The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
October 9, 2002

 

 

 

Important Medical Disclaimer: The content displayed in Personal Health is designed to educate and inform. Under no circumstances is it meant to replace the expert care and advice of a qualified physician. Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate. Accuracy cannot be guaranteed. Personal Health assumes no responsibility for how information presented is used.

Personal Health for the Week of SEPTEMBER 14 - 20

  1. Cyber Classes Help Docs Brush Up On Herbs
  2. Researchers Fix Muscular Dystrophy Damage in Mice
  3. Off-Job Drinking Means On-Job Injuries
  4. Before-Birth Pollen Exposure May Raise Asthma Risk
  5. Car Wrecks Take Toll on the Unborn
  6. Carpal Tunnel Can Be Problem for Dental Hygienists
  7. Alcohol Can Help Post-Menopausal Women
  8. Retirees Will Shoulder More Health Benefit Costs
  9. The ABC's of a Bone Density Test
  10. New Test Picks Up for More Embryo Defects
  11. Girls Have Higher Death Rates After Heart Surgery
  12. Many Drunk Drivers Not Problem Drinkers
  13. Breath Test Has Potential for Lung Cancer Detection
  14. Cocaine Linked to Early Signs of Artery Disease
  15. Hormone Therapy Shows Promise as Male Contraceptive
  16. Half of College Clinics Offer 'Morning-After' Pill

    SUNDAY, SEPTEMBER 15, 2002
     

  17. Know the Score for Dangerous Drugs Like Steroids

    SATURDAY, SEPTEMBER 14, 2002  

  18. Taking the Sting out of Bug Bites
  19. Cholesterol Licked? You're Not Done Yet

Friday, September 20, 2002

Mental Disorders Key Health Problems in Military

Reuters Health
Friday, September 20, 2002

NEW YORK (Reuters Health) - Mental disorders such as depression and substance-abuse problems are among the most common health conditions in the US armed services, according to military researchers.

Their study of all active-duty personnel during the 1990s also found that service men and women were much more likely to leave the service after treatment for a mental health condition, compared with a physical ailment.

There is no reason to believe that mental health problems affect members of the military any more than the general US population, the researchers note. Rather, they report, the fact that conditions were so common in a generally young, healthy population highlights the "pervasive nature of mental disorders" in society.

Dr. Charles W. Hoge of the Walter Reed Army Institute of Research in Silver Spring, Maryland, and his colleagues report the findings in the September issue of the American Journal of Psychiatry.

Hoge's team looked at hospitalizations for all active military personnel between 1990 and 1999, as well as outpatient clinic visits in 1998 and 1999. They found that by 1995, mental disorders had become the second-leading reason for hospitalization and were the fifth-leading cause of outpatient clinic visits in 1998-1999.

Of the more than 1.5 million hospitalizations for service men and women during the 1990s, 13% included a mental disorder diagnosis--which in most of these cases was the "primary" diagnosis. Alcohol- and drug-related disorders were the most frequent mental health problem, followed by mood disorders such as major and mild depression, and a group of conditions known as adjustment disorders. Adjustment disorders involve an inability to deal with stressful events that is severe enough to get in the way of work and life.

Overall, the researchers found, mental health problems appeared much more likely than physical ills to affect service members' ability to stay on the job. For example, nearly half of soldiers hospitalized for a mental disorder in 1996 left the service within 6 months. That compares with 12% of those hospitalized for physical conditions.

"Our analyzes confirm that mental disorders are a major public health problem and a leading cause of occupational dysfunction in this population," Hoge's team writes.

According to the researchers, the findings raise questions about the impact of mental disorders on civilian job loss.

They also stress that "these medical data do not suggest that the impact of mental disorders is greater among service members than in the general US population."

Studying the military, Hoge's team notes, provides a "unique opportunity" because it is one of the healthiest US populations, is ethnically diverse and has equal access to healthcare.

The fact that mental disorders have such an impact in the military, they conclude, provides new evidence that mental illness is "common, disabling, and costly to society."

Source: American Journal of Psychiatry 2002;159:1576-1583.

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Warming Up to the E-Couch

By Nancy A. Melville
HealthScoutNews Reporter

HealthScoutNews

Friday, September 20, 2002

FRIDAY, Sept. 20 (HealthScoutNews) -- The Internet may be many things to many people, but for some it can be downright therapeutic.

 Among the professions that have been transformed by the ability to connect online, the field of psychiatry, despite its special demands for confidentiality, has been no exception.

As with many areas of medicine, information on diagnosing various mental health problems online abounds. Worried that your social drinking may be crossing over into problem drinking? Take this quick online questionnaire. Is your increasingly gloomy mood a normal reaction to events in your life, or are you suffering from clinical depression? Take that test to find out. Feel like your anxiety since the 9/11 terrorist attacks is unusual? Click here.

The questionnaires are not unlike any that have appeared in magazine articles and on morning programs for years. They typically advise heading to your local therapist if you meet the criteria for needing professional help, and may even offer links to help you find the right one.

Depending on the therapist you hook up with, however, the Internet may continue to be an important tool in your care.

More and more therapists are extending their care beyond the traditional face-to-face sessions to include telephone, e-mail and even Instant Message "coaching."

Such accessibility has broad appeal -- ranging from patients and therapists who simply are too busy to coordinate schedules to meet regularly, to patients who may feel the need for support between appointments.

Dr. Michael Nuccitelli, executive director of SLS Health, a residential treatment and wellness center in Brewster, N.Y., that offers such services, says the operative word is "coaching." Due to both legal and professional considerations, the practice of psychotherapy can still only be conducted in a professional, face-to-face setting.

"It's important to clarify that e-coaching and phone-coaching are used as supplemental tools to professional help," he says. "It's not psychotherapy -- if a patient hasn't been to a therapist, it's an encouragement to seek professional help. And with existing patients, it's a tool to teach and reinforce prevention education techniques."

Nuccitelli says in those cases, e-mail can let patients contact therapists seven days a week with pressing problems that can't wait until the next appointment.

"For instance, a patient is perhaps traveling, he has a problem with panic attacks and drinking, and is feeling tempted to become intoxicated to deal with it. He may call or e-mail me and I can help coach him through it until he can return and come in for an appointment," he says.

Similar situations can arise among patients with problems ranging from stress and anger management to weight reduction, Nuccitelli says.

While the same measures are taken to ensure patients' confidentiality as are taken in office visits, Nuccitelli says those skittish about online privacy ( news - web sites) may want to think twice before discussing issues over the Internet with their therapist.

"Our policy is to delete all e-coaching e-mails after we read them, but people who don't trust the privacy of the Internet probably should just not use the option of e-coaching at all," he adds.

The American Psychiatric Association's policy on the subject is that it "supports the use of telemedicine as a legitimate component of the mental health delivery system to the extent that it's used in the best interest of the patient and is in compliance with the APA policies with medical ethics and confidentiality."

Despite the endorsement, however, health plans will only rarely cover fees stemming from e-coaching, and billing practices for online assistance are in fact as varied as the prevalence of therapists who offer such services.

Many psychotherapists still don't offer such accessibility at all; some who do may simply offer their e-mail address for clients in special cases, but not choose to bill for accessibility, while others may offer e-coaching as a standard option, complete with standard fee schedules.

Whether or not they offer e-coaching, however, the consensus among many in the field is that online accessibility is, in most cases, an advantage for patients.

"Based on the research on this, my opinion is that (e-coaching) is useful in some cases, as long as its primary purpose is as an adjunct to regular therapy, because it allows patients to have a better sense of connection to the doctor between appointments," says psychotherapist Dr. Russell Lim, an assistant clinical professor at the University of California, Davis.

"In the context of one-on-one therapy, I think it's very helpful," he says.

What To Do

People who don't have therapists and begin their search online for mental help may face a daunting array of options. Experts recommend starting with recognized professional organizations such as the American Psychiatric Association or the National Mental Health Association.

Visit the American Psychological Association to read why the broad range of Internet therapeutic offerings make it hard for the organization to come down for or against online therapy.

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Feeling Like a Burden Ups Suicide Risk for Some 

By Charnicia E. Huggins
Reuters Health

Friday, September 20, 2002

NEW YORK (Reuters Health) - Although people may contemplate suicide for a variety of reasons, those who consider themselves a burden to others are more likely to complete their suicide attempt and to use more lethal means in the process, researchers report.

"If you feel like you are a burden on your loved ones, your risk for suicide seems increased, and this risk exceeds even that associated with well-known risk factors like hopelessness," study author Dr. Thomas E. Joiner, Jr. of Florida State University in Tallahassee, told Reuters Health.

Joiner and his colleagues rated 40 suicide notes left by people in the southwestern US on the extent of feelings of burdensomeness, hopelessness, general emotional pain and other factors. Half of the notes were left by suicide completers, who were more often male, and half were left by people who did not complete their suicide attempt, most of whom were female.

The investigators found that suicide completers thought of themselves as more of a burden to others than did the attempters, they report. Thus, the notes left by suicide completers more highly endorsed the idea that their loved ones would be better off after they are gone, the report indicates.

None of the other factors greatly differed between the suicide attempters and completers, the authors note.

The findings will be published in an upcoming issue of the Journal of Social and Clinical Psychology.

Joiner's team conducted a second analysis of notes left by 40 German men and women who committed suicide. They found that those who considered themselves a great burden to their loved ones were also more likely to choose more lethal means of suicide.

For example, these individuals were more likely to die by gunshot or hanging, rather than poisoning or cuts. This was true regardless of gender, even though men are generally known to be more violent in their suicidality, the researchers note.

"Taken together, the pattern of findings provided some support for the view that perceived liability to one's loved ones is a feature of completed suicide," the authors write.

In light of the findings, "psychotherapists should focus on perceived burdensomeness," Joiner said. "Almost always people perceive that they are a burden when they really aren't, and if the therapist points this out--i.e., through cognitive therapy--it should help."

Source: Journal of Social and Clinical Psychology; in press.

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How Much Exercise Is Enough? 

HealthScoutNews

Friday, September 20, 2002

(HealthScoutNews) -- How much exercise is enough? To raise your HDL (good cholesterol) level, about 30 minutes of good aerobic exercise -- the kind that makes you breath a little harder -- several times a week could do the trick. That amount also can help you control your weight, lower your blood pressure and burn off some of the stress in your life, says the Presbyterian Hospitals of Greenville & Commerce (TX).

Depending on the person and his or her goals, programs can include brisk walking, running, swimming, cycling, dancing, jumping rope, skating, and even such active sports as basketball.

More "passive" exercises could include gardening, a leisurely evening stroll or "anything that can get you off the couch and on the road to better health," the hospitals' Health Tip says.

It's always wise to consult your doctor before starting any kind of rigorous exercise program.

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Mono Virus Sometimes Passed Through Sex -Study

Reuters Health
Friday, September 20, 2002

NEW YORK (Reuters Health) - Sexual intercourse may be an important route of transmission for the "kissing disease" mononucleosis among teenagers, a study of UK college students suggests.

Infectious mononucleosis, an illness marked by fatigue, fever, sore throat and swollen glands, is caused by the Epstein-Barr virus (EBV). EBV is an extremely prevalent type of herpesvirus, with more than 90% of the population in countries like the UK and US estimated to carry the virus.

Children often become infected and typically have no symptoms. But when EBV infection occurs in adolescence or young adulthood, it causes mono anywhere from 35% to 65% of the time, according to various estimates.

EBV is known to be present in saliva--hence its kissing-disease reputation. But some studies have also found the virus in genital secretions, although evidence of this route of transmission is "very limited," according to the authors of the new study.

To investigate, Dr. Dorothy H. Crawford of the University of Edinburgh and her colleagues studied just over 1,000 students entering the university in 1999. They asked students about their sexual behavior and whether they ever had mono. They also took blood samples to test for past EBV infection.

Overall, three-quarters of the students tested positive for EBV, but students who had ever had sex were more likely to be EBV-positive than those who never had--83%, versus 64%. Moreover, sexually active students were three times more likely to have ever had mononucleosis, according to findings published in the September 15th issue of the Journal of Infectious Diseases.

It is unclear whether intercourse, kissing or oral sex might have been the route of EBV transmission in many of these cases, the researchers acknowledge. However, they note, because the virus has been found in genital fluids, "direct spread of virus during sexual intercourse is possible."

In addition, the investigators found that students who said they always used condoms were somewhat less likely to be EBV-positive, and the odds of carrying the virus increased with the number of lifetime sex partners students reported.

Crawford's team also found that three quarters of students who did not carry EBV said they had never had sex.

The authors note that, statistically, about 90% of these EBV-negative students will become infected while in college, and up to 65% of them will develop mono. These individuals, according to the researchers, could potentially benefit from the EBV vaccines that are under development.

Source: Journal of Infectious Diseases 2002;186:731-736.

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Winter Weather Calls for Being Alert 

HealthScoutNews
Friday, September 20, 2002

(HealthScoutNews) -- Winter storms and sudden cold snaps cause untold numbers of hospital visits every year in this country.

The Oregon Public Health Services (OPHS) has compiled a list of suggestions for acting wisely during harsh weather periods:

  • As well as causing car accidents, slippery conditions put you at greater risk for falls and potentially serious injuries. Don't go out unless you must, and use extra caution if you do.
  • Make sure all heating devices are properly vented. Tasteless, odorless indoor air pollutants -- such as carbon monoxide from an un-vented propane heater or even your gas range, when it's being used improperly to heat your home -- can be deadly.
  • Hypothermia and frostbite are real dangers, particularly for small children. Make sure all skin, except the face, is covered by warm, water-resistant materials.
  • Overexertion and cold weather can be a deadly combination. If you are not in good physical shape or have a heart condition, shoveling snow or other strenuous activity can lead to a heart attack or stroke.
  • Downed power lines are much more likely with snow and ice conditions. Treat any power line on the ground as being live, and avoid contact with it.
  • Be sure to check in with neighbors, friends or family members who live alone or may need occasional assistance with daily living tasks.

Above all, OPHS says, "Use common sense and be more careful and cautious when making decisions that could put you, your family, or others at risk" when winter turns harsh.

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Study Says Love Means Sharing the Same Diseases 

Reuters
Friday, September 20, 2002

LONDON (Reuters) - Married couples share more than their homes, cars and finances--they are also likely to have some of the same diseases, experts say.

If a spouse suffers from asthma, depression, peptic ulcers, high blood pressure or raised cholesterol levels, the chances are their partner will be afflicted with the same illness.

"Partners of people with specific diseases are at increased risk of the disease themselves--at least 70% increased risk for asthma, depression and peptic ulcer disease," Julia Hippisley Cox of the University of Nottingham, central England said Friday.

Cox and her team said the most likely reason for the shared diseases was environment. Married couples usually eat the same foods, are exposed to the same allergens and often have similar exercise patterns. These can contribute to ailments such as allergies, high blood pressure and raised cholesterol.

The British Heart Foundation said there was also likely to be a strong association with coronary heart disease (CHD), one of the biggest killers in industrialized countries.

"Sharing a home environment means that partners may well have similar diet, physical activity and smoking patterns so that if one develops CHD the other has a similar risk of developing the disease," said Belinda Linden, the head of medical information at the foundation.

Cox and her colleagues studied the medical history of 8,000 married couples, aged 30 to 74.

After adjusting for age, obesity and smoking status, which also have an impact on disease risk, they found that spouses whose partners had a certain illness had a higher risk than the general population of suffering from the same disease.

The scientists, whose findings are published in the British Medical Journal, believe screening spouses for some diseases should be considered.

"The findings could have implications for targeting screening or disease prevention measures at partners of participants with one of these diseases," Cox added.

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New Use for Anthrax Killer 

HealthScoutNews

Friday, September 20, 2002

FRIDAY, Sept. 20 (HealthScoutNews) -- The same gas that cleansed federal office buildings of anthrax can also kill deadly bacteria on fruits and vegetables.

That surprising finding appears in the September issue of Food Microbiology.

Purdue University researchers were already doing experiments using chlorine dioxide (Cl02) gas to kill bacteria on food before the anthrax attacks. Their latest research measured the effects of different levels of the gas on Listeria monocytogenes cells on apples.

They found the vapor of Cl02 gas was able to eradicate listeria from the skin of apples and greatly reduce the amount of bacteria in the stem cavity and on the bottom of the apple.

"We see more and more cases of food-borne diseases associated with fruits and vegetables. Some of this is because we encourage people, especially children and the elderly, to eat more and more of these types of foods for added health benefits. Yet these are two of the groups most susceptible to bacteria on food," says study author Richard Linton, director of Purdue's Center for Food Safety Engineering.

He says that just 10 to 100 listeria cells on a piece of fruit can make a person sick, but it's possible for 1,000 to 10,000 listeria cells to be on a piece of fruit. Listeria is the most deadly of food-borne pathogens. It has a 20 percent fatality rate.

The study found that Cl02 gas used at a concentration of 4 milligrams per liter for 30 minutes reduced the level of listeria by a minimum of more than 1,000-fold for all three areas of the apple that were tested. On the apple pulp, the average reduction was more than 100,000-fold.

More information

The U.S. Food and Drug Administration ( news - web sites) has more on listeria.

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Analysis Confirms Hormone Replacement Dangers 

By Patricia Reaney

Reuters
Friday, September 20, 2002

LONDON (Reuters) - A British study backed US findings on the side-effects of hormone replacement therapy (HRT) on Friday, saying the treatment taken by women to relieve menopause symptoms increases the risk of breast cancer ( news - web sites) and stroke.

A review of four major studies into the effects of HRT found that women who took the treatment for five years had a higher risk of breast cancer, stroke and blood clots in the lung but were less likely to suffer from bowel cancer or hip fractures.

Overall, the analysis showed that a woman is more likely to contract a life-threatening disease when on HRT than to be protected against one.

"The four major trials that have been done, although in different settings and with different combinations (of HRT), really show consistent results," Professor Valerie Beral, of Britain's Cancer Research UK charity, told Reuters.

Millions of women who use HRT to relieve hot flushes and mood swings or to prevent osteoporosis were caught off guard in July after an American trial showed HRT raises the risk of stroke, breast cancer and blood clots.

Shares in HRT manufacturers like US-based Wyeth and Germany's Schering tumbled in the wake of the US trial news in July.

US Findings Backed

Beral said her analysis of four trials involving 20,000 postmenopausal women, which is published in The Lancet medical journal, confirm the findings of the US study.

"They basically support the Women's Health Initiative study," Beral said, referring to the US trial of women taking combined estrogen and progestogen HRT.

Three of the trials in the analysis studied the effects of combined HRT and one involved estrogen only.

"Putting all the data together, the results look very similar," said Beral. "What there is suggests there is no difference between the different types of HRT preparations."

For women in their 50s taking HRT for five years, the greatest risk is for developing breast cancer. Women in their 60s have a higher chance of suffering a stroke or pulmonary embolism, or blood clots in the lungs.

"These result estimates provide a rough guide to the likely overall change in incidence of these conditions over a five-year period for typically healthy women in Western countries who use HRT," said Beral.

The review estimates that for healthy women on HRT for five years there would be a total of six extra cases of either breast cancer, stroke or clot on the lung among every 1,000 HRT users between aged 50-59.

The number would double to 12 for HRT users aged 60-69.

By contrast, there would be an estimated 1.7 fewer cases of bowel cancer or hip fracture per 1,000 HRT users aged 50-59 and 5.5 per 1,000 users betwe
en 60-69.

The review found no significant change in the risks of endometrial cancer or coronary heart disease.

Women on the treatment for longer would have an increase in risk that accumulates with time, said Beral

"We've tried to provide risk estimates for women that they can relate to in making a decision about whether they want to take HRT or not," she added.

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On the Trail of a Killer 

HealthScoutNews
Friday, September 20, 2002

FRIDAY, Sept. 20 (HealthScoutNews) -- Researchers in Baltimore are looking for volunteeers to help them learn more about a rare heart defect that kills athletes.

The defect, called arrhythmogenic right ventricular dysplasia (ARVD), seems to run in families and occurs when the healthy heart muscle tissue of the right ventricle is replaced by fat and scar tissue. That abnormal tissue may interfere with electrical messages sent to the right ventricle and lead to a potentially fatal "short-circuit" arrhythmia.

ARVD affects about 1 in 5,000 people, and accounts for about a fifth of all cases of sudden cardiac death in people younger than 35. It often happens during vigorous exercise.

To better understand the condition, researchers at Johns Hopkins Medical Institutions are working with other researchers around the world to find the best way to diagnose ARVD and find the genetic causes of it.

They're looking for people with possible ARVD to take part in the United States Multicenter ARVD Trial. For more information or to schedule an appointment to be tested at Johns Hopkins, contact Crystal Tichnell at 410-502-7161 or email her at ctichnell@ jhmi.edu.

The actual cause of ARVD is unknown, but researchers suspect it's genetic. There is no cure for ARVD. Many patients receive an implantable defibrillator. The pacemaker-like device monitors heartbeats and delivers an electric shock to the heart if it senses a dangerous arrhythmia. Some people with ARVD receive medications to manage the condition. People with ARVD are advised to avoid strenuous, competitive exercise.

More information

Read more about ARVD.

