logan
NEW YORK (Reuters Health) - The editors of a major medical journal are calling for stringent regulation of dietary supplements, after a new study cited the potentially dangerous effects of the weight-loss supplement ephedra.
Dietary supplements, the editorial said in part, "are widely promoted, often with unsubstantiated claims of benefit and rarely with any mention of potential hazards."
The editorial was spurred by the results of a RAND Corporation study that found limited benefit from the use of ephedra and also found that the stimulant, touted as a weight loss treatment and athletic performance enhancer, could have a potentially life-threatening effect on the nervous system and heart.
The Food and Drug Administration (news - web sites) currently classifies ephedra as a "dietary supplement." Under the Dietary Supplement Health and Education Act of 1994, dietary supplements do not have to undergo pre-market safety evaluations with the FDA.
However, Dr. Phil Fontanarosa, executive editor of JAMA, said the new study is "sufficient evidence" to restrict the use of ephedra and regulate it with similar oversight as over-the counter medications or prescription drugs.
While the FDA has reportedly sent warning letters to ephedra manufacturers instructing them to remove unproven claims from their product labels and proposed a "black box" warning--the strongest type of warning on a drug label--indicating serious adverse effects and deaths, JAMA editors claim "major" regulation changes are needed.
"The current system for regulation of dietary supplements is inadequate for ensuring the protection of the health and safety of the public who choose to use ephedra and other dietary supplements," Fontanarosa and colleagues write in a JAMA editorial.
They suggest the FDA re-examine dietary supplements, subject products making health claims to "rigorous" regulation, enforce "mandatory" reporting of adverse events and ensure advertising "is accurate and not misleading."
"They're saying dietary supplements need to be regulated like drugs and we would disagree with that," Wes Siegner, legal counsel for the Ephedra Education Council, told Reuters Health. He argued that the Dietary Supplement Health and Education Act of 1994, if enforced, would guarantee the safety of products. "Our view is that (the law) hasn't been implemented yet. The FDA hasn't enforced it. When that happens there won't be any issue."
MONDAY, March 10 (HealthScoutNews) -- If you sometimes have questions about the safe use of prescription and over-the-counter medications, there's a new brochure to help you.
Think It Through: A Guide to Managing the Benefits and Risks of Medicines is now available from the U.S. Pharmacopeia's Center for the Advancement of Patient Safety.
The eight-page brochure provides consumer information on five critical steps in making informed decisions and safely using medications. Those steps are: talk, know, read, avoid, monitor.
No medicine is entirely risk-free and these five steps help consumers lower the risks and get full benefit from medications.
Here's what the brochure says:
Here's where you can get a free copy of the brochure.
NEW YORK (Reuters Health) - Despite recent advances in screening and treatment for colon cancer, the number of people dying from the disease has remained steady since the late 1980s, new study findings show.
"The lack of progress is disturbing, and indicates that much work needs to be done," write the study's authors, a team of researchers from Baylor College of Medicine in Houston, Texas and the University of North Carolina at Chapel Hill.
Cancer of the colon or rectum is the fourth most common cancer among both men and women in the US.
In their report, which is published in the American Journal of Gastroenterology, Dr. Linda Rabenek and colleagues evaluated US data on colon cancer between 1986 and 1997. During that time period, 144,284 individuals were identified as having colon cancer.
Overall, the annual number of cases of colon cancer fell between 1986 and 1997, according to the report. But when the researchers evaluated the data based on race they found that this drop was largely skewed toward white men, with colon cancer rates remaining unchanged among African Americans
Most disheartening, the researchers report that the number of patients surviving 5 years after their cancer diagnosis did not improve, for any race.
"Despite the advances in screening and treatment that have occurred in the past decade, no survival benefit has occurred to date," they conclude.
Colorectal cancer screening methods include testing to identify blood in the stool, colonoscopy and sigmoidoscopy. Currently, the Centers for Disease Control and Prevention (news - web sites) recommends that everyone over 50 have a fecal occult blood test once a year, a colonoscopy once every five years and a full x-ray of the colon every 10 years.