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Viagra May Treat Life-Threatening Lung Condition 

Reuters Health
Friday, September 20, 2002

NEW YORK (Reuters Health) - The impotence drug Viagra may help some patients with a serious type of high blood pressure affecting the lungs, preliminary research suggests.

The study of 16 patients with the lung disorder pulmonary fibrosis found that sildenafil, sold as Viagra, lowered pressure in the arteries feeding the lungs. High blood pressure in these vessels--known as pulmonary hypertension--can arise as a result of pulmonary fibrosis, an inflammatory condition that causes scarring of the lungs. In patients with these conditions, the lungs' ability to get oxygen to the body is severely limited.

The new findings, reported in the September 21st issue of The Lancet, suggest that sildenafil's well-known vessel-dilating effects may also ease pressure in pulmonary arteries.

Right now, the standard treatment for primary pulmonary hypertension--meaning it is not caused by lung or heart disease--is a blood vessel-dilating drug called epoprostenol. But the drug, also known as prostacyclin, requires constant IV infusion, which is cumbersome and carries risks such as infection.

And when pulmonary hypertension is secondary to lung fibrosis, drugs that affect vessel dilation throughout the body can actually make oxygen deprivation worse by boosting blood flow to seriously diseased parts of the lungs.

According to the authors of the new study, all of this highlights the importance of finding a treatment that is easily administered and that specifically dilates blood vessels that feed working areas of these patients' lungs.

To see whether sildenafil might do the job, Dr. Hossein Ardeschir Ghofrani and colleagues at Justus-Liebig-University in Giessen, Germany, assigned 16 lung fibrosis patients with severe pulmonary hypertension to one treatment with either sildenafil or epoprostenol. Before treatment, all patients also received inhaled nitric oxide (NO), a powerful vessel-dilating chemical produced naturally in the body.

The investigators found that while all three agents reduced patients' pulmonary artery pressure, only sildenafil and NO showed specific action in the lung vessels. Epoprostenol patients saw their overall blood pressure fall as well, and the flow of oxygen in the arteries worsened.

According to the researchers, they chose to study sildenafil because it is known to enhance the natural effects of NO by inhibiting an enzyme called phosphodiesterase-5. This enzyme, they note, "is abundantly expressed in lung tissue."

Although large studies are needed to confirm the current findings, Ghofrani's team concludes, "the unique profile of sildenafil...suggests that the drug is a promising candidate for long-term treatment of secondary pulmonary hypertension in lung fibrosis."

An editorial published with the report agrees that sildenafil may have a role in treating both secondary and primary pulmonary hypertension--particularly since treatment with inhaled NO itself is costly and there are "technical difficulties" in delivering it.

However, Dr. Raed A. Dweik of the Cleveland Clinic Foundation in Ohio points out, sildenafil patients in this study did show some increase in their overall blood pressure.

"A truly selective pulmonary vasodilator (like inhaled NO) should not affect systemic blood pressure," Dweik writes, adding that the "search goes on" for an oral drug that fits the bill.

Source: The Lancet 2002;360:886-887, 895-900.

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Individualized Treatment Reaches Autistic Children 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Friday, September 20, 2002

FRIDAY, Sept. 20 (HealthScoutNews) -- Treating autism effectively has always been a challenge, but British researchers have developed a program they say can help reach autistic children.

In fact, in the initial phase of the study, the researchers report that 94 percent of the children with autistic spectrum disorder were able to attend mainstream schools after completing their program.

"The South West Autism Project (SWAP) treatment is tailored to the needs of families, rather than a one-size-fits-all approach," says lead researcher Alec Webster, a professor of educational psychology at the University of Bristol in England. "Our work uses contingent problem-solving, which tries to understand the reasons for challenging behavior, rather than eliminating it."

At least one or two of every 1,000 American children has autistic spectrum disorder, according to the National Institute of Mental Health. It is a brain disorder that affects the ability to communicate, form relationships and to properly respond to the surrounding environment. It is significantly more common in boys, but girls with the disorder often have more severe symptoms. Autism costs about $3 billion annually in this country.

Children enrolled in SWAP were first given a baseline test to assess the severity of their autism, which researchers defined numerically using what is known as a developmental quotient. Developmental quotient is a child's developmental age divided by their chronological age and multiplied by 100. So, a child who is exactly on target for their age would have a developmental quotient of 100. Children from 26 families were included in the project, and their developmental quotients ranged from 24 to 100.

The researchers then worked with the parents to develop an individual education plan for these preschool children. Parents were able to select the number of hours they wanted their children to participate each week, ranging from 2.5 hours to 25 hours per week. According to Webster, the average was 10 hours weekly.

The project's goal was to improve the children's communication skills, flexible thinking and their ability to interact socially. Each treatment plan included small learning steps with a lot of structure and repetition.

Kids who had trouble with changes in routine would be shown a certain card before change occurred, so they knew something different was about to happen. Youngsters with poor social skills were taught turn-taking and asking politely for what they want through a bubble-blowing game. For children who were afraid of specific places, such as the bathroom, the researchers would place pictures of favorite objects in those areas to help the children make a positive association.

After 18 months of treatment, one third of the children showed developmental quotient gains of more than 45 points. Half of the children made gains of at least 20 points, and one child jumped 60 points in a year and a half. Sixteen of the seventeen youngsters who have completed the program have gone on to mainstream schools. Webster says in most cases the children are doing very well, and the school staff is "delighted" with their progress.

"I think what they're doing is adding a few wrinkles to time-tested intervention strategies," says Dr. Richard Perry, a child psychiatrist from New York University Medical Center who specializes in treatment children with autistic spectrum disorder.

Perry cautions parents of autistic children not to get overly excited by these findings. He says individualized treatments and early intervention programs are effective and should be used, but they are not new.

What To Do

For more information on autism, visit the Center for the Study of Autism or the National Institute of Mental Health.

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Smoking Ups Cervical Cancer Risk in Women with HPV 

By Steven Reinberg

Reuters Health
Friday, September 20, 2002

NEW YORK (Reuters Health) - Women with human papillomavirus (HPV) infection who smoke have a significantly increased risk of developing cervical cancer compared with HPV-infected women who do not smoke, according a report in the September 18th issue of the Journal of the National Cancer Institute ( news - web sites).

There are more than 100 different types of HPV, including some that cause genital warts. Some of these viruses are sexually transmitted, and some are linked to cancer. It is believed that certain "high-risk" HPV subtypes are the primary cause of cervical cancer. However, HPV infection usually goes away on its own, and most women who get the virus do not develop cervical cancer.

"Smoking, but not oral contraceptive use or past number of live births, was linked with a two- to four-fold increased risk of cervical pre-cancer and cervical cancer in a 10-year follow-up of women who had an HPV infection at the beginning of the study," lead author Dr. Philip E. Castle told Reuters Health.

Castle, from the National Cancer Institute in Rockville, Maryland, and colleagues evaluated 1,812 women who were part of an ongoing cervical cancer study at Kaiser Permanente in Portland, Oregon. The women tested positive for HPV and completed a questionnaire on smoking, oral contraception and other factors.

After 10 years of follow-up, the researchers found that neither oral contraceptive use nor giving birth was associated with the risk of developing cervical cancer.

However, women who smoked one or more packs of cigarettes per day were four times as likely as nonsmokers to develop precancerous or cancerous changes in the cervix. Former smokers had about three times the risk of such changes compared with never-smokers.

Castle said these findings have profound public health implications, particularly in developing countries.

"In resource-poor regions of the world where cigarette smoking is now on the rise and there are suboptimal Pap smear screening programs, we are concerned that smoking may contribute to increased rates of cervical cancer," he said.

Source: Journal of the National Cancer Institute 2002;94:1406-1414.

Seeing Beyond Eye Fashion 

By Robert Preidt
HealthScoutNews Reporter

HealthScoutNews

Friday, September 20, 2002

FRIDAY, Sept. 20 (HealthScoutNews) -- The allure of cosmetic contact lenses is coloring the judgment of many people who are putting their eyesight at risk by buying the contacts illegally.

They're an especially popular fashion accessory with teenagers, for obvious reasons. Cosmetic contact lenses come in a kaleidoscope of colors and designs that can match your clothing or mood. Their glamour and appeal is enhanced by the fact that they're worn by movie and rock stars.

Eye experts are concerned because many teenagers don't bother to purchase these tinted contacts from an eye-care professional. They buy them on the Internet, at flea markets, video stores, at the beach, costume stores and other unlicensed outlets.

Federal law says contact lenses, including cosmetic varieties, can only be sold by licensed vendors to people with prescriptions. However, many stores simply turn a blind eye to those rules.

Buying cosmetic contact lenses from these illegal outlets can lead to serious eye problems, says Prevent Blindness America (PBA).

The eye health risks include bacterial infections, eye pain, swelling, decreased oxygen flow to the cornea, conjunctivitis (pink eye), loss of clarity, corneal scratches and corneal ulceration. However, many teenagers don't understand such dangers.

"They just think of them as makeup, a fashion accessory, which they're not. When you stick a foreign object in your eye, then it's not the same as makeup," says PBA spokeswoman Betsy van Die.

Cosmetic contact lenses have the same risks as regular contact lenses, and require the same kind of care and caution.

"If a kid is just sticking these in their eyes just because they want to look cool, then they're not taking the same kind of precautions," van Die says.

"If you don't go to an eye-care professional for contact lenses, then you're not going to get a proper fit. It's because of the improper fit that a lot of these problems will occur," she says.

Cosmetic contact lenses are medical devices that must be prescribed by an eye-care professional, stresses Dr. Thomas L. Steinemann, an ophthalmologist and director of the division of ophthalmologic surgery at MetroHealth Medical Center in Cleveland.

"What you have currently have is a naive, uninformed consumer-patient who makes the purchase of a medical device illegally without a prescription from a vendor without a license, without an eye exam, without a fitting, without proper instruction on safe handling and care of the contact lenses, and without follow-up. That's a recipe for disaster," Steinemann says.

He's seen the consequences firsthand. That includes teenager Robyn Rouse. She bought colored contacts at a video store, and developed a pseudomonas bacterial infection in one eye.

"It is probably one of the most feared infections in the eye because it can destroy the eye rapidly," Steinemann says.

He had to perform a corneal transplant on Rouse to repair the damage caused by the infection.

"She's darn lucky she didn't lose her eye. She's doing reasonably well, but that's a pretty heavy price to pay for a youthful indiscretion when you're 14 or 15 years old," Steinemann says.

He says teenage girls seem to be the main consumers of the colored contacts.

Cosmetic contacts have been a hot topic recently with news reports that the U.S. Food and Drug Administration ( news - web sites) (FDA) was considering deregulating cosmetic contact lenses by listing them as a cosmetic instead of medical device. That would make it legal to sell them without a license or prescription.

"Our stance is that it would be very foolish, especially from a consumer standpoint, to change the policy. Contact lenses are not cosmetics, they're not makeup. You cannot view something that is put in the eye as the same thing as lip gloss or mascara or anything like that," van Die says.

FDA spokeswoman Sharon Snider says the FDA is not considering any move to change the status of cosmetic contacts.

"We haven't made any decisions on cosmetic contact lenses, but no deregulation is planned. And whatever we do down the road, our intention will be to protect the public health, whatever is needed to do that," Snider says.

Both van Die and Steinemann say public education about cosmetic contacts is essential. PBA offers the following advice:

·         Always see a licensed eye-care professional to be fitted for contact lenses and always wear them under the supervision of an eye-care professional.

  • Clean and disinfect contact lenses according to instructions.
  • Store contact lenses in a clean storage case.
  • Use water-soluble cosmetics or those that are labeled safe for use with contact lenses. Don't apply skin creams or moisturizers too close to your eyes.
  • Never buy contact lenses without a prescription.
  • Don't wear contact lenses when you sleep.
  • Don't wear opaque contact lenses if you have night vision problems.
  • Never share or trade contact lenses with other people.
  • Get immediate medical attention if you have eye pain, irritation, redness, blurriness or visual changes.

What To Do

For more information about all kinds of contact lenses, go to Prevent Blindness America.

Here's more on the debate surrounding the possible deregulation of cosmetic contact lenses.

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US Falls Short in Caring for Kids' Mental Health

By Dana Frisch

Reuters Health
Friday, September 20, 2002

NEW YORK (Reuters Health) - Over three quarters of the nation's children who need mental health services are not receiving them, a new study has found.

The research also identifies Latino children, uninsured children and preschoolers as having the greatest unmet need, with over 80% of these children not receiving services or an evaluation despite reports of symptoms.

"There hasn't been any national-level data on child's mental health service use and we felt that it was important to understand on a national level what was going on," said Dr. Sheryl Kataoka, lead author and assistant professor of child and adolescent psychiatry at the University of California, Los Angeles.

Earlier studies have found that approximately one in five children between the ages of 3 and 17 has a mental health disorder. Such disorders, if left untreated, can interfere with kids' performance at school, make them feel demoralized, affect their relationships with their peers and even lead to suicidal thoughts, Kataoka said.

To investigate how many children who needed mental healthcare were receiving it, the researchers analyzed three national data sets including almost 50,000 children. In the surveys, parents had been asked about their children's behavior and whether they were receiving any mental health services.

This study, published in the September issue of the American Journal of Psychiatry, found though that on average, 7% of children were receiving mental health services. But the researchers found that 21% of children who required a mental health evaluation actually got services, leaving an estimated 7.5 million children in need of mental healthcare without it.

"We were surprised at the magnitude of the unmet need," Kataoka told Reuters Health. "Even though (the parents) were reporting that their kid had these problems, they weren't getting the services."

Among children and adolescents, the most common mental disorders are attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, conduct disorders and depression, according to Kataoka.

Kataoka said she and her colleagues expected to find lower mental health services use by minorities, and that further studies are necessary to determine why minority populations' needs were not being met. The findings, she said, should inform policy and help professionals figure out better ways to deliver mental healthcare to children.

Source: American Journal of Psychiatry 2002;159:1548-1555.

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Pregnancy Hormone May Help Those With MS

HealthScoutNews

Friday, September 20, 2002

FRIDAY, Sept. 20 (HealthScoutNews) -- A pregnancy hormone called estriol appears to show promise as a treatment for early-stage multiple sclerosis (MS).

In a study done at the University of California, Los Angeles (UCLA), researchers say a pill form of estriol decreased the size and number of brain lesions and improved protective responses in people with relapsing remitting MS.

Previous studies found similar results in pregnant women and animals with early-stage MS. Estriol is a weak form of estrogen made by the fetal placental unit. Only pregnant women have appreciable amounts of estriol.

Estriol is widely used in Europe and Asia to treat symptoms of menopause. Because it doesn't prevent osteoporosis, estriol isn't approved in the United States for hormone replacement therapy.

The UCLA Phase 1 clinical trial included six women with relapsing remitting MS and six women with secondary progressive MS. All six with relapsing remitting MS completed the trial, along with 4 women in the other group.

The researchers found a significant decrease in the number and size of inflammatory brain lesions, an increase in protective immune response and improvement in cognitive test scores after the women with relapsing remitting MS were treated with estriol.

When the women were taken off estriol, their brain lesions increased to pre-treatment levels. Those lesions declined when the women were put back on estriol, according to the study, which is published in the October edition of Annals of Neurology.

The women with secondary progressive MS showed no significant improvement when taking estriol.

"Based on these results, a larger, placebo controlled trial of estriol is warranted in women with relapsing remitting multiple sclerosis. If larger studies confirm the benefits of estriol treatment, further studies for longer periods of time will be needed to determine whether estriol can decrease relapse rates and disabling symptoms," says principal investigator Dr. Rhonda Voskuhl, associate professor of neurology at UCLA.

MS is a chronic, disabling disease that affects 1 in 10,000 people. Symptoms, which range from numbness in the limbs to paralysis or blindness, typically appear between ages 20 and 30.

More information

The National Institute of Neurological Disorders and Stroke has a complete guide to MS.

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Breast-Feeding May Not Ward Off Allergies, Asthma

By Amy Norton

Reuters Health
Friday, September 20, 2002

NEW YORK (Reuters Health) - A new long-term study is challenging the notion that breast-feeding helps protect children from developing allergies and asthma, one of the widely promoted potential benefits of breast-feeding.

In fact, researchers found that of the more than 1,000 children they followed to age 26, those who were breast-fed for at least 4 weeks were more likely to develop asthma or various types of allergies.

The findings are published in the September 21st issue of The Lancet.

Health experts including the World Health Organization ( news - web sites) and the American Academy of Pediatrics (AAP) recommend that women breast-feed their babies' during their first year for a variety of reasons. Breast milk is recognized as the best source of infant nutrition, and it is thought to cut the risk of various infant infections and have numerous other health benefits for mother and baby.

"There's 101 reasons to breast-feed," Dr. Malcolm R. Sears, the new study's lead author, told Reuters Health. However, he said, the new findings indicate that lower long-term risks of allergy and asthma are not among them.

Dr. Nancy Krebs, chair of the AAP's nutrition committee, said the findings "don't take away from the recommendation to breast-feed for one year," with introduction of baby food around 6 months of age.

She told Reuters Health that "we don't need to try to attribute every (health) effect to breast-feeding" for it to be the preferred form of infant nutrition.

Sears, a researcher at McMaster University in Hamilton, Ontario, Canada, and his colleagues based their findings on data from 1,037 children born in New Zealand between 1972 and 1973. The children, about half of whom were reportedly breast-fed for at least 4 weeks, were assessed for allergies and asthma every few years between the ages of 9 and 26.

The researchers found that breast-fed children were actually more likely to suffer from allergies to cat dander, pollen and other common triggers at the age of 13 or 21, when skin tests were performed. Asthma was also more common among breast-fed children, with a two- to three-times higher risk found among 9- to 13-year-olds who had been breast-fed.

The findings stand in sharp contrast to "common knowledge" about the effects of breast-feeding on allergy and asthma risk, Sears said. However, he and his colleagues point out, past studies have produced conflicting results on the issue.

In an interview, Sears explained that much of the uncertainty may be due to the duration of these studies. He said "a dozen or more" have shown breast-feeding to be protective against wheezing in infancy, but this effect may not hold up in the long term.

Sears pointed to a Tucson, Arizona study that linked breast-feeding to less wheezing before age 2, but to a greater longer-term risk of asthma among children whose mothers had the lung disease.

In their study, Sears and his colleagues found that, unlike in the Tucson study, family history of allergies and asthma had no bearing on the risk associated with breast-feeding. Why, he said, is unclear.

Also unclear is the mechanism by which breast-feeding could raise the odds of allergy and asthma later on. Breast-feeding might have some effects on the bacterial balance in infants' intestines or on the developing immune system that could predispose children to these conditions, but a study like the current one cannot address these questions, Sears said.

It is well accepted that genetics and environmental factors conspire to put certain people at risk of allergies and asthma, two child-health experts point out in an editorial published with the report.

But in studies to date, the effect of breast-feeding on these conditions "is not consistent between studies and changes with the age of the child," write Drs. Peter D. Sly and Patrick G. Holt of the Telethon Institute for Child Health Research and Center for Child Health Research in Perth, Australia.

"Although there are many valid reasons for encouraging breast-feeding...," they write, "based on the current evidence the prevention of asthma and allergies is not one of them."

Source: The Lancet 2002;360:887-888, 901-907.

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HIV Vaccine Trials May Be Opposed by AIDS Victims

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, September 20, 2002

FRIDAY, Sept. 20 (HealthScoutNews) -- The very groups who may most benefit from an AIDS ( news - web sites) vaccine may also be the ones who offer the most resistance to its final testing phase.

 Researchers said this week they expect opposition to widespread HIV ( news - web sites) vaccine tests from groups comprising gay men, blacks and IV drug users.

"There are social and political challenges," said Joy Workman, a senior program manager with the National Institutes of Allergy and Infectious Diseases, at the annual U.S. Conference on AIDS in Anaheim, Calif.

In a series of video interviews presented at the conference, people in the major risk groups said they feared taking part in health research because they don't trust their government. Many summed up their concerns by mentioning the words "guinea pig" and "Tuskegee" -- a reference to the disastrous study of syphilis among Alabama black men.

The willingness of people to participate in vaccine testing is no minor matter, experts said. As many as 15,000 people must take part in the final testing phase of any HIV vaccine, said Steve Wakefield, associate director for community relations with the HIV Vaccine Trials Network. And it makes the most sense to launch the studies in developed countries that have strong health systems in case someone gets infected with HIV, he said.

Researchers have been testing HIV vaccines on people since 1987. Their goal is to develop a vaccine that will prevent infection by HIV, the virus that causes AIDS.

While researchers have studied 50 vaccines worldwide, only one has reached so-called "Phase III" testing, in which thousands of people at high risk are given the vaccine and then followed for several years to see if they become infected. The other phases, which last as long as two years each, test the vaccines on small numbers of people, usually at low risk, to determine if they are safe and if they work better than placebos.

Results from testing of the one vaccine in Phase III -- known as AIDSVAX -- are expected next year. It is being developed by the VaxGen company, which has been examining its effectiveness among subjects in North America, Puerto Rico, the Netherlands and Thailand.