Source: American Journal of Gastroenterology 2003;98:471-477
(HealthScoutNews) -- Bedbugs are making a comeback after being virtually eradicated in 1950s and 1960s. And according to New Scientist.com, second-hand furniture sales are largely to blame for the return of the little critters.
The bugs can hide in telephone handsets, electrical goods and inside crevices in wooden furniture. They feast on human blood, leaving itchy skin bumps in their wake.
So when you buy second-hand goods, check for telltale specks -- deposits left by the bedbugs before they nestle in to digest their meal -- near crevices. The specks have a sweet "peppermint" or "musty" odor.
NEW YORK (Reuters Health) - Another study has found that moderate caffeine consumption by pregnant women is not likely to harm the developing fetus.
"This study provides reassurance that moderate caffeine consumption during pregnancy does not meaningfully influence fetal growth," write Dr. Michael B. Bracken of Yale University School of Medicine in New Haven, Connecticut and colleagues.
"Large amounts of caffeine should be avoided, but we found no evidence of risk from consumption of decaffeinated coffee," they add in the March issue of the American Journal of Epidemiology.
But serious effects could be seen among women who drink six or more 10-ounce cups of coffee daily, they add. The findings mirror research released last month by Danish researchers that found pregnant women who drank four cups of coffee daily or more were at greater risk of having a stillborn child.
In the current study, researchers asked nearly 2,300 pregnant women in Connecticut and Massachusetts about their caffeine consumption, and tested their urine for caffeine.
The investigators found that caffeine consumption did not increase the risk of low birth weight or preterm delivery, and had no effect on fetal growth in the womb.
But the researchers did see a relationship between caffeine consumption and birth weight, with weight reduced by 28 grams (just under one ounce) for every 100 milligrams of caffeine consumed daily, the equivalent of about one cup of coffee.
The reduction, the researchers say, is unlikely to have any clinical effect, except among women consuming 600 milligrams of caffeine (6 cups of coffee) daily or more.
Much larger effects were seen for women who smoked during pregnancy, the researchers note. Those who smoked 10 cigarettes daily cut their baby's birth weight by about 180 grams (6.3 ounces), while babies of women who smoked a pack of 20 cigarettes a day weighed about 360 grams (12.7 ounces) less than newborns whose mothers didn't smoke at all.
Source: American Journal of Epidemiology 2003;157:456-466.
(HealthScoutNews) -- If your snack attacks are defeating your efforts to lose weight, try making healthier picks the next time the munchies sneak up on you, advises Acadia University in Nova Scotia, Canada.
Here are some snack tips:
to the Top
NEW YORK (Reuters Health) - A 13-year-old girl who was born with heart disease contracted a life-threatening infection of the membrane lining her heart soon after having her navel pierced, Michigan doctors report.
While there are no existing recommendations on whether people with such congenital heart conditions should take antibiotics preventively before having a piercing or tattoo, the researchers note, the girl's case suggests that they should be warned about the risks of such infections, known as endocarditis.
Infective endocarditis, currently the fourth leading cause of infection-related death in the United States, occurs when bacteria or fungus colonizes the valves of the heart. If left untreated, it can lead to a fatal destruction of heart muscle.
In recent years, there have been repeated reports of people developing infectious endocarditis after body piercing, the authors note. But this is the first case of a person with a history of congenital heart disease developing the condition after navel piercing, they add.
People with heart-related abnormalities are advised to take antibiotics whenever they are having invasive procedures, such as surgery or dental work, because bacteria can gain access to the bloodstream. Once inside the body, the bacteria can take hold in the heart, causing endocarditis.
Writing in The Pediatric Infectious Disease Journal, Drs. Jason B. Weinberg and R. Alexander Blackwood of the University of Michigan Medical Center in Ann Arbor report on the case of the 13-year-old girl, who became seriously ill one month after piercing her own navel.
The girl went to her doctor when she became very ill with a fever and was admitted to a pediatric intensive care unit. The doctors learned that the girl had been born with a heart malformation that was surgically corrected when she was 3 years old. The girl reported having pierced her navel a month prior to her illness, but said she removed the navel ring two days after performing the piercing because she thought it looked infected.