There's reason to believe a vaccine is possible, because some people at extremely high risk -- prostitutes, for example -- don't get infected despite repeated exposure, said Dr. Gaston Djomand, a clinical trials physician with the HIV Vaccine Trials Network. Also, a small number of HIV-positive people have never developed AIDS despite being infected for many years.

"There is probably a natural mechanism of protection," Djomand said. "We strongly believe that a vaccine is possible."

However, researchers have had to abandon several vaccine strategies because they didn't work, he said. Researchers are no longer looking at using a live weakened strain of the virus (as is used in measles and chicken pox vaccines) or a dead inactivated virus (as in flu vaccines).

The most promising vaccines in development may be able to prime the immune system to protect against transmission of HIV through both sex and blood.

Vaccine experts said education is key to convincing people at high risk to take part in the final phases of HIV vaccine studies, which may become more common. "Just handing out a brochure will not bring out all the information you need," Wakefield said.

The challenges appear to be major, according to a video that studied opinions about vaccine studies among gay men in San Francisco, IV drug users in Philadephia and blacks in Durham, N.C.

"We're in a minority, and in the bigger picture, we're not treated that well by the government," said a gay man. "Are they really going to be honest with us?" asked a woman from Philadelphia.

And a male IV drug user asked, "What good is it going to do for you to cure me?"

Renee Turner, a television producer and member of a federal HIV vaccine communications task force, said researchers must find ways to get people at risk to stop worrying about "boogiemen" and think about the health of their community.

"There is a cost for being left out," she said.

What To Do

Learn more about HIV vaccine development from the HIV Vaccine Trials Network.

The Tuskegee study of black men with syphilis has cast a pall over government medical research. Learn more about its "troubling legacy" from the University of Virginia.

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Fewer Side Effects with New Anti-Inflammatory Drugs

By Jacqueline Stenson

Reuters Health
Friday, September 20, 2002

NEW YORK (Reuters Health) - Amid ongoing controversy over which painkillers are best, a large Canadian study finds that a new class of nonsteroidal anti-inflammatory drugs (NSAIDs) is safer than an older class and that one particular agent stands apart from the rest--celecoxib, sold as Celebrex.

However, an expert said the study still doesn't answer all the questions as to whether newer types of antiinflammatories, known as COX-2 inhibitors, are better than old standbys such as ibuprofen.

NSAIDs have been linked to potentially dangerous gastrointestinal side effects. But the new study, which involved a review of thousands of patient records in Ontario, concluded that celecoxib caused no more stomach bleeding among elderly patients than occurred among people not taking NSAIDs.

In a second study in the same journal, British researchers reanalyzed data from nine studies that compared celecoxib to older NSAIDs like naproxen and ibuprofen or an inactive placebo. Some of this research had previously been sharply criticized for its methodology. The new results showed that celecoxib was just as effective in treating arthritis as the older drugs but with fewer stomach side effects. The study was funded in part by celecoxib's maker, formerly Searle and now Pharmacia.

Neither of the studies, both published in this week's issue of the British Medical Journal, is likely to settle the debate over which medication is optimal.

What is needed, some say, is a very large trial in which the various NSAIDs--including the newer celecoxib and rofecoxib (Vioxx) and the older ibuprofen and naproxen--are compared head to head among patients randomly assigned to a particular drug and then followed for a long enough time to determine if there are any significant long-term side effects, including an increased risk of death from heart problems or other causes.

"At present it is still difficult to give patients an honest, accurate and understandable account of the balance between relief of pain and improved function on the one hand, and the likelihood of serious adverse effects on the other," Dr. Roger Jones of the Guys's, King's and St. Thomas's School of Medicine in London, writes in an accompanying editorial. Jones has served as a paid consultant to Wyeth, which makes aspirin, an NSAID, and Astra Zeneca.

Celecoxib and rofecoxib belong to the new class of NSAIDs known as COX-2 inhibitors. These drugs are designed to suppress the activity of the COX-2 enzyme, while causing fewer stomach side effects than older medications like ibuprofen and aspirin, which block both COX-1 and COX-2 enzymes. COX-1 helps protect the stomach lining, which is why the newer drugs were created with just COX-2 as a target.

But all COX-2 inhibitors may not be alike, said Dr. Muhammad Mamdani, a scientist at the Institute for Clinical Evaluative Sciences, a nonprofit government-funded research group in Toronto, who conducted the first study.

"Vioxx and Celebrex both demonstrated lower risk of gastrointestinal bleeding relative to the traditional NSAIDs," he told Reuters Health. "But the risk of major gastrointestinal bleeding with Celebrex was similar to that of those not taking NSAIDs at all."

Mamdani and colleagues reviewed hospital data on more than 40,000 elderly patients treated with NSAIDs from April 2000 to March 2001. They also looked at health data on 100,000 people who had not taken NSAIDs.

In comparison with people not taking any of these medications, the risk of gastrointestinal bleeding was four times greater for those taking conventional NSAIDs such as ibuprofen and naproxen and nearly two times greater for those on rofecoxib. There was no increased risk with celecoxib.

Mamdani said that based on prior research, he expected there to be less bleeding with rofecoxib, but that was not the case. "We were completely surprised," he said.

The US Food and Drug Administration ( news - web sites) requires the celecoxib label to carry a stronger warning about gastrointestinal side effects than that of rofecoxib.

A spokesperson for Merck, which makes rofecoxib, said the Canadian findings are not conclusive because the study was observational, rather than a trial designed to carefully compare the medications. "I don't think you can draw firm conclusions from it," Dr. Alise Reicin, executive director of clinical research for the company, said in an interview.

Source: British Medical Journal 2002;325:607-608, 619-627.

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Tight State Budgets Are Forcing Medicaid Cuts 

By Julie Rovner

Reuters Health

Friday, September 20, 2002

WASHINGTON (Reuters Health) - More than half the states in the US are planning to reduce eligibility for the Medicaid health program for the poor or to reduce benefits, according to a survey of state Medicaid directors released Thursday.

"The situation is really quite severe," said Vern Smith, a former Michigan Medicaid director, whose firm, Health Management Associates, conducted the survey for the Kaiser Commission on Medicaid and the Uninsured. The survey was released at a briefing on Capitol Hill sponsored by the commission and the Alliance for Health Reform.

The survey of Medicaid directors in all 50 states and the District of Columbia found that, faced with increasingly tight budgets, states in 2002 mostly exhausted one-time cash infusions like rainy-day funds or tobacco settlement money.

Faced with increasing enrollments and continuing double-digit cost increases--Medicaid spending rose 12.8% last year--and revenues that are flat or declining, states have no choice but to impose cuts, the survey found.

For fiscal 2003, 18 states plan to reduce or restrict Medicaid eligibility, including Missouri, which dropped more than 32,000 adults on July 1; Nebraska, which plans to cut 25,000 children and adults from its rolls; and New Jersey, which stopped accepting applications for its "Family Care" program.

The survey found 15 states reducing benefits, primarily dental services for adults, but also restrictions on home health care, podiatry, chiropractic services, eyeglasses, psychological counseling and translator services.

At the same time, states are also making what Kristin Testa, of the advocacy group Children's Partnership, referred to as "backdoor cuts," making it more difficult for eligible people to sign up for benefits. California, for example, has decided not to implement a program that would let families sign their children up for medical benefits at the same time they sign up for the school lunch program.

Smith said the number of states making cuts is significant, particularly given that states "know that cutting eligibility is a self-inflicted wound," since it deprives states of federal matching money.

Joy Wilson of the National Conference of State Legislatures said her organization will soon release a survey of state budget officers that will show the situation is not improving. "State revenues are continuing to decline overall, and many states are looking at across-the-board cuts" that will include more Medicaid reductions, she said.

In July, the US Senate overwhelmingly approved a $9 billion increase in spending for Medicaid and other social service programs. But the amendment was part of a generic drug bill the House appears unlikely to consider. Efforts are underway to include the $9 billion in a Medicare provider payment package expected to pass before Congress adjourns for the year.

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HIV Vaccine Trials May Be Opposed by AIDS Victims 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, September 20, 2002

FRIDAY, Sept. 20 (HealthScoutNews) -- The very groups who may most benefit from an AIDS ( news - web sites) vaccine may also be the ones who offer the most resistance to its final testing phase.

Researchers said this week they expect opposition to widespread HIV ( news - web sites) vaccine tests from groups comprising gay men, blacks and IV drug users.

"There are social and political challenges," said Joy Workman, a senior program manager with the National Institutes of Allergy and Infectious Diseases, at the annual U.S. Conference on AIDS in Anaheim, Calif.

In a series of video interviews presented at the conference, people in the major risk groups said they feared taking part in health research because they don't trust their government. Many summed up their concerns by mentioning the words "guinea pig" and "Tuskegee" -- a reference to the disastrous study of syphilis among Alabama black men.

The willingness of people to participate in vaccine testing is no minor matter, experts said. As many as 15,000 people must take part in the final testing phase of any HIV vaccine, said Steve Wakefield, associate director for community relations with the HIV Vaccine Trials Network. And it makes the most sense to launch the studies in developed countries that have strong health systems in case someone gets infected with HIV, he said.

Researchers have been testing HIV vaccines on people since 1987. Their goal is to develop a vaccine that will prevent infection by HIV, the virus that causes AIDS.

While researchers have studied 50 vaccines worldwide, only one has reached so-called "Phase III" testing, in which thousands of people at high risk are given the vaccine and then followed for several years to see if they become infected. The other phases, which last as long as two years each, test the vaccines on small numbers of people, usually at low risk, to determine if they are safe and if they work better than placebos.

Results from testing of the one vaccine in Phase III -- known as AIDSVAX -- are expected next year. It is being developed by the VaxGen company, which has been examining its effectiveness among subjects in North America, Puerto Rico, the Netherlands and Thailand.

There's reason to believe a vaccine is possible, because some people at extremely high risk -- prostitutes, for example -- don't get infected despite repeated exposure, said Dr. Gaston Djomand, a clinical trials physician with the HIV Vaccine Trials Network. Also, a small number of HIV-positive people have never developed AIDS despite being infected for many years.

"There is probably a natural mechanism of protection," Djomand said. "We strongly believe that a vaccine is possible."

However, researchers have had to abandon several vaccine strategies because they didn't work, he said. Researchers are no longer looking at using a live weakened strain of the virus (as is used in measles and chicken pox vaccines) or a dead inactivated virus (as in flu vaccines).

The most promising vaccines in development may be able to prime the immune system to protect against transmission of HIV through both sex and blood.

Vaccine experts said education is key to convincing people at high risk to take part in the final phases of HIV vaccine studies, which may become more common. "Just handing out a brochure will not bring out all the information you need," Wakefield said.

The challenges appear to be major, according to a video that studied opinions about vaccine studies among gay men in San Francisco, IV drug users in Philadephia and blacks in Durham, N.C.

"We're in a minority, and in the bigger picture, we're not treated that well by the government," said a gay man. "Are they really going to be honest with us?" asked a woman from Philadelphia.

And a male IV drug user asked, "What good is it going to do for you to cure me?"

Renee Turner, a television producer and member of a federal HIV vaccine communications task force, said researchers must find ways to get people at risk to stop worrying about "boogiemen" and think about the health of their community.

"There is a cost for being left out," she said.

What To Do

Learn more about HIV vaccine development from the HIV Vaccine Trials Network.

The Tuskegee study of black men with syphilis has cast a pall over government medical research. Learn more about its "troubling legacy" from the University of Virginia.

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One Bad Copy of Gene Boosts Colon Cancer Risk 

By Keith Mulvihill

Reuters Health

Friday, September 20, 2002

NEW YORK (Reuters Health) - A gene mutation found in people of Ashkenazi Jewish descent appears to boost colorectal cancer risk, according to a report released Thursday.

Scientists already knew the gene defect causes Bloom syndrome, a rare cancer-susceptibility condition that occurs when both copies of the gene--one inherited from each parent--are defective.

The new study suggests that people who inherit one healthy copy and one mutated copy of the gene have two to three times the risk of developing colorectal cancer as people without the gene mutation.

"The main finding of our study is that a genetic mutation found in about 1 in 120 people of Ashkenazi Jewish descent causes colorectal cancer," said the study's lead author Dr. Stephen B. Gruber, during an interview with Reuters Health. "We estimate that this one genetic alteration accounts for somewhere between 1% to 2% of all colorectal cancer among Ashkenazi Jews," said Gruber, of the University of Michigan Medical School in Ann Arbor.

The gene is called BLM and two studies of the gene--one in mice and one in humans--are published in the September 20th issue of the journal Science.

In the first study, Gruber, Dr. Nathan A. Ellis of Memorial Sloan-Kettering Cancer Center in New York, and colleagues compared the DNA of 1,244 colorectal cancer patients of Ashkenazi Jewish ancestry with 1,839 healthy people, also of Ashkenazi ancestry.

Ashkenazi Jews are a branch of European Jews who historically settled in Central and Northern Europe.

The investigators found that 2% of patients carried the gene mutation compared with less than 1% of healthy people.

Although the particular mutation is not found in other populations, Gruber said other mutations of the BLM gene may contribute to colorectal cancer in the general population.

Ordinarily, the BLM gene guards DNA to protect it from excessive recombination and mutation, Gruber explained.

"Until now, we thought that one healthy copy of the BLM gene was good enough to guard against DNA damage and maintain the stability of DNA in our cells," he said.

"What is new about our finding is that the BLM gene was previously thought to be perfectly harmless unless both copies were altered," Gruber told Reuters Health.

"Now we are beginning to appreciate that autosomal recessive disorders like BLM syndrome can have implications to the carriers of just one bad copy," said Gruber. "In other words, one dose of a healthy BLM gene is enough to prevent Bloom syndrome, but isn't enough to prevent colorectal cancer."

Bloom syndrome is characterized by small stature, a weakened immune system, male infertility and a susceptibility to many types of cancer.

In spite of the current findings, Gruber said the current findings do not change how physicians diagnose or treat colorectal cancer, and other researchers will need to replicate the team's findings.

In the second study, a research team led by Dr. Joanna Groden of Howard Hughes Medical Institute in Cincinnati, Ohio, examined the equivalent form of the BLM gene in mice.

Groden, who is also a co-author on Gruber's study, and colleagues report that one mutant copy of the BLM gene also leads to an increased risk of cancer in mice.

Source: Science 2002;297:2013, 2051-2053.

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FDA Advisors Back Stronger Acetaminophen Warning 

By Ori Twersky

Reuters Health

Friday, September 20, 2002

WASHINGTON (Reuters Health) - Advisors to the US Food and Drug Administration ( news - web sites) (FDA) urged the agency on Thursday to require a stronger warning on acetaminophen product packaging to stress that misuse of the popular pain reliever can lead to liver toxicity.

Acetaminophen is found in Tylenol, but is also in almost 200 different products, including cold and flu remedies. Taken by about 100 million Americans a year, acetaminophen is the most widely used nonprescription drug in the US.

The FDA's Nonprescription Drugs Advisory Committee expressed almost unanimous support for an immediate change to the drug's labeling, citing concerns about consumers who use the product inappropriately.

The FDA convened Thursday's advisory panel as part of an ongoing review of over-the-counter drugs that began in 1988. On Friday, the panel will consider whether warnings on other popular nonprescription pain relievers, including ibuprofen, provide adequate information about possible gastrointestinal side effects.

US regulators have discussed and debated acetaminophen's possible liver toxicity since 1977. The purpose of Thursday's meeting was to revisit the issue in light of recent data suggesting that additional measures might be needed to prevent unintentional overdoses.

Overdoses are the most often cited cause of acetaminophen-associated liver toxicity. According to federal figures, acetaminophen overdoses lead to about 56,000 emergency room visits, 26,000 hospitalizations and 450 deaths a year. Although the majority of the events are suicide-related, FDA officials said during Thursday's meeting that about 13,000 of the emergency room visits, 2,200 of the hospitalizations and 100 of the deaths are apparently unintentional.

Causes include inadvertent use of multiple acetaminophen-containing products at the same time and the misinformed belief that larger doses will lead to faster relief, the FDA officials said.

Advisory panel members recommended adoption of a label that more clearly outlines the possible effects of an overdose and points out the presence of acetaminophen in products such as cough and cold medications.

"We don't want to make Tylenol look like a dangerous drug," said panel member Dr. Nathaniel Katz, an anesthesiologist in New Rochelle, New York. "Still, it seems to me that someone buying something in the supermarket should know what's in it."

The FDA is not required to follow its advisors' recommendations, but it often does so.

If the agency does require stronger labels, it will have the support of some industry members.

McNeil Consumer, the Johnson & Johnson subsidiary that makes Tylenol, already has proposed the adoption of a label cautioning that inappropriate use could lead to liver toxicity.

McNeil Vice President Dr. Anthony R. Temple told Reuters Health the firm has been encouraging other manufacturers to adopt the new label on a voluntary basis. "It would certainly help if the FDA finalized a rule," he said.

But both McNeil and the FDA stressed that unintentional overdoses and liver toxicity are rare events given the number of users of acetaminophen.

"The agency continues to believe that acetaminophen is a safe and effective OTC analgesic that benefits tens of millions of consumers every year," the FDA said.

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Chronic wasting disease may be spreading

From the National Desk
United Press International

Friday, September 20, 2002

 MADISON, Ill., Sept. 20 (UPI) -- Wisconsin natural resources officials Friday worried chronic wasting disease has spread from the initial outbreak area near Madison to infect deer in other parts of the state.

The Department of Natural Resources said a white-tailed buck shot on a game farm in Portage County tested positive for the disease, which is similar to mad cow in cattle. Discussions were under way on whether to speed up plans to test the deer population throughout the state.

The infected deer was killed Sept. 4 by a hunter on a preserve. Officials said the buck is believed the first captive deer to test positive for the disease in the nation. Previously only captive elk had tested positive for chronic wasting disease.

Investigators have not yet determined the infected animal's movements or whether the hunter processed meat.

The game farm has been quarantined, along with another game farm in Walworth County. It has not yet been determined whether all the animals will be destroyed.

There are 946 game farms in Wisconsin, where hunters pay up to $100 to hunt. The farms have more than 35,000 animals, many of which came from Nebraska, Colorado and Saskatchewan, where chronic wasting disease first surfaced. Investigators have been eyeing game farms as a possible source of the disease in the wild deer population.

The state authorized four off-season deer hunts to kill 25,000 animals in a bid to stop the disease from spreading from the initial outbreak area near Mount Horeb, where 31 infected deer have been found.

In Minnesota, the Animal Health Board said Thursday officials will destroy the remaining 48 elk on a farm where the state's first case of chronic wasting disease was discovered last month.

The animals will be shipped from a farm in Aitkin, Minn., to the University of Minnesota's Veterinary Diagnostic Laboratory in St. Paul, where they will be tested and destroyed. Brain-stem samples will be sent to the U.S. Agriculture Department lab in Ames, Iowa.

Like mad cow in cattle and scrapie in sheep, chronic wasting disease is caused by abnormal proteins that attack the brain and nervous system, causing weight loss and behavioral changes. Researchers have not yet figured out how chronic wasting disease is spread or whether it is transmittable to humans.

No cases of chronic wasting disease have been found in Minnesota's wild deer population.

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THURSDAY, SEPTEMBER 19, 2002 

Kids Using Prescription Drugs More  

By Theresa Agovino

AP Business Writer

The Associated Press

Thursday, September 19, 2002

NEW YORK (AP) - When Christy Olson's daughter developed asthma as a toddler 12 years ago, she was reluctant to put her on prescription drugs.

"I was so worried about side effects. I didn't want to give it to her unless I had to," said Olson, who lives in Rochester, Minn., and is a nurse herself. She decided it was a necessary move, and her daughter, now 15, still takes medicine for her condition.

While parents then and now are often nervous about medicating children, it is becoming more common. Use of prescription drugs is growing faster among children than it is among senior citizens and baby boomers, the two traditionally high consumer groups, according to a new study.

Spending on prescription drugs for those under 19 grew 28 percent last year, according to the survey by Medco Health Solutions, a Franklin, N.J.-based pharmacy benefits manager.

Meanwhile, spending per patient rose 23 percent for those between the ages of 35 and 49 and less than 10 percent for those above 65.

Children are also spending 34 percent more time on medication than they were five years ago, the study found.

Treating children is still relatively inexpensive, costing an average of $84.72 per patient each year. That compares to an average expense of $944.40 per year for people aged 65 to 79.

The Centers for Medicare and Medicaid Services, a government agency, estimates that overall spending on prescription drugs rose 16.4 percent to $142 billion last year.

Among children, the most prescribed drugs were for allergies, asthma and infections. Prescriptions for Ritalin ( news - web sites) and other medicines for neurological and psychological disorders were also substantial — a finding that renewed concern among some experts who worry that such drugs may be over-prescribed for children.

Some doctors also were alarmed that spending on prescription drugs to treat heartburn and other gastrointestinal disorders surged 660 percent over five years, according to the study. The jump was seen as linked to the increasing number of overweight children in the United States.

Some of the findings on prescription drugs mirrored trends seen in disease patterns. For example, the incidence of asthma and allergies are generally increasing, so doctors said it wasn't surprising that children's prescriptions for such ailments would also grow.