Tests identified an infection with Staphylococcus aureus in one of the valves in her heart. The girl was treated with antibiotics as well as heart surgery and was released from the hospital after 22 days.
Since piercing of the navel and other parts of the body do carry a risk of endocarditis to patients born with heart malformations, the researchers note, these patients should be warned of this potential complication, as well as other more common piercing risks.
Source: The Pediatric Infectious Disease Journal 2003;22:94-96.
By Kathleen Doheny
MONDAY, March 10 (HealthScoutNews) -- Even if your home looks clean, chances are good you've got mold, often at levels high enough to trigger allergy and asthma attacks.
That bit of dour news comes courtesy of a new study that also found the mold is frequently in areas most people don't associate with it -- windowsills, for instance.
After surveying 160 homes in seven U.S. cities, Kelly A. Reynolds of the University of Arizona, Tucson, found that 100 percent of the homes tested positive for mold on some inside surface.
"On average, four sites per house were positive for mold," says Reynolds, who presents her findings March 10 at the annual meeting of the American Academy of Allergy, Asthma and Immunology in Denver.
Although 96 percent of the homeowners in the study knew mold could be a problem, she adds, only 17 percent felt their home would have a mold problem.
Then came the survey results: 88 percent of the homes had mold on window sills; 83 percent had mold on refrigerator seals (that accordion-like part), 83 percent had it under the kitchen sink and 82 had it percent in air vents.
Predictably, the bathroom was also a good breeding ground, though not as good as other areas. Almost half of the shower grouting areas and the walls above the showers showed evidence of mold.
Reynolds did not measure exact levels of the molds, but rather did a "presence-absence" test, basically getting a positive or negative result for mold but not how much was there.
Mold releases microscopic fungal spores that, if inhaled, can trigger allergy and asthma symptoms in sensitive people, Reynolds say. Mold can also worsen or cause sinus infections. High mold levels can also cause symptoms such as coughing and sniffling, which people often mistake for colds or flu, she adds.
The levels of mold needed to trigger an allergy, asthma or sinus problem vary greatly by type of mold and an individual's sensitivity, Reynolds says.
"The molds we found were all highly allergenic molds," says Reynolds, whose research was funded by an educational grant from the Clorox Co., which makes bleach.
"No standards have been set by any agency" to say at what level molds can cause health ill effects, she adds, noting "some experts say any mold you can smell or see should be eliminated."
Even though the surveyed homes were in various climates, including Dallas, New York, Atlanta, San Francisco, Tampa, Tucson and Chicago, no substantial geographic differences were found in the levels of mold, Reynolds adds.
Mold releases microscopic fungal spores that, if inhaled, can trigger allergy and asthma symptoms in sensitive people, Reynolds explains. It can also lead to sinus infections.
One piece of relatively good news from the study: Only .2 percent, or two samples, of the 1,330 taken were found to be Stachybotrys, the so-called "toxic" or "black" mold that can cause bleeding in the lungs of infants.
Another expert, Dr. Jordan S. Josephson, a New York City sinus infection expert, is not surprised by the findings.
"I know mold is pretty much ubiquitous," he says. "You can smell it in movies, locker rooms," and other dark, damp places where molds thrive.
Mold can not only aggravate asthma and allergy, but can also lead to or worsen sinus problems, adds Josephson, director of the New York Nasal and Sinus Center and an attending physician at Lenox Hill Hospital in New York City.
"Once you end up with fungal sinusitis, it lingers," he says. "Most people aren't aware that mold causes such problems."
Keeping mold at bay requires vigilance and the proper cleaning solution. Reynolds recommends cleaning areas with bleach before mold has a chance to build up.
"Follow the directions about how to dilute it," she says.
To learn about mold allergy, visit the National Institute on Allergy and Immunology. For tips on eliminating mold in homes and businesses, see American Academy of Allergy, Asthma and Immunology.
By Merritt McKinney
NEW YORK (Reuters Health) - The effect of cocaine and other stimulant drugs on the brain may linger long after a person stops abusing drugs, researchers report.
"There are still some effects even after a year of not using the drug," Dr. Rosemary Toomey told Reuters Health in an interview.
The study included 50 sets of adult twins. One of each twin pair had abused cocaine or amphetamines but had been drug-free for at least one year and the other had not abused drugs. The twin with the drug abuse history had lower scores on several tests of attention and motor skills than the one who had not abused cocaine or amphetamines.
The differences in attention and motor skills were "subtle," Toomey said. She noted that all the scores were still within the normal range. Still, the findings show that the effects of drug abuse may be long lasting, she said. These effects could be more severe in some people, according Toomey, who is the first author of a report on the findings that appears in the March issue of the journal Archives of General Psychiatry. Dr. Ming T. Tsuang, also of Harvard, was the principal investigator of the study.
But there was "a kind of twist" in the findings, said Toomey.
Although twins who had abused cocaine or amphetamines had poorer scores on several tests, they actually received better scores on a test that measures "visual vigilance," or the ability to pay attention over time.
Toomey said that there has been speculation that some people who abuse cocaine are "self-medicating" to make up for some sort of attention deficit. The fact that twins who had abused stimulants performed better on this one measure of attention is interesting, but the results of the current study "can't really answer that question," Toomey said.
Several studies have shown that problems with memory, concentration and other mental abilities are common in people who go into withdrawal after they stop using cocaine. Such deficits may persist for as long as six months, other research has shown. But one study found no significant effects in former cocaine abusers who had been drug-free for three years.
Source: Archives of General Psychiatry 2003;60:303-310.
By Ed Edelson
MONDAY, March 10 (HealthScoutNews) -- Everyone knows that hardening of the arteries is a bad thing, a process that can lead to heart attack and stroke. Now researchers show the same is true of hardening of a heart valve.
"Hardening of the arteries" is a decidedly unscientific term for atherosclerosis, the buildup of deposits that narrow those blood vessels until a blockage causes a heart attack or stroke. There is a roughly analogous process in which deposits of calcium can build up on a heart valve, reducing its ability to control the flow of blood. Specifically, it is the mitral valve, which controls the flow of blood between the two left chambers of the heart.
An analysis of data on participants in the long-running Framingham Heart Study shows this mitral annular calcification (MAC), as it is called, increases the risk of heart ailments and stroke in direct proportion to the amount of buildup -- a 10 percent increase in risk for every millimeter of calcification.
"MAC is fairly common," says Dr. Emilia J. Benjamin, director of echocardiography and vascular testing for the Framingham study. She was the lead author of the paper reporting the finding in March 11 issue of Circulation. "We found it in 14 percent of the persons tested. This was what about we expected, because it was an elderly cohort."
Echocardiograms -- ultrasound images of the heart -- were done on 445 men and 752 women between 1979 and 1981. The men were 69 years old and women 73 years old on average. The researchers followed the participants for 16 years, during which there were 307 new cases of cardiovascular disease -- heart attack, congestive heart failure, stroke and the like -- and 213 deaths caused by heart disease.
Participants with MAC were 50 percent more likely to develop cardiovascular disease and 60 percent more likely to have died of it than those without MAC, the report says. MAC was also related to deaths from all causes.
The finding is "not surprising," says Dr. Mario J. Garcia, director of echocardiography at the Cleveland Clinic, but it does provide solid evidence to support the dangers of MAC.
"It is something that people in the field have suspected for a long time," he says. "There have been small trials that suggested this was a marker for stroke, but this study shows that it seems to indicate a higher risk of atherosclerosis in general."
MAC is a condition that is easily detected and can be treated effectively, Garcia says. "The echocardiogram is a very good tool that is used on every patient with hypertension," he says. "The thickness of the heart muscle is a marker of how well hypertension is controlled," and it also shows calcification of the mitral valve.
Once detected, MAC can be controlled and even reversed, Garcia says: "If you treat high cholesterol with drugs, you reduce the progression of calcification. It can regress if cholesterol is well controlled with drugs."