"It is good news that more kids are getting treated for asthma because it means less trips to emergency rooms and hospitals," said Dr. Robert Epstein, chief medical officer of Medco Health.

About 7 percent of children have asthma and 25 percent have allergies, approximately double the incidence 25 years ago, according to Dr. Michael Blaiss, a pediatrician who specializes in such ailments.

Olson, the Minnesota nurse, also has a 13-year-old son who has asthma and is receiving medicine. She suffers from asthma herself.

Medicating her children has at times been a difficult process. Her daughter, when she was 9, had a severe reaction to steroid she was taking and went into shock. It took 18 months of experimenting to find a correct dosage.

Even so, she's more comfortable now than she was at first with having her daughter taking drugs. "I feel differently now because I see that she needs it and she is better because of it," Olson said.

"I know things have gotten better since that time, but drugs are such an important part of treatment that we need more studies," she said.

The survey also found that spending on antibiotics among children increased 42 percent. Doctors say antibiotic resistance is a widespread problem.

Spending on drugs for Attention Deficit Hyperactivity Disorder increased 122 percent over the past four years and accounted for 8 percent of the total spent on prescription drugs for children, up from 7 percent in 1997. Spending for depression medicines held steady at 5 percent of the total.

Dr. Lawrence Diller, author of "Should I Medicate My Child?" worries that such drugs are over-prescribed. He also pointed out that, while Ritalin and other drugs for ADHD are generally seen as safe for children, there haven't been many studies of the effects of antidepressants on children.

"The antidepressants are known to have sexual side effects. I wonder what the long-term effects of that is going to be on adolescents," Diller said.

The vast majority of prescription drugs are developed for adults, and drug makers are not obliged to test them on children. In 1997, Congress passed legislation that gave drug companies an additional six months of market exclusivity if they tested their drugs on children. That has sparked more tests, but experts say more studies are needed.

"I think practitioners feel more confident now that there is more data to back up prescription patterns," said Dr. John Ring, who sits on the American Academy of Pediatrics' Committee on Drugs.

But he said most of the prescriptions written for children are still written for drugs that haven't been approved for youngsters.

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Carbon Monoxide Can Kill Boaters in Minutes: CDC 

Reuters Health

Thursday, September 19, 2002

NEW YORK (Reuters Health) - The near-fatal illnesses of two Georgia children highlight the dangers posed by high levels of carbon monoxide in boat exhaust, according to a report from the US Centers for Disease Control and Prevention ( news - web sites) (CDC).

In one case, a 2-year-old stopped breathing and was rendered unconscious after spending less than a minute at the stern of a boat during a family water-ski outing.

In fact, since 1990, US government officials have recorded "17 fatalities and 37 nonfatal poisonings on US waters resulting from exposure to the propulsion engine exhaust of ski boats and cabin cruisers," according to the CDC. Their report on the case of the two Georgia children is published in this week's issue of the CDC journal Morbidity and Mortality Weekly Report.

According to witnesses, in June of this year, a Georgia family--including two boys aged 4 and 12 years, and a girl aged 2--went water skiing on a lake. While the boat was idling, the 2-year-old girl climbed onto a wooden swim platform at the boat's stern, lying on her back and kicking her legs in the water.

"In less than 1 minute, she became unconscious and unresponsive," the CDC report indicates. Her father, a doctor, quickly realized that she was not breathing but still maintained a pulse. After performing mouth-to-mouth resuscitation, the child began to breathe again and 35 minutes later EMS personnel arrived to provide her with oxygen. However, even 3 hours later her levels of carboxyhemoglobin--CO-laden blood cells--were still more than 14%. Less than 5% is considered normal.

The family's troubles were not over, however. As his father attempted to revive her, the girl's 4-year-old brother stood on the same swim platform as the boat continued to idle. "Several hours after being removed from the water, he complained of severe headache, vomiting, and fell asleep," the report authors relate. The boy was quickly transported to the hospital where he received oxygen therapy to combat high levels of carbon monoxide in his blood.

Luckily, both children made full recoveries and were later discharged from the hospital. But experts at the CDC say the incidents serve as a perfect illustration of how quickly carbon monoxide--a colorless, odorless gas--can overwhelm unsuspecting individuals. And while many boaters may understand the dangers of CO poisoning on larger craft such as houseboats, the Georgia report "describes CO poisoning resulting from direct exposure to CO in the exhaust of a ski boat."

To minimize CO poisoning risks, the CDC recommend that boaters "avoid swimming or body surfing near the exhaust system while the boat or generator is running," and to be aware that CO from motor exhaust can collect in the rear portions of boats, as well. Boaters also need to be aware that typical symptoms of CO poisoning--headache, nausea, vomiting or dizziness--can mimic other maladies such as seasickness or heat exhaustion.

They also call for more research and public education into the issue. "Studies of CO concentrations in the air around boats and of carboxyhemoglobin levels in recreational boaters are needed to determine the extent of boat-related CO poisonings, and public health campaigns to warn of the danger," they write.

Source: Morbidity and Mortality Weekly Report 2002:51:829-830.

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Stress Cited in 'Out-of-Body' Claims  

By Joseph B. Verrengia

AP Science Writer

The Associated Press

Thursday, September 19, 2002

A study suggests the oft-reported sensation of leaving the body during a brush with death may have a simple explanation in the body itself.

These "out-of-body" and "near-death" experiences — in which people resuscitated on the operating table speak of being drawn toward a brilliant light, or looking down on their own bodies — may be influenced by a portion of the brain misfiring under stress, the study suggests.

The paper describes one patient's visions while she was being evaluated for epilepsy and does not wrestle with issues of the soul. And researchers noted that the brain-mapping results may not entirely explain the phenomenon.

The study focuses on a processing center in the brain known as the angular gyrus, thought to play an important role in the way the brain analyzes sensory information to give us a perception of our own bodies. When it misfires, they speculate, the result can be visions of floating outside of ourselves.

The findings were published in Thursday's issue of the journal Nature.

"We do not fully understand the neurological mechanism that causes OBEs," conceded the study's lead researcher, neurologist Dr. Olaf Blanke at the University Hospitals of Geneva and Lausanne in Switzerland.

Skeptics of out-of-body experiences said the experiment goes a long way toward providing a scientific explanation for what some believe is a paranormal phenomenon, even if the study is based on only one patient.

"It's another blow against those who believe that the mind and spirit are somehow separate from the brain," said psychologist Michael Shermer, director of the Skeptic Society, which seeks to debunk alien abductions and other paranormal claims. "In reality, all experience is derived from the brain."

Other researchers described the experiment as modest but interesting.

Neurologist Dr. Bruce Greyson of the University of Virginia said the experiment does not necessarily prove that all out-of-body experiences are illusions.

"We cannot assume from the fact that electrical stimulation of the brain can induce OBE-like illusions that all OBEs are therefore illusions," Greyson said.

The Swiss researchers mapped the brain activity of a 43-year old woman who had been experiencing seizures for 11 years. They implanted electrodes to stimulate portions of her brain's right temporal lobe.

The temporal lobe, which includes the angular gyrus structure, is associated with perception of sound, touch, memory and speech.

Blanke suspects that the right angular gyrus integrates signals from the visual system, as well as information on touch and balance.

When electrical stimulation was applied, the patient reported seeing herself "lying in bed, from above, but I only see my legs and lower trunk." She also described herself as "floating" near the ceiling.

Millions of people have reported OBEs, but relatively few have been clinically analyzed.

Last December, the British medical journal Lancet published a Dutch study in which 344 cardiac patients were resuscitated from clinical death. About 12 percent reported seeing light at the end of a tunnel, or speaking to dead relatives.

Other researchers have suggested that OBEs occur as brain cells die from lack of oxygen, or when the brain releases pain-reducing chemicals called endorphins.

On the Net:

Nature journal: http://www.nature.com/

Skeptic Magazine: http://www.skeptic.com/

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MS might be sexually transmitted

From the Science & Technology Desk
United Press International

Thursday, September 19, 2002

 LONDON, Sept. 18 (UPI) -- Building on a longstanding theory that multiple sclerosis is triggered by an as-yet-undiscovered virus, a British researcher has assembled evidence from dozens of different studies he claims support his hypothesis MS might be transmitted primarily by sexual contact.

A number of experts contacted by United Press International questioned the validity of the data used to support the theory, however.

"This is a new way of looking at multiple sclerosis -- it provides a testable hypothesis," Christopher Hawkes, a neurologist at London's Institute for Neurology and the expounder of the idea, told UPI.

"It's a sensitive subject, because if you had MS and you had a perfectly respectable upbringing, respectable life, with just one or two partners before you married, you wouldn't like to think it had the same stigma as something like syphilis," Hawkes said.

Sufferers of multiple sclerosis progressively develop scarring of the myelin, the protective sheath that covers the nerves. The condition leads to muscle weakness, blurred vision, slurred speech, tremors and other symptoms. MS affects as many as 500,000 people in the United States. There is no known cure.

Hawkes' research turned up four small MS epidemics that occurred on the Faroe, Orkney and Shetland islands and in Iceland following large influxes of Allied troops during World War II. This suggests sexual activity between women on the islands -- who previously had lower rates of infection -- and troops from geographic regions with higher rates of infection led to the outbreaks. There are questions about the accuracy of some of the relevant statistics, however.

Hawkes suggested -- as have other researchers -- that because the human T-Cell lymphotrophic virus-1, or HTLV-1, has been shown to cause a disease with symptoms quite similar to MS, a viral agent might be at work and might be transmitted sexually.

Among the studies cited by Hawkes are one done in Kashmir, India and another in Thugbah, Saudi Arabia, where extramarital sexual relations are thought to be relatively rare. Both showed extremely low rates of MS.

In contrast, research shows increased MS rates in western countries following the introduction of birth control pills and less use of barrier methods, beginning in the 1970s, he said.

"There is absolutely no data to support (this) hypothesis," Lauren Krupp, a neurologist and co-director of the MS center at the State University of New York at Stony Brook, told UPI. "For every point that the author raises to support his argument there is a very strong counter-argument," she said. "The specific kinds of things you would look for to support his argument aren't found in the existing data in the literature."

Krupp, who also is a spokeswoman for the National Multiple Sclerosis Society, cited a study -- also used by Hawkes -- of 13,000 married couples with one spouse contracting MS but showing no evidence of a higher rate of transmission to the other spouse.

Hawkes responded he thinks susceptibility to the disease is higher at younger ages and some studies of couples do show five times the rate expected in the general population. In addition, he said, in tropical spastic paraplegia, the disease caused by HTLV-1 -- which is known to be sexually transmitted -- transmission among married couples is relatively low. The same may be true for MS.

He acknowledged, however, that a virus, if it exists, also might need to act along with genetic susceptibility -- generally thought to be a key ingredient to developing the disease. "I say let's have a look at it rather than talking it into the ground. ... You've got to keep an open mind because nobody has the answer on MS," Hawkes said.

Although there may very well be a viral agent, or multiple viral agents, Krupp said, increased rates following higher levels of troops in isolated communities could be explained by viral transmission that was not necessarily sexual -- something Hawkes agrees is possible.

Graeme Stewart, an immunologist at Westmead Hospital in Sydney, Australia, told UPI, "The sexually transmitted infection hypothesis in multiple sclerosis is of low credibility."

Hawkes theory will be published in the October issue of the Journal of Neurology, Neurosurgery and Psychiatry.

Reported by Joe Grossman, UPI Science News, in Santa Cruz, Calif.)

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Students Work on Realistic 'Patient'  

By Jim Fitzgerald

Associated Press Writer

The Associated Press

Thursday, September 19, 2002

YONKERS, N.Y. (AP) - A healthy, 30-year-old jogger named Stan died at a suburban hospital when he was purposely given an overdose of Adrenalin. A dozen people watched as his heart rate jumped, then flat-lined, and his breathing stopped.

It was no big deal. Stan has died before, and he'll die again.

Stan — short for Standard Man — is a Human Patient Simulator, part dummy and part computer, life-size and so anatomically correct that he can be intubated, medicated, ventilated, defibrillated and killed.

He is giving students at the Cochran School of Nursing, part of St. John's Riverside Hospital, hands-on experience handling dozens of medical conditions without having to wait for the real thing — or endangering a live patient.

Want to practice treating congestive heart failure? A click of the mouse gives Stan all the symptoms and signals him to react to treatment the way a human would.

"This is a significant bridge between just practicing with equipment and working on a patient," said Kathleen Dirschel, the school's director. "Here they have the chance to see something they might not otherwise encounter until they're in the ER, and they can practice until it's second nature."

The hospital bought Stan and his software for $220,000 this year and spent an additional $30,000 for his lab setup. About 300 of the simulators are in use worldwide, mostly at medical schools, said Grace Carlson, spokeswoman for Medical Education Technologies Inc. of Sarasota, Fla., which designed the simulator.

For a demonstration Wednesday, Stan was brought to life on a gurney, hooked up to an intravenous tube, a heart monitor, a catheter and the computer. With a computer command, Stan's rubbery chest started to rise and fall, his somewhat raspy breathing could be heard and his pulse could be felt.

Eleanor Fitzpatrick, who directs the lab, filled a hypodermic needle with sterile water, which registered as Adrenalin when a bar code on the needle was waved at a scanner near Stan's neck.

"I gave him a lot, so I might kill him," Fitzpatrick said after injecting the dummy.

Indeed, Stan was a goner within about 45 seconds. Fitzpatrick said that in normal teaching, students would be called on to treat him for the overdose with other drugs or to restore his heart rhythm with the defibrillator, which connects to two metal plates on Stan's chest.

"Regular mannequins are so unresponsive," said nursing student Brian Ford. "This gives you the real experience instead of just hearing about it in a classroom."

For a clean-living guy, Stan gets sick a lot: There are about 50 scenarios, including a heart attack, asthma or internal bleeding. He can act as if he nearly drowned or was shot. There's even a program that makes him the victim of a land mine.

His eyes can close or blink at different speeds and his pupils react to light. There's a remotely operated speaker in his mouth, so he can even seem to talk, except when his tongue swells to mimic conditions that make intubating difficult.

"He's as physiologically close to human as is possible right now," Fitzpatrick said.

Though he's 6 feet 2 inches tall, Stan can even be Stella. On Wednesday he was equipped with male genitalia, but his parts are interchangeable and a sex-change is a snap. He even has a wig.

The software can be swapped to have Stan react as if he were an obese 60-year-old truck driver or an elderly woman with extremely low blood pressure. There's even a new pediatric model, which some hospitals call Stan Jr.

Though Stan's ability to come back from the dead makes him a valuable teaching tool, there are times when his problems aren't quite human.

"Sometimes he just has to be rebooted," Fitzpatrick said.

On the Net:

St. John's Riverside Hospital and Cochran School of Nursing: http://www.riversidehealth.org

Medical Education Technologies Inc.: http://www.meti.com

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Parasites May Help Explain Gender Longevity Gap 

By Merritt McKinney

Reuters Health

Thursday, September 19, 2002

NEW YORK (Reuters Health) - It's no secret that women tend to live longer than men, but it may not be just that men drive too fast and take other risks, new research suggests. Parasites could be to blame, at least in part, according to a study from the UK.

In an article in the September 20th issue of the journal Science, Drs. Sarah L. Moore and Kenneth Wilson of the University of Stirling report evidence that male mammals are more susceptible than females to parasites, which are a common cause of death in wild animals.

And there is some evidence, according to an editorial that accompanies the study, that parasites could affect sex differences in death rates among people, too, since men are more likely than women to harbor parasites.

Exactly why parasites seem to have it in for men is uncertain, but size might have something to do with it, study co-author Wilson told Reuters Health.

Wilson explained that in most mammal species, males compete with each other for the right to mate with females. He noted that in many species, including gorillas, baboons, antelopes and wild sheep, males have evolved to be bigger, on average, than females "since large males tend to do better in fights."

"What our study shows is that one of the downsides to evolving to be large is that the risk of becoming parasitized increases," Wilson said.

In an analysis of parasite infection rates in a variety of mammal species, Wilson and Moore found that male mammals were more likely to be infected with parasites than female mammals. The difference was small, but it was large enough that it most likely did not occur by chance.

Being infected with parasites "appears to be costly," Wilson said. He noted that in mammals, the sex that is larger and thus most likely to have parasites, usually the male, tends not to live as long as the smaller sex. But Wilson said the link between parasites and a shorter life holds true even for the minority of species in which females are larger than males and have higher rates of parasites--some kinds of gerbils, rats, bats and rabbits, for example.

"Our study suggests that parasites are contributing to sex differences in mortality rates in wild mammal populations," Wilson said.

The gender gap in parasite infection rates was most pronounced, the study found, in species where there were greater size differences between the sexes or where there was more intense mating competition among males.

Why size puts larger animals at greater risk of parasites is still a mystery, according to Wilson. Testosterone, which is more plentiful in males, is known to suppress the immune system somewhat, Wilson said, but that would not explain why large females are also more likely to have parasites. Another possibility, according to the UK researcher, is that larger animals simply provide a bigger target for mosquitoes that often carry parasites.

Or something in the lifestyle of larger animals may put them at greater risk of parasites, according to Wilson. "Perhaps they forage over wider areas looking for food and this exposes them to more parasites," he said.

More research is needed, Wilson said, to understand what causes these differences and to confirm that parasites play a role in the sex differences in longevity.

In an accompanying editorial, Dr. Ian P.F. Owens of Imperial College London points out that human males also seem to be more vulnerable to parasites than women.

"In the United States, United Kingdom and Japan, men are approximately twice as vulnerable as women to parasite-induced death," Owens writes. And he adds that in Kazakhstan and Azerbaijan, this rate is quadrupled in men.

In his comments to Reuters Health, Wilson said, "In fact, the magnitude of the sex difference in mortality due to parasitic and infectious diseases is similar to the sex difference in mortality due to homicide, so parasites and diseases do appear to be important in generating sex differences in life span."

Source: Science 2002;297:2015-2018.

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This CD Could Save Your Child's Life 

HealthScoutNews

Thursday, September 19, 2002

THURSDAY, Sept. 19 (HealthScoutNews) -- A new interactive ( news - external web site) CD for pediatricians, family doctors, nurses and medical office staff may help save children's lives in medical emergencies.

About 2,000 copies of the CD, called Office PERC (Office Preparedness for Emergency Response to Children), will be distributed across the country. Drs. Robert Wiebe and Patricia Primm of the University of Texas Southwestern Medical Center were among the experts who developed the CD.

"Although the office practice setting is usually not equipped to handle true emergencies, patients will often use their primary-care provider as an entry point to health care when an emergency occurs," Wiebe says.

"A prudent physician must prepare the office to recognize and stabilize potential emergencies, and have a plan to get them [patients] to definitive care emergency resources in a timely fashion. Information provided by Office PERC will give the primary-care provider all the tools necessary to have an office that is emergency prepared," Wiebe says.

The CD includes information on emergency drills, supplies, assessment methods and treatment information.

"One of the most significant issues in Office PERC is knowing the components of your EMS system. For example, knowing which EMS paramedics will respond and how quickly is one of critical importance. Office PERC is a mechanism that will aid the office practitioner to identify the EMS responder level and what pediatric medical equipment is available on ambulances responding to his office," Primm says.

More information

The Mayo Clinic has tips on how to keep your child out of the emergency room.

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New cancer treatment wipes out tumors  

By Steve Mitchell
UPI Medical Correspondent
From the Science & Technology Desk
United Press International

Thursday, September 19, 2002

 WASHINGTON, Sept. 19 (UPI) -- An experimental treatment has eliminated deadly skin tumors in six patients whose cancer previously had resisted conventional therapies, scientists at the National Cancer Institute report.

The technique, which replaces a patient's ineffective immune system with cancer-fighting cells, also might find use against other cancers and help fight viral infections such as AIDS.

For now, the therapy only targets the deadly version of skin cancer known as metastatic melanoma, said research leader Steven Rosenberg, chief of surgery at the NCI. Still, of 13 patients receiving the treatment, six had tumors shrink by at least 50 percent, with some losing nearly all of their melanomas. Four other patients experienced some tumor shrinkage while the remaining three did not respond to the treatment.

"The remarkable thing is that we could convert 90 percent of the person's immune system to fight cancer," Rosenberg told United Press International. "Now we need a deeper understanding of why it happened."

The body's immune system can generate defenders called T-cells that attack and burst tumorous and infected cells. Often, however, these cells are too few in number to stave off aggressive cancers.

Over the past 20 years, Rosenberg and colleagues have tried to boost the level of T-cells by taking some from the patients' tumors, growing them in large numbers in lab dishes and injecting them back into the patients' bodies.

"The problem is that fewer than 1 percent of the cells injected back were able to survive," Rosenberg said. "Whenever we transferred cells in the previous studies, they were generally gone in a week. It's very hard to get enough cells to fight cancer."

The transferred cells might be unable to stick around because the immune system can accommodate only so many of them, Rosenberg explained. To "make room" for transferred cells, Rosenberg's team tried suppressing the patients' immune systems with a week's worth of chemotherapy prior to the T-cell transplant.

"We raised 10 to 100 billion of these T-cells with each treatment, which took about a month to grow," Rosenberg said.