It can influence whether a patient should be prescribed lipid-lowering drugs, Garcia says, since MAC is so closely related with cholesterol levels. "Many people fall into the borderline for indications of drug therapy, such as aspirin," he says. "Having this finding on an echocardiogram can be a reason to recommend therapy."
By Merritt McKinney
NEW YORK (Reuters Health) - No one knows what causes multiple sclerosis (MS), but a new study hints that infection with a common bacteria may increase the risk of developing the degenerative neurological disease.
"These results suggest, but do not prove, that infection with C. pneumoniae may adversely affect MS progression," study author Dr. Alberto Ascherio told Reuters Health.
"This question will have to be addressed in larger prospective investigations," according to Ascherio, who is at the Harvard School of Public Health in Boston, Massachusetts.
Chlamydia pneumoniae, or C. pneumoniae, which normally affects the respiratory system, has recently come under suspicion as a possible factor in MS. In one person with MS who had a C. pneumoniae infection that had spread to the central nervous system, MS symptoms improved after treatment for the bacterial infection.
Since then, several studies have examined the possible connection between C. pneumoniae and MS, but the results have been mixed.
Ascherio's team looked for an association between C. pneumoniae and MS in 141 women with MS and 282 healthy women of the same age. The women were drawn from two large health studies.
The researchers found that women with one type of MS were more likely than healthy women to have produced antibodies to fight off infection with C. pneumoniae. Women with the progressive form of MS tended to have higher levels of the antibodies than healthy women. In progressive MS, symptoms continually worsen, while in relapsing-remitting disease symptoms come and go.
Women in the study with relapsing-remitting MS had levels of C. pneumoniae antibodies similar to those of healthy women.
The findings are reported in the March issue of the journal Epidemiology.
The study raises the possibility that treating C. pneumoniae infection may improve symptoms in people with MS, according to the researchers. Several ongoing clinical trials are testing this approach.
However, Ascherio's team cautions that the higher levels of antibodies in women with one type of MS could have another explanation. For instance, MS is considered to be an autoimmune disease, meaning that it causes the immune system to turn against the body's own cells. The elevated levels of antibodies for C. pneumoniae could be a result of a malfunctioning immune system, the authors suggest.
In MS, the slow destruction of myelin--the thin, protective coating that insulates nerve fibers in the brain and spine--can lead to numbness, muscle weakness and stiffness, impaired vision and coordination problems.
Source: Epidemiology 2003;14:141-147.
MONDAY, March 10 (HealthScoutNews) -- People with obstructive sleep apnea can reduce their daytime drowsiness by using continuous positive airway pressure (CPAP) therapy.
The researchers analyzed data from 11 randomized trials that used the Epworth Sleepiness Scale (ESS) to determine whether CPAP reduces daytime drowsiness in people with sleep apnea.
The ESS goes from 0 to 24, with 0 indicating no daytime sleepiness and 24 indicating severe sleepiness during daytime.
After analyzing the 11 studies, the researchers found CPAP reduced the ESS score by an average of 2.94 points. That reduction was greater in people with severe obstructive sleep apnea and daytime sleepiness.
Obstructive sleep apnea is a common disorder that affects about 4 percent of middle-age men and 2 percent of middle-age women. It causes frequent waking during the night that can translate into daytime sleepiness, decreased quality of life, and an increased risk of injury from industrial accidents and motor vehicle crashes.
The primary treatment for obstructive sleep apnea is CPAP therapy, where pressurized air is continually blown through the airway to keep it from collapsing while a person is sleeping.
Here's where you can learn more about sleep apnea.
By Jesse J. Logan
NEW YORK (Reuters Health) - Before 51-year-old Norma Brenes tried an experimental laser procedure to correct her vision, she needed two pairs of high-powered reading glasses and was afraid of driving a car.
"I could not even read large print," says Brenes, an educator in community economic development at Cornell Cooperative Extension in New York. "In the dark, forget about it. I was blind."
So in January, Brenes signed up to became one of the first patients on the East Coast to undergo an experimental surgical procedure to fix her presbyopia, a condition in which parts of the eye become less flexible with age, making it hard to focus on objects and read at close distances.