The transferred cells, which were injected along with a T-cell growth-stimulating protein known as interleukin-2, remained in "numbers that have never been approached before," Rosenberg said. "We're not getting 1 percent of cells persisting but are getting up to 90 percent." The cells persisted not just for a week, but for several months, destroying cancer cells throughout the body, he said. Suppressing the previously ineffective immune system also may have removed anything responsible for inhibiting T-cell growth in the first place, he added.

Over time, the patients' immune systems recovered, restoring their ability to fight infections. Only occasional opportunistic infections developed during treatment. Other side effects included mild disorders where patients' immune systems attacked healthy tissue. While this resulted in vitiligo, a skin disorder that produces white patches of skin, and uveitis, an iris inflammation treatable with steroid drops, "it's a small price to pay for getting rid of your cancer," Rosenberg said.

Rosenberg and his colleagues now are trying to determine exactly what made the therapy so successful in some and less so in others. Because T-cells also are responsible for attacking virally infected cells, he said, this approach may prove useful against such diseases as well.

"It's just the first step, but it's an exciting first step," said Bernie Fox, chief of molecular and tumor immunology laboratories at the Earl A. Chiles Research Institute in Portland, Ore. "We have a study based on the same principle in prostate cancer next year ourselves," Fox told UPI. "I think this work will help bolster people still struggling doing this relatively expensive therapy to do it."

The research is published in the Sept. 19 online version of the journal Science.

(Reported by Charles Choi, UPI Science News, in New York)

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Marriage Keeps Ex-Cons Out of Trouble 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 19, 2002

THURSDAY, Sept. 19 (HealthScoutNews) -- If you want to avoid a life of crime, get married.

Ex-convicts who tied the knot were less likely to commit another crime, says a new study from University of Florida researchers. Those who couldn't make the commitment and simply lived with their significant others didn't fare as well.

The findings appear in the September issue of Social Science Quarterly.

"There is something about marriage that leads offenders to turn away from crime," says lead author Alex Piquero, a professor of criminology and law at the University of Florida. "But common-law relationships [or living together] actually led to more crime among non-white offenders."

Piquero says he suspects marriage brings stability and a positive routine to ex-cons' lives, along with accountability to another person. Conversely, those who just live together don't feel that same sense of responsibility and may live more erratic lifestyles, Piquero explains.

Piquero and his colleagues followed the lives of 524 young men for seven years after they had been paroled from the California Youth Authority (CYA). The CYA, according to Piquero, is the last stop for serious youthful offenders. The men -- who were in their teens and early 20s -- had been jailed for crimes such as burglary, auto theft, assault, rape and even murder. Almost 50 percent were white, 33 percent were black and nearly 17 percent were Hispanic.

After parole, the researchers followed the men's lives for seven years, keeping track of things such as marriage, employment, repeat arrests and drug or alcohol abuse. About 23 percent got married during that time period, Piquero says.

Marriage was the only lifestyle factor studied that appeared to deter crime, while living together and heroin dependency emerged as two factors that made it more likely for ex-convicts to break the law again.

Piquero says his results are encouraging because they show criminals can change and that "once an offender does not necessarily mean always an offender."

Dr. Hiten Patel, a psychiatrist at William Beaumont Hospital in Royal Oak, Mich., says he isn't surprised by the study's findings.

"[Mental health professionals] find that people who are married, especially males, generally tend to do better overall," says Patel. "That's also true for physical health."

This study does raise one important question, however, Patel says. Was it marriage that made these ex-convicts clean up their act, or was it that the men who wanted to stay out of jail were the ones most likely to marry?

What To Do

To learn more about what works for preventing crime, visit the http://www.inform.umd.edu/CampusInfo/Departments/InstAdv/UnivRel/outlook/1998-09-08/sep-8/crime.html">University of Maryland.

For more information on the benefits of marriage, visit The National Marriage Project at Rutgers University.

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Safest to Treat Urinary Infection During Pregnancy 

By Emma Hitt, PhD

Reuters Health

Thursday, September 19, 2002

ATLANTA (Reuters Health) - Nearly one in four women with urinary tract infections (UTIs) during pregnancy may not fill their antibiotic prescriptions, which could increase their risk of having a child with mental retardation, according to new research.

Dr. Suzanne McDermott of the University of South Carolina and colleagues presented their findings here at the 1st Centers for Disease Control and Prevention ( news - web sites) Conference on Birth Defects, Developmental Disabilities, and Disability and Health.

The researchers analyzed the relationship between UTIs with or without antibiotic treatment and mental retardation and fetal death.

Two data sets, representing roughly 42,000 South Carolina Medicaid pregnancies and about 42,000 pregnancies from the National Collaborative Perinatal Project (NCPP) were included in the analysis.

Among women on Medicaid, about 14% had UTIs and about 11% of women in the NCCP contracted a UTI during pregnancy.

The researchers found no link between UTIs and mental retardation risk when antibiotic prescriptions were filled. But among the 23% of women with UTIs who did not fill their prescriptions, the risk for mental retardation or developmental delay was increased by more than 40% in both the first and third trimesters compared to those who did fill their prescriptions.

And when a woman's medication status was unknown, the risk of fetal death associated with maternal UTI was doubled.

McDermott told Reuters Health that the bacterium enterococcus was the only bug for which risk was not eliminated by filling an antibiotic prescription.

"The drugs considered safe for treating UTIs during pregnancy may not be effective against enterococcus, so there is a need for the development of safe yet effective drugs against enterococcus," she said.

Although the study population consisted of poor women, noted McDermott, the problem of not filling antibiotic prescriptions is probably similar in the general population, based on other research her team has conducted.

She also speculated that one of the main reasons the prescriptions were not filled was because of concerns that antibiotics would harm the baby.

"Doctors need to explain that antibiotics will help, not hurt the baby, but not taking the antibiotics and leaving a UTI untreated might hurt the baby," she said.

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Proteins Unlock Secrets of Heart 

HealthScoutNews

Thursday, September 19, 2002

THURSDAY, Sept.19 (HealthScoutNews) -- Two proteins that influence heart size and function have been identified and genetically uncoupled by University of Toronto researchers.

Their findings appear in tomorrow's issue of Cell.

The discovery about PTEN and PI3K alpha and gamma proteins could lead to improved treatments for people with cardiovascular disease.

"We initially had a hint that the protein called PTEN controls cell size," says lead author Josef Penninger, professor of medical biophysics and immunology.

"We knew that cardiovascular disease triggers increased heart size and eventually heart failure so we set out to figure out if PTEN also has a function in the heart. We found that PTEN is absolutely critical to how large our hearts become. But to find out that it also plays a major part in controlling heart muscle pumping and function was completely novel and unexpected," Penninger says.

In experiments using mice, Penninger and his colleagues examined what happened when these proteins were removed from hearts. They found that when they removed PTEN, the mice developed huge hearts. When the researchers shut down production of PI3K alpha protein, the hearts of the mice were only half-size.

That means the two proteins work together to regulate heart size. The researchers also found that PI3K gamma protein and PTEN combine to influence heart function.

"The data is black and white. When we knocked out PTEN, we had a huge heart and less function; when we knocked out PI3K gamma, we had normal heart size and much better function. With both of these proteins shut down, we had huge hearts and much better function," Penninger says.

"When we took out PI3K alpha, the mice had tiny hearts but normal function, and when we took out both PTEN and PI3K alpha, the mice had tiny hearts and heart failure. With these genes, we can determine heart size and can genetically control how well our hearts pump, irrespective of the heart being normal or enlarged," he says.

More information

The American Heart Association ( news - web sites) has more on heart disease.

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FDA Panel: Strengthen Drug Warning  

By Lauran Neergaard

AP Medical Writer

The Associated Press

Thursday, September 19, 2002

SILVER SPRING, Md. (AP) - Federal scientists urged stronger warning labels Thursday on every bottle of acetaminophen, based on evidence that thousands of Americans may unwittingly take toxic doses that could harm their livers.

"You cannot allow more innocent men, women and children to suffer," Kate Trunk, whose 23-year-old son Marcus was one of about 100 people thought to die every year from unintentional overdoses, told a panel of Food and Drug Administration ( news - web sites) advisers. "Death is not an acceptable side effect."

The FDA panel voted 21-1 to back her call for more warnings about the risk.

Some 100 million people a year take acetaminophen, and serious liver damage is very rare, manufacturers insist. Although best known by the Tylenol brand, acetaminophen is in almost 200 different branded and generic products, from headache relievers to cold-and-cough remedies. While mostly sold without a prescription, it's also in a few prescription painkillers such as Percocet and Vicodin.

Acetaminophen bottles currently recommend taking no more than 4 grams a day, or eight extra-strength pills, and to seek help for overdoses.

People often attempt suicide by swallowing handfuls of acetaminophen. That got to be such a problem in Britain that it now restricts how many tablets are sold at once.

But unintentional overdoses also can destroy the liver. Consumers often swallow a few extra pills in hopes of faster pain relief, falsely thinking that over-the-counter medications are safe enough to push the dose. Because acetaminophen is in so many products — often listed merely in the fine print — taking a few different remedies the same day can mean unknowingly ingesting potentially toxic amounts.

And some scientists warn that even taking the maximum safe dose for a long period, instead of the recommended day or two, may be risky. The question is how to tell who is at risk. "It's very clear the average dose for the average person is very safe. But we are not all average people," said FDA senior scientist Dr. John Senior.

Regardless, unintentional poisonings should be preventable, critics argue. The FDA asked its scientific advisers Thursday what steps it should take.

An FDA review found more than 56,000 emergency room visits a year due to acetaminophen overdoses, about a quarter of them unintentional — and about 100 deaths. That's probably a severe underestimate of deaths because many hospitals don't report unintentional poisonings, said University of Pennsylvania pharmacist Sarah Erush.

Acetaminophen appears to be the leading single cause of acute liver failure, the most severe type of liver damage, contends Dr. William Lee of the University of Texas Southwestern Medical Center. His database of 395 patients linked 40 percent to the painkiller, more than any other liver-harming medication or disease.

Acetaminophen is safe, but "people misuse these products," acknowledged Dr. Anthony Temple, vice president of McNeil Consumer & Specialty Pharmaceuticals, Tylenol's maker. So McNeil is about to place new warnings on all its acetaminophen products to say that "taking an overdose may cause liver damage." In addition, even multi-ingredient products, like Tylenol Cold, will now display acetaminophen as an ingredient in large type on the box front.

FDA's advisers praised McNeil's new labels as a good first step, but urged more changes for all acetaminophen makers: every bottle should say it contains acetaminophen in large bold type in the front; a warning that "taking more than the recommended dose may cause liver damage;" and a warning not to use other products that contain acetaminophen because the dose will add up.

They also called for consumer education about the risk — but cautioned against making the warnings too scary. "We don't want to make Tylenol look like a dangerous drug," said FDA adviser Dr. Nathaniel Katz of New Rochelle, N.Y.

And some babies die every year when parents mix up doses of infant acetaminophen drops with children's liquid acetaminophen — they're not interchangeable products. The FDA is considering McNeil's request to help ease that problem by adding to the label the proper doses for children under age 2; currently bottles advise asking a doctor what dose to give a baby.

FDA's advisers recommended making all children's dosages more clear.

This isn't the first time acetaminophen has drawn federal concern.

In 1977, the FDA's advisers recommended more explicit warnings not to exceed the dose or take acetaminophen for more than 10 days "because severe liver damage may occur." The FDA never followed that advice but pledged to quickly consider its advisers' latest recommendation.

Packages also warn not to use if it you consume more than three alcoholic drinks, because the combination can harm the liver.

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Ultrasound May Help ID Breast Cancer Early

By Alicia Ault

Reuters Health

Thursday, September 19, 2002

WASHINGTON (Reuters Health) - Stating that mammography does not effectively catch cancerous tumors in as many as two thirds of premenopausal women, a researcher suggested here Thursday that perhaps ultrasound tests should be added as a screen for that group.

These women--and as many as 25% of postmenopausal women, along with half of postmenopausal women taking hormone replacement therapy--have dense tissue in their breasts that blocks detection of tumors on mammogram films, said Dr. Thomas M. Kolb, a radiologist in private practice in New York.

Kolb spoke here at a science reporters' conference sponsored by the American Medical Association. His research will be published in October in the journal Radiology.

Kolb just completed a study of 11,130 women, comparing how well mammography, physical breast exams and ultrasound detected cancers. These women had 27,825 consecutive screening sessions. Kolb found that "density is the most significant predictor of mammography sensitivity."

Dense tissue--which is mostly glandular, not fatty--appears solid white on film. Tumors appear black, so the dense white often hides the cancerous tissue. Kolb found that mammography could only detect 48% of cancers in the densest tissue, and only slightly more in less-dense tissue. Mammography detected only 9% of the most aggressive, invasive cancers, he said.

Adding ultrasound after a mammogram greatly improved detection in his study. The two tests together found 98% to 100% of tumors in less-dense breasts and 94% in the densest tissue.

"This is clearly a more acceptable state of affairs," said Kolb. "The importance of ultrasound cannot be overstated right now."

However, ultrasound screening is largely viewed as unproven and is rarely performed by physicians, Kolb said. And it is almost never paid for by insurance.

There are other downsides. In his study, 2.5% of women were sent for biopsies of suspicious masses that later turned out to be negative. But he said that is a fairly low false positive rate, and one that may be acceptable when traded off with increased detection rates.

Kolb said more study is needed before ultrasound will be accepted and added to current screening. There are no other ongoing US studies of ultrasound, though several are planned, he said.

Ultrasound testing could also help answer the question on whether mammograms do cut death rates, he added.

Kolb suggested that women ask their doctors to tell them their breast density after a mammogram. If they have dense tissue, they could seek an ultrasound test at a clinic that performs them often, he explained. But women will have to absorb the average $100 cost, he said.

Source: Radiology 2002;225:165-175.

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Vitamin E Won't Slow Hardening of Arteries 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 19, 2002

THURSDAY, Sept. 19 (HealthScoutNews) -- Vitamin E, long touted as an anti-aging antioxidant that can ward off heart disease, may not deliver on the promise.

A new study finds it did reduce the oxidation of low-density lipoprotein (LDL), the so-called bad cholesterol. However, that reduction didn't translate into a slower progression of the hardening of the arteries that boosts the risk of heart disease, says Dr. Howard N. Hodis, professor of medicine and preventive medicine at the Keck School of Medicine at the University of Southern California. Hodis is lead author of the study, which appears in the current issue of Circulation.

Veteran antioxidant researchers say that while the study is disappointing, it isn't the last word. It?s certainly not a reason to throw out your supply, since the vitamin may help protect against a number of other diseases.

Hodis and his team assigned more than 300 healthy men and women, aged 40 and older, all with LDL levels above the 130 milligrams-per-deciliter level that is considered undesirable for heart health, to take a placebo or to take 400 international units (IUs) of vitamin E daily. They followed 258 of them for the full three years of the study, evaluating them every six months.

"They were pre-selected to be healthy, actually quite healthy," says Hodis. "The only risk factor we wanted them to have was to have an LDL above 130. The average LDL was about 145."

When they evaluated the effect of vitamin E on heart disease risk, Hodis says, they found it reduced the oxidation of LDL cholesterol in the blood. "It has been thought that if you can protect someone's LDL, by making it more resistant to oxidation, that can ward off atherosclerosis, or hardening of the arteries," Hodis says.

Then came the disappointment. The researchers used ultrasound to look at the thickness of an artery wall, which helps evaluate how hardening of the arteries is progressing. "The progression of atherosclerosis was the same between groups," Hodis says.

Other studies have found vitamin E boosts heart health. "What is new about this study is we looked directly at the atherosclerosis process, right at the arterial wall, to see if there was an effect. Others have looked at outcomes [of people] who took vitamin E and who had a heart attack," he explains.

"This study is cause and effect," Hodis says. "For those given the vitamin E, there is no beneficial effect on atherosclerosis. That's consistent with a half dozen other studies finding the same conclusions."

Hodis offers some caveats about the study. "It might be that long-term use would work," he says. Perhaps he should have studied subjects in their 20s instead of those in their 40s or older, he says, and followed them for much longer periods.

Other antioxidant experts call the research results disappointing. However, they say it's too soon to give up on the vitamin.

"Clearly it's another disappointment for vitamin E," says Jeffrey Blumberg, professor of nutrition at Tufts University and a well-known antioxidant researcher. "There were no effects [on atherosclerosis progression] seen, but also no harm done."

Still, Blumberg says, other studies have shown that vitamin E does slow progression of the arterial wall thickening.

"This is a good study," Blumberg says, but it won't be the last. Other studies, for instance, have looked at higher doses of the vitamin and found benefit, he says.

"By no means does this study close the door on vitamin E being protective," says Dr. Meir Stampfer, a professor of epidemiology and nutrition at the Harvard School of Public Health. "You have to interpret this as evidence against vitamin E, but not definitive."

The group studied, Stampfer says, was quite healthy, except for the undesirable LDL levels. It could be, he says, that vitamin E would have a more protective effect in less healthy subjects.

Advice? "There is nothing in this [latest] study that would tell someone who is taking vitamin E to stop," Blumberg says. "And there are other reasons to continue taking vitamin E. It may help prevent prostate cancer ( news - web sites), macular degeneration [of the eye], and Alzheimer's disease ( news - web sites)."

What To Do

For information on vitamins and minerals, try the American Dietetic Association. For information on antioxidants and life extension, click on the National Institute on Aging.

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Study: No Cell Phone-Cancer Link  

By Tommy Grandell

Associated Press Writer

The Associated Press

Reuters Health

Thursday, September 19, 2002

STOCKHOLM, Sweden (AP) - A review of cell phone studies commissioned by the Swedish Radiation Protection Authority has found no "consistent evidence" of an increased risk of cancer from usage, the agency said.

Studies have differed on whether the use of mobile phones increases the risk of cancer as the handsets have become increasingly popular and efficient.

The governmental agency asked Dr. John D. Boice Jr. and Dr. Joseph K. McLaughlin of the International Epidemiology Institute in Rockville, Md., to evaluate published epidemiological research on the subject.

The review looked at nine studies since 1996 that included factors such as type of phone, duration and frequency of use and brain tumor location and found that more research was needed.

"No consistent evidence was observed for increased risk of brain cancer (or other forms)," the scientists said in the review, released Wednesday.

The agency acknowledged public concern about the issue and said many studies were still being performed and continued follow-up was needed on any possible carcinogenic effect linked to mobile phone usage.

"You can never say that something is without risk, but at least we can say that there is no scientific evidence for a causal association between the use of cellular phones and cancer," said Lars-Erik Paulsson, a radiation expert with the agency.

Magnus Ingelman-Sundberg, a professor in molecular toxicology at Stockholm's Karolinska Institute, agreed that there was no clear risk that cell phone usage increases the risk of cancer.

"From a cell biological and molecular biological standpoint, it is not possible to explain how cancer could arise from the energy and the type of radiation that is transmitted by cell phones," said Ingelman-Sundberg, who was not connected to the study.

The review singled out research by Swedish oncologist Lennart Hardell, which said that long-term users of old-fashioned analog cell phones were at least 30 percent more likely than nonusers to develop brain tumors. Newer digital phones emit less radiation than older analog models of the sort studied.

Hardell has testified in connection with an $800 million lawsuit against Motorola Corp. and other major mobile-phone carriers that was brought by Christopher Newman, a Maryland doctor stricken with brain cancer.

Hardell, whose study was published recently in the European Journal of Cancer Prevention, studied 1,617 patients with brain tumors and compared them with a similar-sized group of people without tumors.

He did not return phone calls seeking further comment.

The review said Hardell's study and some U.S. research with similar findings were "non-informative, either because the follow-up was too short and numbers of cancers too small, or because of serious methodological limitations."

It contrasted those with three studies in the United States, and studies in Finland and Denmark, which Paulsson said used more reliable sampling methods and were based on medical reports rather than interviews with patients.

Those studies found "a consistent picture ... that appears to rule out, with a reasonable degree of certainty, a causal association between cellular telephones and cancer to date," the agency said.

On the Net:

Swedish Radiation Protection Authority site, http://www.ssi.se/english/

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Green Acres Keep Kids Asthma-Free 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 19, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- Farm living may be hard work, but the payoff is not just toughened hands and sinew: Kids who grow up around barns and stock are much less likely than other children to suffer allergies and asthma, new research shows.

The European study, appearing in tomorrow's issue of The New England Journal of Medicine ( news - web sites), offers strong support for the "hygiene hypothesis." This theory states that as developed nations become cleaner -- reducing childhood infections that toughen the immune system -- their citizens become more vulnerable to allergies.

In this model, the chief agent of irritation is endotoxin, a term for the fatty proteins that make up the outer shells of bacteria in animal feces. Contact with endotoxin at key points in the development of the immune system primes the body's defenses enough so that future meetings with the proteins don't spark allergic reactions.

With their hideous filth, cities were once a major source of endotoxin. However, that changed thanks to improvements in sewage, plumbing and other mercies of modernity.

Farms that support stock have always been rife with bacteria. So they offer researchers a ready test bed for the hygiene hypothesis. If kids living on farms are exposed to more endotoxin -- which physician-author Lewis Thomas once called one of "Nature's darkest secrets" -- they should have fewer allergy problems than those raised in homes with less of the stuff around.

Led by Dr. Charlotte Braun-Fahrländer, the researchers compared asthma and allergy rates and endotoxin exposure in 812 Swiss, German and Austrian children, aged 6 to 13, growing up in rural communities. Of those, 319 were raised on farms.

Braun-Fahrländer interviewed parents about their child's history of asthma and hay fever. They also took blood samples from the boys and girls to look for immune system activity. Last but not least, they vacuumed their mattresses to measure how much endotoxin they encountered every day.

The level of endotoxin in bedding was higher on the farm, and children exposed to more endotoxin at home were less likely to have hay fever and asthma, the researchers found. Blood tests showed that contact with more endotoxin was tied to muted production of immune molecules called cytokines, which help trigger inflammatory responses.

The results suggest that "environmental exposure to endotoxin may have a crucial role in the development of tolerance to ubiquitous allergens."

Dr. Andy Liu, an allergy expert at Denver's National Jewish Medical and Research Center, calls the new research "a nice piece of work" that begs for additional studies. The most important of these, Liu says, would be following children from birth to see who develops allergies and what irritants they were exposed to rather than asking their parents years later about their contact with potential allergens.

Liu says these farms are rich in endotoxin. His own research has shown that concentrations of endotoxin in barn dust are as much as 50,000 times higher than they are in dust from cities. Barns are also far dustier than homes, increasing the volume of exposures.

Another factor of farm life, Liu says, is exposure to endotoxin in unpasteurized dairy products, such as raw milk. In an earlier study, some members of the European research team showed that babies whose mothers had fed them unpasteurized milk had remarkably low rates of asthma as children.

While the latest study bolsters the hygiene hypothesis, it leaves several questions unanswered. Some exposure to endotoxin appears protective, yet many people suffer from contact with very high levels of germ protein. So there seems to be a middle ground that's beneficial, Liu says, but scientists haven't yet found it. "That's still kind of out there, in terms of how much is too much," he says.

Dr. Scott Weiss, an immunologist at Harvard Medical School ( news - web sites) in Boston, agrees the study "tends to support the hygiene hypothesis, but it doesn't move us in the direction of any kind of clinical cure or treatment." No one is going to feed dirt to a baby or put their crib in a barn to shield them from allergies later in life.

Nor, adds Weiss, author of an editorial accompanying the journal article, does the work prove that endotoxin -- and not some other aspect of farm life -- is protecting children. "I think it would be wrong to say that endotoxin exposure explains everything that's protective about farm life," Weiss says.

What To Do

For more on allergies, try the American Academy of Allergy, Asthma and Immunology. And for a look at how allergens trigger an immune reaction, check out HowStuffWorks.

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Even Low Levels of Radon May Up Lung Cancer Risks 

Reuters Health

Thursday, September 19, 2002

NEW YORK (Reuters Health) - Long-term exposure to radon, a naturally occurring radioactive gas, can more than double a person's risk of developing lung cancer, even at levels below those thought to pose little harm, scientists in Spain have found.

Radon gas seeps into buildings from the surrounding soil. A person is unable to see or smell radon gas and the only way to know if a problem exists is to test for it. Long-term exposure to radon is known to increase the risk of lung cancer in adults, particularly in smokers.

Currently, health experts recommend that people in buildings and homes where radon gas levels exceed 4 picoCuries per liter (pCi/L) take action--like increasing ventilation--to lower levels of the gas.

In the current study, lead author Dr. Juan Miguel Barros-Dios of the University of Santiago de Compostela and colleagues measured radon exposure levels in the homes of 163 patients diagnosed with lung cancer and compared them with levels from a group of 241 healthy people.

People living in homes that had radon gas levels between 1 to 1.4 pCi/L, 1.5 to 3.9 pCi/L and greater or equal to 4 pCi/L were found to have a 2.73 times, 2.48 times and 2.96 times increased risk of lung cancer, respectively, the authors report in the September issue of the American Journal of Epidemiology.

What's more, the researchers confirm that smokers with a long-term exposure to radon had a much higher lung cancer risk than nonsmokers.

"The results of this study suggest that residential radon constitutes a risk factor for lung cancer," write Barros-Dios and colleagues. "Although reported elsewhere, this is the first study to find that, at low doses,...radon constitutes a risk factor for the general population."

Source: American Journal of Epidemiology 2002;165:548-555.

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Blood Screening For West Nile Near 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, September 19, 2002

THURSDAY, Sept. 19 (HealthScoutNews) -- Health officials may soon call for screening of blood and blood products for the West Nile virus ( news - web sites), which almost certainly can be transmitted through transfusions and organ transplants.

"At this time, the results are not totally conclusive," says Dr. Jesse Goodman, a U.S. Food and Drug Administration ( news - web sites) infection expert. But "it is most prudent to assume" that transmission can occur through blood and tissue donation.

Officials say they're investigating seven cases of blood and organ recipients who contracted West Nile meningitis, encephalitis -- infections of the brain lining or the organ itself -- or fever linked to the virus. "FDA really believes that since this transmission by transfusion is likely, we will need to move rapidly toward testing of donor blood," Goodman says.

However, health officials are bedeviled by the lack of a keen test for West Nile in the blood supply. The protein markers of infection, called antibodies, take some time to appear after the virus enters the bloodstream, so a person can be infectious before the pathogen can be detected or symptoms arise. Compounding the problem, levels of West Nile virus in blood are typically lower shortly after infection than those of other viruses tested, such as hepatitis C or HIV ( news - web sites).

Screening for viral genetic material is a finer net, but it's also more difficult and time-consuming, Goodman says. "This is a route that has been taken to tremendously improve the safety of our blood supply for other pathogens," he adds.

Goodman says people who have elective surgeries planned may want to consider delaying the operations until a test for West Nile is available. They may also want to consider stockpiling their own blood for the procedure. Currently, he adds, officials have "too little information to make a general recommendation."

Health officials are also warning doctors to consider West Nile infection in people with sudden bouts of polio ( news - web sites)-like paralysis.

Acute flaccid paralysis is an uncommon effect of West Nile encephalitis, but the Centers for Disease Control and Prevention ( news - web sites) (CDC) says several patients this year have developed the condition.

Experts have believed the muscle weakness associated with West Nile was part of a nerve problem called Guillain-Barré syndrome (GBS). However, Dr. Jim Sejvar, a medical epidemiologist at the CDC's National Center for Infectious Diseases, says the paralysis may in fact be closer to polio.

The distinction's important, Sejvar says, because the two treatments for GBS can have potent side effects but aren't effective against polio-like illnesses. "If the person does not need that treatment, it could potentially do more harm than good," he explains.

Officials say that as of Wednesday, 1,641 people have contracted West Nile this year, and 80 have died from the virus. Human cases have occurred in 36 states and Washington, D.C., with North Carolina the latest to join the list.

Nearly all of the cases are the result of mosquito bites, says Dr. Lyle Petersen, a CDC West Nile expert. Petersen says the outbreak appears to be tapering off in the South, but it's too soon to tell if it's fading in the North and Midwest.

Dr. Louis M. Katz, who heads the transfusion transmitted disease committee of the American Association of Blood Banks, says he believes West Nile can be passed from person to person by blood donations. However, he's not convinced the nation's blood supply needs screening for the virus.

"Lots of things are transmitted by blood that we don't test for that may be more frequent than West Nile," says Katz, vice president for medical affairs at the Mississippi Valley Regional Blood Center. These include Chagas disease, which is caused by a parasite that eludes current screening methods, and bacteria that infect platelets.

In addition, Katz says the epidemiology of the West Nile outbreaks may affect the testing debate. In Israel, the disease surged in the 1950s but quickly died down and now appears only in sporadic blips. If the same pattern holds in the United States, policymakers who opt for testing will have to consider when to stop, since screening is expensive and strains blood labs.

Tests for HIV and hepatitis C, for example, can run $10 each, and there are 14 million blood donations each year in this country. Laboratories are already complaining that they're taxed doing DNA screening for these two viruses, Katz says.

Screening experts and government health officials will meet tomorrow to discuss the evidence of West Nile's transmissibility in blood and organ donations. So to test or not to test will soon be determined, Katz says. If the answer is yes, no screening tool for the virus will be available before the end of the current mosquito season, which lasts only a few more weeks, he says.

What To Do

For more on West Nile virus, visit the Centers for Disease Control and Prevention. For more on the safety of the blood supply, try the American Association of Blood Banks.

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Study: Gene Mutation Ups Cancer Risk  

By Paul Recer

AP Science Writer

The Associated Press

Thursday, September 19, 2002

WASHINGTON (AP) - Mutation of a single gene is enough to double or triple the risk of colon cancer among people of eastern European Jewish ancestry, according to a study of DNA from more than 3,000 Ashkenazi Jews in New York and northern Israel.

The study searched for mutations among Ashkenazi Jews living in New York and Israel, analyzing the structure of a gene called BLM, for Bloom syndrome, that has been linked to various kinds of cancer and to other syndromes. The study group included 1,244 colon cancer patients and 1,839 Ashkenazi Jews who did not have the disease.

The researchers found that the Ashkenazi Jews with colon cancer were two to three times more likely to have a single mutation of the BLM gene than were those who did not have the cancer, said Kenneth Offit, a Memorial Sloan-Kettering Cancer Center researcher who was senior author of the study appearing Friday in the journal Science.

"This means there is about a three times greater risk for colon cancer in an individual carrying a single copy of the mutated gene," said Offit.

Double mutations of the BLM gene have long been identified as the cause of Bloom syndrome, a condition that causes a number of physical defects, including a predisposition to many types of cancer. Bloom syndrome occurs in all ethnic groups, but is most common among Ashkenazi Jews, or Jews of Eastern European descent.

Now the new finding shows that it takes only a single mutation to increase the risk of colon cancer. Offit said the data set used in the study also was examined for evidence of higher risk for other types of cancer in people with a single mutation of the BLM gene and no linkage was found.

He said the finding was based on the distribution of disease among the studied group and that researchers could only speculate on the biological mechanism that predisposes people to colon cancer.

"But it is interesting that a study in mice has found that this same gene pathway is associated with colon cancer," he said.

Only about one percent of the Ashkenazi Jews have the single BLM gene mutation, said Offit. A much smaller percentage, he said, have the double mutations.

Dr. Neal J. Meropol, a colon cancer researcher at the Fox Chase Cancer Center in Philadelphia, said the study by Offit and his colleagues is part of a growing effort to identify specific and subtle genetic risk factors for various types of cancer.

"Over the next several years, there are likely to be many gene alternations identified that modify one's risk of developing a particular kind of cancer," said Meropol. "This doesn't mean that it is a certainty that one will get cancer, but it may prompt you to get (medical) screening or to alter behaviors that also confer risk."

Smoking has been linked to colon cancer. A diet overly rich in fats and sparse in fiber has also been linked to colon cancer, although this connection is not universally accepted among researchers.

There are an estimated 10 million Ashkenazi Jews worldwide, with about 2.5 million in Israel and about 1 million in the New York City metropolitan area. The Ashkenazi trace their origins to Eastern Europe, but they live in many countries.

Colon cancer is the third leading cause of cancer death in the United States. There are about 148,000 new cases of colon cancer diagnosed in the country each year. About 56,000 people die of the disease.

Offit said it is possible that studying the biological mechanism linking the BLM mutation to colon cancer may lead to a basic understanding of what causes all colon cancers.

"Although this finding relates only to Ashkenazi Jews, we think the mechanism will be the same for all colon cancer," said Offit.

The BLM gene is known to play a role in checking the DNA in cells. When a cell divides, there are sometimes DNA mistakes. Genes such as BLM detect and, in some cases, correct those genetic errors. When these mistakes are not corrected because genes such as BLM are flawed, it is possible that a cell will retain DNA errors that could, in turn, lead to cells that divide without control, forming tumors.

Offit said eventually it may be possible to conduct genetic screening to identify patients with BLM mutations, but for now "tests such as this one are not ready for clinical use."

Instead, he said people should have regular colonoscopy screenings on a schedule that is suggested by their family history of colon cancer. In families where cancer or colon polyps have been found, he said, the screening may start at an earlier age and be scheduled more often than the generally recommended five-year interval.

Offit said colon cancer is considered a completely preventable disease. The cancer is generally preceded by formation of colon polyps. If these polyps are removed during regular colon screenings, then the cancer does not form, he said.

On the Net:

Science: http://www.sciencemag.org

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Study: Breast-Feeding Won't Protect Against Allergies 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Reuters Health

Thursday, September 19, 2002

THURSDAY, Sept. 19 (HealthScoutNews) -- Breast-feeding has long been seen as critical to child development, including when it comes to shielding infants from allergies and asthma later in life.

But a new study of children in New Zealand finds that those who nursed were more likely, not less likely, to grow up with allergies and asthma.

"There are many, many reasons why breast-feeding is good. Preventing asthma and allergies can no longer be included in those reasons," said Dr. Malcolm Sears, a lung expert at McMaster University in Ontario and leader of the research effort.

Ten years ago, Sears said, doctors advised parents afraid of allergies in their kids to get rid of their cat when baby made three and to be sure to breast-feed for as long as possible. "Now we're saying own a cat," but that nursing is no longer part of the equation, he said. Still, he said, "there are 101 reasons to breast-feed," and parents shouldn't consider a lack of protection from wheezing sufficient to avoid the practice.

Sears and his colleagues, who report their findings in the Sept. 21 issue of The Lancet, followed more than 1,000 New Zealand residents for up to 23 years. They assessed their allergy and asthma history with questionnaires, skin tests and lung capacity. Roughly half the subjects had been breast-fed for at least four weeks, and for an average of about five months, while the rest had been given infant formula.

Judging from the results of past studies, these children should have had fewer problems with allergies and asthma as they grew up. But the opposite was true.

Between ages 13 and 21, they were more likely to be allergic to cats, dust mites and grass pollen than the formula-fed children, and at ages 9 and 26 they were more prone to asthma.

The effect held no matter how long the children were nursed and regardless of their parental history of allergies and asthma. It also applied in boys, who are more likely girls to suffer asthma early in life -- though that pattern switches in adolescence.

Sears said it's not clear why breast-feeding might be detrimental to allergies. Nursing is key to bolstering a baby's immune system, and allergies are an immune reaction, but the two processes must differ.

Dr. Jaqueline Worth, an ob-gyn at Lenox Hill Hospital in Manhattan, said the latest study won't change her recommendations to women about the value of nursing. "My patients think that breast-feeding is healthy in general for the baby, and I still feel that way," she said.

Breast-feeding promotes bonding between mother and infant, provides an unparalleled source of nutrition, and helps a woman return to her pre-pregnancy weight by burning calories, Worth said. The American Academy of Pediatrics recommends exclusive breast-feeding for the first six months of a baby's life. The group encourages women to nurse for longer if possible.

What To Do

Learn about the breast-feeding from the American Academy of Pediatrics . For more on allergies and asthma, check out the American Academy of Allergy Asthma and Immunology or the Childhood Asthma Research and Education (CARE) Network.

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Asian Tiger Mosquito Found in Israel 

Reuters

Thursday, September 19, 2002

JERUSALEM (Reuters) - The Asian Tiger mosquito, which can spread potentially fatal diseases, has been found in Israel for the first time, the Environment Ministry said in a statement on Thursday.

It said its workers found the mosquitoes in water pools in used tires piled in a field near Lod, a city in central Israel.

"The spread of the mosquito throughout the world is primarily through the trade of used tires," the statement said.

Environment Minister Tzahi Hanegbi ordered Israelis to destroy used tires and report potential breeding spots, such as small water pockets and piles of tire scraps.

Scientists in Europe and North America said the striped mosquito spreads diseases such as Dengue fever and yellow fever.

Researchers at the University of Tennessee in the United States said in a statement last year they suspect it may be associated with infecting children with a type of encephalitis.

Asian Tiger mosquitoes have traveled the globe through tire shipments. They arrived in the United States in Texas in a tire shipment from Japan in 1985, and spread to at least 30 states, according to the university researchers and media reports.

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WEDNESDAY, SEPTEMBER 18, 2002 

Fainting May Betray a Faint Heart 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 18, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- If you faint -- and the odds are you will at one time or another during your life -- tell your doctor. It could be harmless, but it also could be a warning sign of a life-threatening heart condition.

That's the message of the findings about syncope (the medical term for fainting) from the long-running Framingham Heart Study, which has followed residents of a Massachusetts town for decades.

"Other studies of syncope have been among select groups of individuals, such as Air Force recruits and those in nursing homes, not of the general population," explains Dr. Daniel Levy, medical director of the study. A report in tomorrow's New England Journal of Medicine ( news - web sites) describes an analysis of 822 fainting spells reported over 17 years by 7,814 Framingham participants.

"There has been a debate in the medical literature whether syncope carries a bad prognosis or is relatively benign," Levy says. "We tried in a relatively simple but elegant manner to get an answer."

When they sorted out the data, the researchers found that more than one-third of the fainting episodes had no known cause, while just under 10 percent had a cardiac cause. Slightly more than 20 percent had a vasovagal cause, meaning that the body's ordinary response to stress somehow went awry -- instead of increasing blood pressure and heart rate, the parasympathetic nerve system reduced blood flow enough to cause the brain to black out temporarily.

Vasovagal fainting did not put people at higher risk of death, an analysis of mortality rates showed.

But there was a substantially increased risk associated with a cardiac cause for fainting: The study found that these people were twice as likely to die from a stroke or from any cause, and 2.66 times likelier to die of heart disease. And while the numbers showed a slighter increase in mortality for fainting with no known cause, that increase was related to heart disease, often undiagnosed until then.

"When the cause of syncope is unknown, those people are at high risk, primarily from a cardiac outcome," Levy says.

"The take-home message of the study is that most episodes are benign, but they should never be ignored," says Dr. William G. Stevenson, director of the clinical cardiac electrophysiology laboratory at Brigham and Women's Hospital in Boston, and co-author of an accompanying editorial in the journal.

"Syncope should be reported to a physician and in some cases warrants a careful examination to see if there are signs of a heart problem," Stevenson says.

Going to a doctor is especially important for anyone with a known heart condition who faints, Stevenson says. "But it can also be an initial sign of a cardiovascular condition," he says.

Someone who reports several fainting episodes over a long period of time might be outfitted with a monitor to detect an abnormal heart rhythm, says Stevenson. A diagnosis can be made in about 90 percent of such cases. Most of the time the diagnosis will be reassuring, but doctors will be alert for "signs of a possibly fatal arrhythmia," he says.

What To Do

For more about fainting, consult the American Heart Association or the National Institute of Neurological Disorders and Stroke.

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Kids Using Prescription Drugs More  

By Theresa Agovino

AP Business Writer

The Associated Press

Wednesday, September 18, 2002

NEW YORK (AP) - When Christy Olson's daughter developed asthma as a toddler 12 years ago, she was reluctant to put her on prescription drugs.

"I was so worried about side effects. I didn't want to give it to her unless I had to," said Olson, who lives in Rochester, Minn., and is a nurse herself. She decided it was a necessary move, and her daughter, now 15, still takes medicine for her condition.

While parents then and now are often nervous about medicating children, it is becoming more common. Use of prescription drugs is growing faster among children than it is among senior citizens and baby boomers, the two traditionally high consumer groups, according to a new study.

Spending on prescription drugs for those under 19 grew 28 percent last year, according to the survey by Medco Health Solutions, a Franklin, N.J.-based pharmacy benefits manager.

Meanwhile, spending per patient rose 23 percent for those between the ages of 35 and 49 and less than 10 percent for those above 65.

Children are also spending 34 percent more time on medication than they were five years ago, the study found.

Treating children is still relatively inexpensive, costing an average of $84.72 per patient each year. That compares to an average expense of $944.40 per year for people aged 65 to 79.

The Centers for Medicare and Medicaid Services, a government agency, estimates that overall spending on prescription drugs rose 16.4 percent to $142 billion last year.

Among children, the most prescribed drugs were for allergies, asthma and infections. Prescriptions for Ritalin ( news - web sites) and other medicines for neurological and psychological disorders were also substantial — a finding that renewed concern among some experts who worry that such drugs may be over-prescribed for children.

Some doctors also were alarmed that spending on prescription drugs to treat heartburn and other gastrointestinal disorders surged 660 percent over five years, according to the study. The jump was seen as linked to the increasing number of overweight children in the United States.

Some of the findings on prescription drugs mirrored trends seen in disease patterns. For example, the incidence of asthma and allergies are generally increasing, so doctors said it wasn't surprising that children's prescriptions for such ailments would also grow.

"It is good news that more kids are getting treated for asthma because it means less trips to emergency rooms and hospitals," said Dr. Robert Epstein, chief medical officer of Medco Health.

About 7 percent of children have asthma and 25 percent have allergies, approximately double the incidence 25 years ago, according to Dr. Michael Blaiss, a pediatrician who specializes in such ailments.

Olson, the Minnesota nurse, also has a 13-year-old son who has asthma and is receiving medicine. She suffers from asthma herself.

Medicating her children has at times been a difficult process. Her daughter, when she was 9, had a severe reaction to steroid she was taking and went into shock. It took 18 months of experimenting to find a correct dosage.