The first research trials for the procedure began last December in Las Vegas and in New York soon after. Since then, 10 people have undergone the laser surgery in the U.S.
By September, up to 350 people will have received the surgery at different sites around the country, according to Surgilight, Inc., the Orlando, Florida-based company that makes the Optivision system to perform the procedure.
While most people with presbyopia are prescribed reading glasses or bifocals, Brenes has been anxiously anticipating an alternative.
"I was desperate, to be honest," she says. "This was what I was waiting for."
The procedure, called laser-assisted presbyopia reversal (LAPR), is a surgical fix, similar to the LASIK laser surgery that corrects nearsightedness. But LAPR uses a different mechanism, according to Dr. Colette Cozean, CEO and chairwoman of Surgilight.
Whereas LASIK changes the shape of the cornea, the new procedure--which involves eight shallow incisions on the white part of the eye--changes the shape of the lens, allowing it to expand and focus on close objects again. The entire process takes about 20 to 30 minutes for each eye, according to Cozean.
A month after the procedure, Brenes went from 20/70 to perfect 20/20 vision, according to Dr. Sandra Belmont, lead investigator of the trial at Weill Cornell Medical Center in New York. A second volunteer went from 20/80 to 20/25 vision.
While Belmont says she is "cautiously optimistic" about the results, she is also "very excited" about its success so far. "The patients are ecstatic. They feel like they're able to read the way they were able to 20 years ago."
Belmont says she has received hundreds of phone calls from middle-aged people interested in signing up. By April, she plans to enroll up to 50 volunteers in her research trial.
"It's just amazing that potentially every human being that lives to be 40 will avail themselves of this opportunity," Belmont says.
Critics are skeptical, however.
"Everyone's really hopeful, but I'm not really optimistic," says Dr. Ernest Kornmehl, a corneal and refractive surgeon in private practice in Boston. He says there needs to be definitive proof that it works on a larger number of people.
"It's very early," he says. Right now, he says, the only foolproof tools for correcting presbyopia are eyeglasses.
Researchers haven't reported any significant complications with LAPR in the U.S., but Cozean says there were "isolated" instances of minute perforations and diplopia, or double vision, after surgeries abroad. She says there is also a chance the effects of laser-corrected vision could lose power over time, meaning patients would need "enhancement" surgery later on.
"It's too early to know," Cozean says. "It looks at this point that it will probably give 10 years of reading without glasses. (Patients) may need enhancements as the disease progresses."
In Las Vegas, where the second research trial is taking place, Dr. Jon Siems, an ophthalmologist and refractive surgeon, has tested eight people who've had the procedure. One now relies on reading glasses for small print and dark conditions, while seven no longer need glasses.
"It has exceeded my skeptical expectations at this point in time," he says.
If approved by the FDA, and offered to the general public, the procedure would cost about $1,000 to $2,000 per eye and probably would not be covered by health insurance, Cozean says.
In the meantime, Brenes says she is so pleased with the results that she has started shopping around for her first pair of prescription-free sunglasses. She even signed up to take a road test in order to get her driver's permit.
"Now I feel I can do it," she says.
By Ross Grant
MONDAY, March 10 (HealthScoutNews) -- Too much fast food and TV are pit stops on the road to heart disease and Type 2 diabetes.
White people who watch 2.5 hours of TV every day and eat fast food twice a week have nearly three times the risk of becoming obese and developing high blood sugar, which are strong risk factors for heart disease and Type 2 diabetes, the study found.
Even the average white person, who watches two hours of TV a day and eats fast food once or twice a week, has double the risk they should, says study co-author Mark Pereira, an assistant professor of pediatrics at Harvard University School of Medicine.
Curiously, the study found fast food did not have the same effect on black people.
"Fast food consumption in this country has increased dramatically," says Pereira.
He blames the rise, which mirrors growing obesity in the United States, largely on advertising and the sedentary lifestyle that accompanies TV viewing.
"It's a question of energy expenditure, but we're realizing that it's also a question of exposure to marketing strategies," Pereira says. "There's no question that it influences behavior."