Even so, she's more comfortable now than she was at first with having her daughter taking drugs. "I feel differently now because I see that she needs it and she is better because of it," Olson said.

"I know things have gotten better since that time, but drugs are such an important part of treatment that we need more studies," she said.

The survey also found that spending on antibiotics among children increased 42 percent. Doctors say antibiotic resistance is a widespread problem.

Spending on drugs for Attention Deficit Hyperactivity Disorder increased 122 percent over the past four years and accounted for 8 percent of the total spent on prescription drugs for children, up from 7 percent in 1997. Spending for depression medicines held steady at 5 percent of the total.

Dr. Lawrence Diller, author of "Should I Medicate My Child?" worries that such drugs are over-prescribed. He also pointed out that, while Ritalin and other drugs for ADHD are generally seen as safe for children, there haven't been many studies of the effects of antidepressants on children.

"The antidepressants are known to have sexual side effects. I wonder what the long-term effects of that is going to be on adolescents," Diller said.

The vast majority of prescription drugs are developed for adults, and drug makers are not obliged to test them on children. In 1997, Congress passed legislation that gave drug companies an additional six months of market exclusivity if they tested their drugs on children. That has sparked more tests, but experts say more studies are needed.

"I think practitioners feel more confident now that there is more data to back up prescription patterns," said Dr. John Ring, who sits on the American Academy of Pediatrics' Committee on Drugs.

But he said most of the prescriptions written for children are still written for drugs that haven't been approved for youngsters.

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Teen Suffers Seizure After Snorting Antidepressant 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 18, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- A 16-year-old Maryland boy suffered a seizure after snorting six crushed tablets of the antidepressant Wellbutrin, doctors say.

Dr. Christopher J. Welsh, a University of Maryland psychiatrist who treated the boy, says the youth told him several of his friends had also tried to crush and snort the mood pill. One even injected the drug, which acts somewhat like a stimulant. Newer antidepressants, such as Prozac and Zoloft, don't have that property, Welsh adds.

"I don't think we have a good sense of how often this is done with any medication," says Welsh, an addiction specialist. "But almost any [drug] which can be abused, people will do this with."

Snorting a drug gives it quick access to the brain, but it's less direct than either injecting or smoking a substance, adds Welsh, who with a colleague detailed the case study in tomorrow's issue of The New England Journal of Medicine ( news - web sites).

Wellbutrin, or bupropion, is sold by GlaxoSmithKline. The company also markets the drug in slow-release form as Zyban for people trying to quit smoking. Seizures are a rare but documented side effect of bupropion, especially in people who take too much of the medication or scale up their dosing too quickly, as well as those with bulimia.

The boy Welsh treated, who was taking the drug for depression, said he crushed six 150 milligram tablets, more than twice the recommended maximum daily dose. That's a lot, but not an extreme overdose, says Welsh, which makes the seizure all the more disconcerting.

The teen has fully recovered, Welsh says.

"Even with the oral dose, with Wellbutrin the safety window is not that great," he says. The boy had told Welsh that snorting a few pills' worth of the antidepressant gave him a "rush" but no seizures.

Despite the boy's experimentation and that of his friends, Wellbutrin abuse doesn't appear to be widespread, Welsh says.

Dr. Suzanne Doyon, medical director of the Maryland Poison Center, and a co-author of the journal letter, agrees.

Doyon says her office gets about a half dozen calls each year involving crushed Wellbutrin. "It's not very common," she says. "We're talking a handful."

Seizures are extremely unusual, Doyon adds. Most of the complaints are from teens feeling ill after sniffing the drug.

Other prescription drugs are more likely to be snorted, Doyon says. Ritalin ( news - web sites), a stimulant given to people with attention deficit disorder, is one favorite. Lately, the cancer pain drug OxyContin has become a popular pill to crush and sniff -- with occasionally deadly consequences. Government drug officials believe more than 450 people may have died in the last two years from snorting the painkiller.

Dr. Howard Greller, a toxicologist at the New York City Poison Control Center, says he knew of no reports to his agency of problems with people who'd snorted Wellbutrin. However, Greller says the case study from Maryland is of concern. "We'll definitely read it and keep an eye out," he says.

What To Do

To learn more about Wellbutrin, try the National Alliance for the Mentally Ill. And for more on OxyContin, visit the U.S. Drug Enforcement Agency.

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US Considers Ways to Minimize Painkiller Risks 

By Lisa Richwine

Reuters

Wednesday, September 18, 2002

WASHINGTON (Reuters) - A US panel this week will advise the government on how it may help prevent deaths and injuries from over-the-counter pain relievers used safely by millions for decades but deadly to thousands each year.

A 1999 report in The New England Journal of Medicine ( news - web sites) estimated 16,500 people die in the United States annually from aspirin and other pain relievers known as nonsteroidal anti-inflammatory drugs, typically from gastrointestinal bleeding and ulcers.

Even so, regulators consider nonprescription remedies such as aspirin and acetaminophen very safe, and they believe that informing consumers about risks could make use of the treatments even safer, said Dr. John Jenkins, director of the Food and Drug Administration ( news - web sites)'s Office of New Drugs.

"Some consumers don't recognize that over-the-counter drugs are drugs and have risks. They think that since they are over the counter they must be inherently safe," Jenkins said in an interview.

On Thursday and Friday, the FDA will ask a panel of outside experts for advice on whether new warnings or other efforts could help patients avoid harm.

For example, overdoses of acetaminophen, the active ingredient in Johnson & Johnson's Tylenol, can seriously damage the liver. The FDA wants input on how it can help ensure that people do not exceed maximum doses listed on drug labels.

"In some cases, people are unintentionally overdosing on these products because they are either ignoring those dosing instructions or they are using more than one product that contains the same active ingredient," Jenkins said.

With medicines such as aspirin, ibuprofen and naproxen, the FDA is concerned about the potential for serious stomach bleeding.

People are at greater risk for such bleeding if they are older than 65, have had previous stomach ulcers or bleeding, or take certain other medicines at the same time, according to an FDA analysis.

"The adverse events we're talking about associated with these products have been well known for years, and we continue to see reports of events," Jenkins said.

He said it was difficult to determine how often people die or suffer serious injury from any of the widely used pain relievers.

Industry groups have voiced concern to the FDA about how any new warnings will affect consumer habits.

If acetaminophen use is restricted, data suggest the number of deaths from gastrointestinal bleeding with alternative drugs would exceed the number of people potentially spared from liver damage from an acetaminophen overdose, Johnson & Johnson said.

Aspirin maker Bayer AG said it supports stronger warnings for acetaminophen but cautioned against a broad warning for all nonprescription painkillers.

"Nonspecific product labeling, in effect, would dilute the message," Bayer said in comments to the FDA. Bayer also said there was no data to support the view that a new acetaminophen warning would prompt a significant number of people to switch to other pain relievers.

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Cancer Trial to Test Whether CT Scans Save Lives 

By John Dillon
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 18, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- The newest generation of CT scans can spot lung tumors when they are smaller and, presumably, more treatable. But do they save lives?

Common sense would dictate a "yes" answer, but research hasn't proven that yet and some small studies have suggested they don't. The federal government intends to find out once and for all, announcing today that it is launching the biggest and most ambitious study yet to learn whether the high-tech scanners will actually cut the death rate from lung cancer.

Lung cancer rates "have remained high and have not declined as other cancers have," says John Gohagan, chief of the National Cancer Institute ( news - web sites)'s division of cancer prevention and co-director of the National Lung Screening Trial. Although doctors have high hopes for spiral CT scans, right now "we don't have any accepted or proven screening test for lung cancer that we believe will reduce the mortality rate."

The National Cancer Institute (NCI), with help from the American Cancer Society ( news - web sites), will recruit 50,000 smokers and ex-smokers at 30 leading hospitals nationwide. The cancer-free volunteers will be given either CAT scans or more conventional X-rays each year for three years, and researchers will track their health for eight years.

By the study's end, they hope to learn whether CAT scans or X-rays made a better mark on early detection and, especially, death rates. From this, they'll determine whether all smokers and former smokers should have their lungs examined routinely.

Much is at stake because of the disease's toll. Were lung cancer a specific cause of death (officially, it's listed along with all other cancers), it would be the nation's third-leading killer. The disease will claim about 160,000 American lives this year -- more than cancers of the breast, prostate, colon, and ovary combined. Another 160,000 or so Americans will be diagnosed with the disease this year. The NCI says that 87 percent of these patients smoke or used to smoke, and Gohagan says there are 90 million current or former smokers in this country.

Lung cancer is so deadly because it's not usually symptom-specific until it has already done significant damage. A patient often goes to the doctor with a cough, for instance, and an X-ray or CAT scan confirms the presence of a tumor. By that time, the cancer is well established in the lung and perhaps other parts of the body.

The trial will have "considerable application for public health policy," Gohagan says, because it will tell whether CT tests should be routine.

Spiral computerized tomography has been around for about a decade. It takes X-ray images of the whole chest and assembles them into a three-dimensional model. Whereas conventional X-rays can spot a tumor between one and two centimeters wide, a CAT scan can detect tumors smaller than a centimeter.

Whether finding them at a smaller stage will cut the death rate is one aspect of the study. Another is how it affects the patient. The scans also pick up many images that are not cancers, so researchers will look into the incidence of false alarms, whether people are treated unnecessarily, and the "emotional impact of the screening process," says Dr. Denise Aberle, imaging chief at the University of California at Los Angeles and a co-director of the trial. Also, she says, the trial will tell whether such scanning affects smoking behavior.

Even if the trial shows that CT scans don't save lives, there will be one upshot, says John Seffrin, chief executive officer of the American Cancer Society. "If it doesn't work, then those addicted [to tobacco] need to now that their only choice is to quit," he says.

What To Do

Smokers and former smokers between the ages of 55 and 74 are eligible, but there are some restrictions. If you're interested in taking part in the free trial, call 1-800-4-CANCER or the local chapter of your American Cancer Society. Visit the National Cancer Institute for more details.

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Detroit Hit With Syphilis Epidemic  

By John Porretto

Associated Press Writer

The Associated Press

Wednesday, September 18, 2002

Detroit has been hit with the biggest outbreak of syphilis in the nation — an epidemic that has led to a shake-up in the state Health Department.

Health officials said the reason for the crisis is that city and state officials became lax in their battle against the disease after a drop-off in cases during the 1990s.

Detroit had 245 new cases of syphilis this year as of July 30, and the number is likely to reach 500 by year's end, said Loretta Davis-Satterla, director of the state Health Department's sexually transmitted disease division.

Davis-Satterla said she was also informed by the Centers for Disease Control and Prevention ( news - web sites) in Atlanta that when updated national figures are released next month, Detroit will have the highest rate in the country for 2001. Detroit has a population of nearly 1 million.

In the past week, one state Health Department employee was fired and another resigned.

Davis-Satterla would not discuss specifics of the two cases, saying only that "the changes were made to bring about an overall improvement" in eradication efforts. Her office oversees much of the city's sexually transmitted diseases program.

Syphilis typically appears first as a sore, usually on the genitals, then develops as a rash. It can be cured with penicillin, but left untreated it can damage the heart, eyes, brain and other parts of the body.

Its resurgence in Detroit comes at a time when the disease in some parts of the country has been all but eliminated.

The CDC reported last year that syphilis infections dropped to an all-time low in the United States in 2000, with fewer than 6,000 cases reported. The drop was attributed to stepped-up education, testing and treatment during the 1990s.

However, the CDC has been critical of those efforts in Detroit, according to letters from the federal agency obtained by The Detroit News. The CDC said the city Health Department lacked properly trained staff, left key positions vacant and lacked an adequate plan to attack the disease.

Detroit had a syphilis outbreak in 1991 in which the number of new cases jumped to 1,088. An aggressive eradication campaign was launched, and by 1996 the number had dropped to 92.

Davis-Satterla, who took her job three years ago, said that because of the decline, community education and awareness fell and some doctors and public health officials failed to recognize signs of the scourge.

"You're not as quick to see it, and your skills are lacking," she said.

Davis-Satterla said her department has implemented many of the federal agency's recommendations, such as training. She said that in the past year or so her department has sent out medical alerts to 700 doctors and made several staffing and organizational changes.

"We did not wait until the CDC told us there was a problem," Davis-Satterla said. "We already recognized that there was a problem. We weren't surprised when the CDC came in and said the exact thing."

The CDC said it is monitoring the crisis.

"They're moving in the right direction, and we're going to work with them," said spokeswoman Kitty Bina in Atlanta.

On the Net:

CDC syphilis site: http://www.cdc.gov/stopsyphilis

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Study Shows Television Ads Drive Down Youth Smoking

Reuters

Wednesday, September 18, 2002

WASHINGTON (Reuters) - Preliminary results from an American Legacy Foundation study show the anti-smoking group's "truth" campaign is helping to lower smoking rates among US youth, the foundation said on Wednesday.

According to the group, smoking prevalence among high school students who have had "high exposure" to the campaign's television commercials has declined 29% since 2000.

"The more students were exposed to the truth campaign, the less they smoked," said American Legacy Foundation President and Chief Executive Officer Cheryl Healton.

Smoking rates among high school students with medium exposure to the truth commercials fell 21%, while those with low exposure to the ads showed a 12% decline in smoking rates, American Legacy said.

While the study only measured students' exposure to the television commercials, the foundation's campaign also includes radio commercials, magazine ads and a Web site.

American Legacy, a Washington, DC-based public health foundation, was created due to the 1998 Master Settlement Agreement between 46 state attorneys general and the major US cigarette companies.

The data released by American Legacy are part of the National Youth Tobacco Survey 2002, conducted this past spring by the foundation in collaboration with the Centers for Disease Control and Prevention ( news - web sites).

The results are from 69 schools in the 2000 National Youth Tobacco Survey that were surveyed again this year to examine the impact of the campaign over the two-year period. The first television commercials in the campaign aired in February 2000.

The survey for those 69 schools showed an overall 17.9% drop in "current smoking" rates among high school students, from 29% in 2000 to 23.8% in 2002. American Legacy defines current smoking as smoking one or more days in the past 30 days.

Among middle school students, there was an overall 5.4% drop in smoking rates to 10.6%, the foundation said.

The decline in smoking prevalence among high school girls was wider than the decline among high school boys. But middle school girls showed a slight increase in smoking while middle school boys showed a decline, the foundation said.

The data include responses from 9,661 high school students and 6,853 middle school students. The 69 schools, chosen at random, are in 27 US states, American Legacy said.

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Genes Determine Breast Density, a Risk Factor for Breast Cancer 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 18, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- Genetics appear to be a driving force behind whether a woman has dense breast tissue, a major risk factor for breast cancer ( news - web sites).

According to a study in tomorrow's issue of The New England Journal of Medicine ( news - web sites), 60 percent to 67 percent of Western women's breast density is determined by genes.

More than a dozen studies have shown that women who have extensive dense breast tissue have a risk of breast cancer that is 1.8 to six times higher than that of women of the same age with little or no density.

There are several possible explanations for this, says Dr. Norman Boyd, co-lead investigator of the study and head of the division of epidemiology and statistics at the Ontario Cancer Institute in Canada.

One may be that women with dense breasts simply have more cells that are at risk of undergoing the genetic changes that can give rise to breast cancer. These cells may also be dividing more rapidly, or it may be that the relative immaturity of dense tissue makes it more susceptible to developing a malignancy. A woman's breast tissue usually becomes less dense as she ages.

"It may reflect many things, including hormonal levels," adds Dr. Alan Stolier, medical director of the Lieselotte Tansey Breast Center at the Ochsner Clinic Foundation in New Orleans.

Dense breast tissue is visible on a mammogram and is not equivalent with firmness. It is determined by the amount of connective and epithelial tissue in the breast -- as opposed to fat tissue.

A woman with density in 75 percent of her breast is five times more likely to develop breast cancer than someone with little or no breast density. About one-third of breast cancer cases can be attributed to having dense tissue in more than half of the breast, researchers say.

About 5 percent to 10 percent of breast cancer cases can be traced to the BRCA1 and BRCA 2 genes, scientists believe.

However, the new findings suggest that even more genes may be involved.

In the latest study, Boyd, along with co-lead investigator John Hopper of the University of Melbourne in Australia, studied a total of 571 pairs of identical twins and 380 pairs of fraternal twins in the United States, Canada and Australia.

All the study participants were between the ages of 40 and 70 and did not have breast cancer. Although many of the women lived in different cities or even continents than their twins, they were all predominantly of European ancestry.

Heredity accounted for 60 percent of the variation in density in Australia twins, 67 percent in American twins and 63 percent in all twins.

The researchers don't yet know how many genes are involved with breast density or what they might do.

"We postulate that there must be genes that are causing density, and we think that at least some of the genes must also influence susceptibility to cancer. So, we're going to try to find out what genes they are and find out what they're doing physiologically," Boyd says.

One promising hypothesis is that some of these genes affect hormones.

"What that inherited quality is you don't know. But you might take a guess that it has to do with production and metabolism of female hormones," Stolier says. "It would not surprise me to learn that twins who share the same genes also metabolize estrogen and progesterone the same way, and I would think that that may have something to do with the density of breasts."

Boyd agrees. "It's very likely that [the genes are] regulating hormones. We know that specific hormones and growth factors are associated with density."

What To Do

For more information on breast density and the risk of breast cancer, visit the University of Toronto. For more on breast cancer, check the American Cancer Society.

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HIV Infection Rate Is Skyrocketing  

By Barbara Borst

Associated Press Writer

The Associated Press

Wednesday, September 18, 2002

UNITED NATIONS (AP) - HIV ( news - web sites) and AIDS ( news - web sites) infection rates are skyrocketing in much of Eastern Europe and the former Soviet Union, with young people comprising the majority of new cases, the U.N. Children's Fund warned in a report released Wednesday.

Nearly 80 percent of newly registered infections from 1997-2000 in the Commonwealth of Independent States — the grouping of former Soviet republics — occurred among people under the age of 29, according to UNICEF ( news - web sites)'s report, the Social Monitor 2002.

"HIV/AIDS has a young face in this region," UNICEF director Carol Bellamy said in a statement. "Young people account for most new infections and their low level of HIV awareness, combined with increasingly risky behavior, herald a catastrophe."

The UNICEF report parallels earlier warnings from the medical aid group Medecins Sans Frontieres and the Open Society Institute, a charitable foundation active in Eastern Europe.

UNICEF reports that abuse of injected drugs accounts for most of the region's infections of HIV, the virus that causes AIDS. However, it noted that sexual transmission is on the rise in Belarus and Ukraine.

The total number of infections in the region more than doubled from 420,000 in 1998 to 1 million in 2001. While that is small compared with the 28.5 million HIV-infected people in sub-Saharan Africa, the rate of increase in some Eastern European and CIS countries is the world's highest.

In Estonia, 38 percent of new infections occurred among those under age 20, and 90 percent among those under 30, the report states. The Baltic country's total rate of new infections — more than one in every 1,000 people — is 20 times the average for European Union ( news - web sites) countries.

The report cites the increase in substance abuse, early sexual activity and an increase in the number of sex workers as underlying reasons for the rising rate.

It recommends programs to educate people about AIDS prevention, ensure that schools address the issue openly and offer youth-friendly health care. Girls, the poor and others at risk should be especially targeted, it said.

UNICEF found that less than 70 percent of teenagers in Belarus, Ukraine and Latvia knew that condoms offered protection against HIV, while 97 percent of French teens and 87 percent of German teens were aware of that.

Some governments, especially among the former Soviet republics, traditionally have taken a punitive approach to drug use, sex work and homosexuality, the study says.

Lithuania's national action plan, launched in 1995, may have helped the country keep its HIV-infection rate down, the report says. The plan features services that are easily accessible for drug users, offer anonymous treatment and don't require abstinence from drug-taking as a condition for service.

Russia, Ukraine, Belarus and Moldova were the first countries in the region with rapid increases in HIV-infected people. Estonia and Latvia soon followed, and Kazakhstan appears to be on the same course.

"However, current trends in the spread of HIV do not suggest that the epidemic has reached its peak," the report states.

The high incidence of HIV and AIDS among children under 13 — 26 percent of all cases in the region — can be traced mainly to infections in Romania in the early 1990s through blood transfusions and other procedures, the report notes.

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Sports Med Experts Say 30-Min Exercise Rule Sticks 

By Charnicia E. Huggins

Reuters Health

Wednesday, September 18, 2002

NEW YORK (Reuters Health) - The new recommendation by the Institute of hedicine's (IOM) Food and Nutrition Board that Americans exercise for an hour every day may be confusing and disheartening to people who thought 30 minutes of exercise on most days of the week was good enough, according to experts from the American College of Sports Medicine.

"By raising the recommendation to 60 minutes of moderate physical activity per day, the report has the potential to dissuade the most sedentary from initiating a pattern of moderate physical activity that would be a healthy lifestyle change and could lead to additional increases in total physical activity," Dr. Edward T. Howley, ACSM's president, said in a statement.

The IOM released its latest set of recommendations on diet and physical activity earlier this month. In addition to advising that Americans reduce their caloric intake and try to eliminate saturated fats and added sugars from their diet, the panel also said that people should exercise for 60 minutes each day to maintain maximum cardiovascular health and prevent weight gain.