The study followed 2,027 white and 1,726 black adults between the ages of 18 and 30 for 15 years, tracking their lifestyles, diets and health through physical examinations.
For whites, the study found a strong association between TV watching, fast food and health risks associated with heart disease and Type 2 diabetes.
However, the results were more puzzling for blacks.
The researchers couldn't link fast food consumption in blacks to increased risk of obesity and high blood sugar. The disparity may result from different dietary patterns that weren't addressed in the study's interviews, but it may also indicate a striking difference in responses to fatty foods, Pereira says.
"We think this is the first study that has shown this. So, it needs more examination," he says.
While fast food may not be tied to obesity for blacks, excessive TV watching has been linked to obesity, says Carlos Crespo, an associate professor of social and preventive medicine at the University of Buffalo in New York.
"Television is very powerful," Crespo says, noting that 60 percent of TV advertising is for food products.
In a study of 4,000 children completed two years ago, Crespo showed that black and white children both take in more calories the more they watch TV. Kids who watch four hours of TV a day eat about 150 calories more than those who watch two hours.
Americans are eating more and exercising less, he adds. However, what alarms Crespo most is that many adults think exercise alone will help them avoid obesity, without also watching their diets. Even if a person burns 300 calories during 30 minutes of exercise, they take in nearly twice that with each order of French fries, Crespo says.
Still, exercise helps keep weight off, even if it doesn't slim you down. Moreover, studies have show the risk of heart disease, especially for obese Americans, drops with exercise, he says.
"Over 50 percent of Americans are overweight," Crespo says. "We've got a big problem here. In 20 or 25 years, that bomb is going to explode in our hands. It's a major public health priority, and it's just getting worse and worse."
To learn more about obesity trends in the United States, visit the U.S. Centers for Disease Control and Prevention. For suggestions on preventing and treating obesity in children, visit this site by the Office of the Surgeon General.
By Merritt McKinney
NEW YORK (Reuters Health) - Having a mother who has experienced depression can double a child's chances of becoming depressed, a new study shows.
But the risk for childhood depression is only higher than average if the mother has an episode of major depression or is mildly depressed for a prolonged period of time.
Women "don't have to worry" if they have just brief bouts of mild depression, Dr. Constance Hammen, one of the study's authors, told Reuters Health in an interview.
These results should "reassure mothers who worry that any depression is bad for the kids," said Hammen, who is at the University of California at Los Angeles.
But when a woman has had several episodes of major depression or a prolonged bout of mild depression, she should seek treatment not just for her own sake, according to Hammen. Although her children may not need formal treatment, Hammen said that "they should definitely be considered in the treatment of the mother."
In these cases, it is important for parents "to keep their eyes open" for signs of depression or other problems in their children.
Hammen noted that depression may be a result of other family trouble, such as stress, marital problems or substance abuse.
"We have to think of depression as a marker for stressful family life," Hammen said.
In her study of more than 800 women and their children, 20% of children whose mothers experienced depression before the child was 10 years old developed depression by age 15, compared with 10% of children whose mothers had never had depression.
Children who experienced maternal depression were also more likely to develop other psychological problems, particularly anxiety disorders.
For children's risk of depression to be higher than normal, the study showed that mothers had to have mild depression for at least 1 year. But for major depression, even a 1- to 2-month episode significantly increased a child's depression risk.
More study is needed, according to Hammen and Brennan, to understand how maternal depression raises children's depression risk.
Hammen and her co-author, Dr. Patricia A. Brennan of Emory University in Atlanta, Georgia, conclude that the study provides "a more precise answer" to the question of the effect of maternal depression on children's mental health. Results of the study are published in the March issue of the journal Archives of General Psychiatry.
Hammen told Reuter's Health that the increased risk for children of depressed mothers suggests that genetics as well as psychological and social factors are involved.
Hammen noted that the effect of paternal depression on children's risk has been studied less extensively, although she said that a father's depression seems to have a similar impact. While paternal depression seems to be important, the combination of a mother's depression and a father's substance abuse problem seems to be particularly bad for children, Hammen said.
Source: Archives of General Psychiatry 2003;60:253-258.