Yet, in making their blanket 60-minute recommendation--double that of the 1996 US Surgeon General's recommendation of 30 minutes of exercise on most days of the week--the panel failed to address individual variation in health and weight benefits from exercise, ACSM experts said on Wednesday during a telephone media briefing.

"Even for the limited objective of preventing unhealthy weight gain, clearly there are some people who never exercise and never gain weight," said Dr. Steven Blair, scientific editor of the Surgeon General's 1996 Report on Physical Activity and Health. "Clearly there must be individual variation (and) genetic factors that require some people to get more (exercise) than others."

Further, the IOM report states that 30 minutes of activity may not be enough to maintain a healthy weight and benefit from all the purported health effects of exercise. Blair agrees that a half-hour of regular exercise may not give exercisers "maximal" health benefits, but he added that it is not known how much exercise is required for "maximal" benefit.

In fact, there is little evidence that 60 minutes--or any other amount of time--spent in moderate exercise can provide individuals with maximum health benefits, according to Blair. Meanwhile, the evidence backing the 30-minute recommendation is "very strong, and getting stronger every day," he said.

As it stands, exercising for 30 minutes on most days of the week--whether in one half-hour block or three 10-minute spurts--is known to lower a person's risk of heart disease, stroke and hypertension as well as prevent diabetes and delay death from any cause, Blair said.

As for determining how much exercise is needed to prevent weight gain, there are two easy ways to find out, Blair said: "belts and bathroom scales."

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Study Outlines Mammogram Problems  

By Paul Recer

AP Science Writer

The Associated Press

Wednesday, September 18, 2002

WASHINGTON (AP) - Some radiologists report false positive cancer readings in mammogram X-rays almost 16 percent of the time, with younger and more recently trained doctors making more interpretation errors than their more experienced colleagues, a study found.

The report in the Journal of the National Cancer Institute ( news - web sites) said the rate of false positives could be reduced significantly if radiologists always could compare films from previous mammogram screenings.

Dr. Joann Elmore of the University of Washington School of Medicine in Seattle said the rate of false positives — breast cancer ( news - web sites) mammogram screenings that require follow-up tests — are becoming increasingly common in the United States, but it should not discourage women from having annual screenings.

"Mammography is not a perfect test (for breast cancer), but it is the best test we have," said Elmore, first author of the study. "Women should realize that they have a 10 percent chance of being called back for additional tests."

The results of the study, she said, carry this message: Women should continue to have mammograms, but they should try to return to the same testing facility each time so radiologists can compare past test films. False positives are reduced by about 70 percent when radiologists compare current films with images from past tests, Elmore said.

The study involved an evaluation of mammogram readings from 2,169 women by 24 radiologists in a community clinic practice from the years 1985 to 1993, which gave time for follow-up studies of the patients. The study analyzed the rate of false-positive interpretations by the doctors, then related that to the experience and training of the radiologists and to the age and other characteristics of the patients.

It found that the false-positive rate ranged from 2.6 percent to 15.9 percent. But when this rate was adjusted for the effect of patient characteristics, such as age, the false-positive rate dropped to 3.5 percent to 7.9 percent. Age affects the false-positive rate because breast tissue is denser in younger women, which makes their mammograms more difficult to interpret.

The study found that doctors who graduated from medical school in the past 15 years had false-positive rates two to four times higher than more experienced doctors.

Elmore suggested the young doctors may have had training that concentrated on finding cancer without emphasizing that false positives "can cause a lot of women who don't have breast cancer to be called back" for additional tests.

Older doctors also have more experience, she said, and "experience matters."

The threat of malpractice lawsuits may affect mammogram interpretations by causing doctors to err on the side of caution, said Elmore. Mammography "is one of the top causes of medical malpractice allegations," Elmore said.

Although the study determined which of the doctors had the most false positives, it could not determine which of the doctors was most accurate in detecting cancer. Out of the 2,169 mammogram readings, 45 cases of breast cancer were verified.

False positives usually result in women being called back for added tests, which can be limited to examination by a specialist or to additional X-ray exams. For some women, the callback results in a biopsy, removal of a small bit of breast tissue for microscopic examination. This is the "gold standard" for evaluating suspicious lesions detected with mammograms, Elmore said.

In any case, false positive carry a heavy psychological and financial burden for many women, experts say.

Elmore said a women has only a 50 percent chance of having a single false positive in 10 annual mammography tests. Among those called back for more tests, only a small percentage will be diagnosed with cancer, she said. In the United States, the average woman has a one-chance-in-eight lifetime risk of cancer, she said.

On the Net: Journal of the National Cancer Institute: http://jncicancerspectrum.oupjournals.org/

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Breast Tissue Density May Be Inherited: Study 

Reuters Health

Wednesday, September 18, 2002

NEW YORK (Reuters Health) - New research suggests that dense breast tissue, believed to be a risk factor for breast cancer ( news - web sites), may run in families.

Patterns of fat, connective tissue and glandular tissue in the breast as seen by mammography vary greatly from woman to woman. Past studies have shown that women with denser breast tissue--meaning their breasts contain less fat--have up to six times the breast cancer risk of women whose breasts are less dense. The reason why is not clear.

The new study, which involves groups of identical and fraternal twins, suggests that breast density, and its influence on breast cancer risk, may be inherited.

Dr. Norman F. Boyd of the Ontario Cancer Institute in Toronto, Canada, and colleagues reviewed the results of routine mammograms to determine the physical distribution of types of breast tissue in 353 sets of identical twins and 246 fraternal twin pairs from Australia, and 218 sets of identical twins and 134 sets of fraternal twins from the US and Canada.

Identical twins share the same genetic make-up, whereas fraternal twins (like non-twin siblings) share about half their genes.

The investigators found that genetic factors could account for 60% of the variation in breast density in Australian twins, 67% in North American twins and 63% in all twins studied, according to the report in the September 19th issue of The New England Journal of Medicine ( news - web sites).

"These results show that the population variation in the percentage of dense tissue on mammography at a given age has high heritability," the authors write.

"Because mammographic density is associated with an increased risk of breast cancer, finding the genes responsible for this (physical characteristic) could be important for understanding the causes of the disease," they add.

In spite of the current findings, women with dense breast tissue shouldn't approach their regular mammographic screening examinations any differently than women with less dense breast tissue, according to Dr. Erik Thurfjell, who wrote an editorial accompanying the study.

Women should continue to follow the recommendations for their age group, notes Thurfjell, who is with Uppsala University in Sweden.

"When there is a palpable lump in a dense breast and mammographic examination is inconclusive, ultrasonography should be used," Thurfjell writes.

"I would not inform a woman that the mammographic density of her breast increases her risk of breast cancer, since the absolute increase in risk is small. The provision of such iformation might lead only to unnecessary anxiety," Thurfjell concludes.

Source: The New England Journal of Medicine 2002;347:866, 886-894.

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Ground Gained on Bioterrorism Fight  

By Laura Meckler

Associated Press Writer

The Associated Press

Wednesday, September 18, 2002

WASHINGTON (AP) - A year after the first anthrax-tainted letters were dropped into a New Jersey mailbox, the nation is vastly better prepared to face bioterrorism. Yet experts agree that major holes remain in communications, emergency planning and staffing, and many fear the nation's resolve could fade along with memories of last year's attacks.

There have been no arrests and there are officially no suspects in the criminal investigation into the attacks-by-mail, which killed five and sickened 18. But while the probe appears stalled, efforts to prepare for the next attack have moved steadily forward.

"Public health has always been the poor stepchild. It's never received the dollars, it's never received the attention," said Health and Human Services ( news - web sites) Secretary Tommy Thompson. "One of the good consequences of 9-11 is we now have the resources available to build the public health system."

Still, much work remains.

An expanded National Pharmaceutical Stockpile is loaded with medicines, vaccines and supplies, ready to land a cargo plane with 50 tons of material in any city within hours. But many communities have no plan for transporting the goods from the tarmac to the patients.

States have new money to hire public health workers, but there's a dearth of talent for hire.

And while cities are now focusing on the threat, experts worry there is still no efficient way to get medical information to the doctors on the front lines.

The anthrax attacks were limited in scale, yet the public health system was severely taxed under the weight of investigating hundreds of false alarms, testing more than 120,000 environmental samples and distributing antibiotics to thousands of people who may have been exposed to the bacteria.

"Last fall was a tragic dry run," said Dr. Michael Osterholm of the University of Minnesota, who advises HHS on bioterrorism. "That was horrible but we all know what it could have been had the same amount of anthrax been put into air intake systems."

The long-neglected public health infrastructure — the people and systems who guard the community's health — won an unprecedented, rapid infusion of dollars, nearly $1 billion. "I can't remember a time when money went out that quickly," Osterholm said.

Yet he and other experts are concerned states will fail to put up their own money to finish the job or, worse, will cut back existing state spending now that the federal dollars have arrived. Some want Washington to ensure that the states spend the money wisely, something HHS has pledged to do.

But other issues remain:

_National Pharmaceutical Stockpile: A year ago, the stockpile had just 15 million doses of smallpox vaccine; soon, there will be enough for every American. But officials worry that many communities don't have plans to get those supplies to distribution and treatment centers. Also of concern: having enough trained workers to handle mass vaccinations, if needed.

_Communications. During the anthrax crisis, federal officials failed to communicate accurate information to the public, the media and to state and local counterparts. Lack of clear communication "would be my No. 1, my No. 2 and probably my No. 3" biggest failures, said Steve Ostroff, an epidemiologist at the Centers for Disease Control and Prevention ( news - web sites).

CDC has lots of work ahead. New CDC Director Julie Gerberding recently called her agency's emergency line and got a recorded message telling her to call another number. When she called that number, she got the same recording. She called communications the single most important priority for her office's work on bioterrorism.

_Reaching doctors: In a crisis, doctors need up-to-date information about symptoms and treatments, but there is no clear way to disseminate new data fast. Many doctors don't have e-mail in their offices, and most public health departments don't have an up-to-date list of fax numbers, said Dr. Ed Thompson, director of the Mississippi Department of Health. Mail is too slow and much is never opened.

_Research. Some $130 million already has been added to the bioterrorism budget to research new vaccines and treatments. But some wonder whether new vaccines will ever be produced, given the questionable market for them. Private manufacturers already balk at producing standard childhood vaccines because their profit margin is so low.

_Workers. Even with money to hire more workers, experts worry that there aren't enough trained epidemiologists, lab technicians and other public health experts. "Frankly, the talent isn't out there," said Tara O'Toole, director of the Johns Hopkins Center for Civilian Biodefense Strategies.

_Hospitals. The government wants one hospital in each community designated to house contagious smallpox patients, but hospitals fear liability and other consequences of getting that designation.

A small community of experts had long argued that the country was vulnerable to bioterrorism, but their warnings received little attention before last fall. Now experts fear that as memories of the anthrax attacks fade, attention to solving these problems may, too.

Osterholm hopes people stay a little scared. He points to the fire department at the Minneapolis airport. There's never been a fire there.

"But tonight could be the night," he says. "We have to understand today can be the day that the next shoe drops."

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US House Committee Approves Medical Errors Bill 

By Julie Rovner

Reuters Health

Wednesday, September 18, 2002

WASHINGTON (Reuters Health) - The US House Ways and Means Committee Wednesday overwhelmingly approved a bill that would create a voluntary reporting system designed to detect and prevent medical errors. The vote was 33-4.

The measure calls for development of "patient safety organizations" that would receive confidential reports about errors and "near misses" from doctors, hospitals, and other health care providers and make recommendations on how to prevent such problems in the future.

The voluntary reporting system is one of the recommendations made by the Institute of Medicine ( news - web sites) (IOM) in 1999, when it reported that medical mistakes are killing as many as 100,000 Americans each year and injuring many thousands more. The other part of the IOM's proposal--to institute mandatory reporting for errors resulting in death or serious injury--has so far proved too controversial for Congress to implement.

The new bill "will encourage a culture of safety by providing for the legal protection of information reported voluntarily for the purposes of quality improvement and the reduction of medical errors, and ensuring accountability by raising standards and expectations for continuous quality improvements," according to the report from the panel's Health Subcommittee, which approved the measure last week.

At that session, Democrats said there were several problems with the bill as it was written. But subsequent negotiations resulted in changes that prompted all but four Democrats to vote for the bill.

"We have engaged in a constructive, bipartisan legislative effort," said subcommittee ranking member Pete Stark (D-CA). "While it may not do all of the things we would like, it takes a good first step and lays a foundation upon which we can build."

Changes made to the measure include dropping language that blocked the Health and Human Services ( news - web sites) Secretary from requiring providers to make changes recommended by patient safety organizations; clarifying that the organizations cannot be used by providers to hide information from potential lawsuits; and authorizing fines of up to $50,000 against providers who retaliate against "whistleblowers" who report a medical mistake.

A second House committee, Energy and Commerce, must also approve the bill before it can be scheduled for a vote on the House floor. Sponsors of the bill, however, say they still expect the House, and possibly the Senate, to approve the measure before the end of the year.

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Insurance Lack Can Affect Family  

The Associated Press

Wednesday, September 18, 2002

WASHINGTON (AP) - Lack of health insurance by even one person can affect the entire family, according to a study released Wednesday.

"The stress of having even one uninsured family member can ripple through the household as other family members cope with their relative's illness, high medical bills and financial distress," said Dr. Arthur Kellermann of Emory University School of Medicine, co-chairman of the panel that prepared the study.

Caring for the uninsured person can strain families financially and emotionally, said the report from the Institute of Medicine ( news - web sites), an arm of the National Academy of Sciences ( news - web sites).

People who are uninsured also tend to postpone medical care until symptoms are more developed and the disease is harder to treat, the report said.

The study, "Health Insurance is a Family Matter," is the third in a series from the institute looking at health insurance in the United States.

Only 51 percent of uninsured children had visited a doctor in the previous year compared with 76 percent of insured children, the report said. For dentist visits, 21 percent of uninsured children had been checked in the last year compared to half those with insurance.

About 58 million people in the United States are uninsured or live with a family member who is uninsured, the report said.

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Some Fainting Episodes Tied to Higher Death Risk 

By Amy Norton

Reuters Health

Wednesday, September 18, 2002

NEW YORK (Reuters Health) - Fainting from certain causes, such as cardiac problems, may be a sign that a person faces a higher-than-average risk of death from any cause, researchers have found.

They say their findings point to the importance of fully investigating the cause of fainting episodes when none is readily apparent.

On a brighter note, though, the study results also show that the "common faint"--often associated with fear or other emotional stress--as well as episodes triggered by medication and other relatively benign causes, were unrelated to death risk, the study's senior author, Dr. Daniel Levy, told Reuters Health.

Levy and his colleagues from the National Heart, Lung and Blood Institute's Framingham Heart Study report their findings in the September 19th issue of The New England Journal of Medicine ( news - web sites).

Fainting, also known as syncope, is a temporary loss of consciousness that occurs when blood flow to the brain dips for a short time. There are many possible causes of fainting, including blood pressure-lowering medications and extreme stress, as well as more serious problems like heart disease. But little has been known about the prognosis for various kinds of syncope in the general US population, according to Levy's team.

To investigate, they looked at data on more than 7,800 men and women who took part in the long-running Framingham Heart Study between 1971 and 1998.

Over 17 years, 822 of the participants reported having a fainting episode, with the highest incidence among those in their 70s and 80s. The investigators found that when fainting had a cardiac cause, such as a heart-rhythm irregularity, patients were twice as likely to die during the study period compared with those who had no fainting spells. Their odds of dying from coronary heart disease, specifically, were more than 2.5 times higher.

In addition, patients whose fainting episodes were assigned an "unknown cause" also had an increased risk of death from any cause--a finding that Levy called "one of the most important lessons of this report."

In these patients, he noted, it may be "especially worthwhile" to do further testing to discover the cause of the fainting. "Many will turn out to have cardiac syncope," Levy said.

As for patients with so-called vasovagal syncope, the "common" type of faint, their risk of death was no higher than for participants with no fainting episodes. The same was true of those with syncope due to medication or orthostatic hypotension, a dip in blood pressure upon standing up.

"Patients with vasovagal syncope can be comforted by the knowledge that their prognosis is excellent," Drs. William H. Maisel and William G. Stevenson of Brigham & Women's Hospital in Boston, Massachusetts, write in an accompanying editorial.

And, the editorialists note, although cardiac syncope was tied to a higher death risk, patients' whose fainting is due to a heart-rhythm abnormality "may be protected" by a pacemaker or implanted defibrillator, which can automatically shock the heart back to a normal rhythm if necessary.

Source: The New England Journal of Medicine 2002;347:878-885, 931-933.

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Kids' Allergies Tied to Antibiotic Use During Pregnancy 

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 18, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- The children of women who took antibiotics during pregnancy are at higher risk of having asthma and other allergies, a new study says.

Researchers analyzed medical records for nearly 25,000 children born in Britain between 1988 and 1999. About one-third of the women had been prescribed one or more courses of antibiotics during pregnancy.

They found that if mothers used antibiotics, the chances of their child having asthma rose by 31 percent. The chances of their child having hay fever went up by 27 percent, and the risk for eczema increased by 5 percent.

The link was even stronger in the children of mothers who were prescribed two or more courses of antibiotics: They had a 60 percent greater chance of being asthmatic.

"This is the first study to show the relationship between allergies and antibiotics during pregnancy," says lead author Tricia M. McKeever, a research assistant in the department of respiratory medicine at the University of Nottingham in England.

However, some experts caution against jumping to conclusions. The researchers could not fully determine how much of the increased risk of asthma and allergies was due to taking the antibiotics and how much was due to the infection for which the mothers took the medicine.

Another issue is the hereditary component of asthma and allergies. The most common infection the mothers had was respiratory ailments. This could mean many of them were asthmatic themselves.

"Clearly, the central problem is whether the effect they're looking at is an effect of antibiotics or an effect of infection," says Dr. Thomas Platts-Mills, an allergy expert and professor of medicine at the University of Virginia.

In recent years, evidence has been mounting for what's known as the "hygienic theory" or the "cleanliness hypothesis." The theory behind it is that exposure to germs can actually be good for you by boosting the immune system, thereby making you less susceptible to allergies, Platts-Mills explains.

However, our modern lifestyle -- including the increasing use of household disinfectants and microbiological cleaners and the overuse of antibiotics -- has made the world too sterile, Platts-Mills says.

Some believe it could be closely linked to the significant increase in asthma and allergies in children since 1960, when antibiotics became widely prescribed, Platts-Mills says: "Many of us in the medical profession believe that the use of antibiotics is excessive."

McKeever says taking antibiotics during pregnancy could kill microflora in the gut, which are believed to aid in the development of the immune system.

Depending on how you read the study, it could either confirm or refute the "cleanliness hypothesis."

"If the effect is because of antibiotics, then it supports the cleanliness hypothesis," Platts-Mills says. "But if infections in the mother increase the risk of asthma or allergies, than it's completely the opposite."

Platts-Mills also notes women took antibiotics mainly for respiratory illnesses, perhaps indicating the women had asthma and allergies themselves. Allergies have a hereditary component.

In the paper, which appears in the September issue of the American Journal of Respiratory and Critical Care Medicine, researchers say they controlled for allergies in the mother, smoking and age.

What's an expectant mother to do?

Keep the study in perspective, says Dr. Kathleen Sheerin, vice chairwoman of the public education committee for the American Academy of Allergy, Asthma and Immunology.

"This study is not saying if you take an antibiotic during pregnancy, you will have an allergic child," Sheerin says. "This study is an interesting observation, not fact."

If you are pregnant and have an infection, discuss it with your doctor, Sheerin advises. "Then take antibiotics for infections that call for antibiotics."

Sheerin uses the example of her own pregnancy. She had a urinary tract infection and took antibiotics to treat it. For her, she believes it was the right course of action because urinary tract infections can cause premature labor.

"You have to weigh the risk versus the benefit," she says.

What To Do

Read more about allergies and how to treat them at the American Academy of Allergy, Asthma and Immunology. Find out how allergens trigger an allergic reaction at How Stuff Works.

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Toxin in Dust May Protect Kids from Asthma: Study 

By Amy Norton

Reuters Health

Wednesday, September 18, 2002

NEW YORK (Reuters Health) - A common bacterial toxin found in not-so-clean environs, from farm animal pens to household dust, may help protect young children from developing allergies and asthma, new study findings suggest.

Researchers say the results suggest a reason for the lower risk of allergies and allergy-triggered asthma that has been found among children who grow up on farms or with household pets. Bacterial components called endotoxins--which are particularly high when farm animals are around--may push the developing immune system to tolerate the environmental irritants commonly behind allergies.

The new study, conducted in rural Germany, Austria and Switzerland, found that school-age children whose mattresses contained relatively higher levels of endotoxin were less likely to suffer from hay fever or allergy-related asthma, or to show sensitization to airborne allergens like pollen and cat dander.

Dr. Charlotte Braun-Fahrlander, of the Institute of Social and Preventive Medicine in Basel, Switzerland, and her colleagues report the findings in the September 19th issue of The New England Journal of Medicine ( news - web sites).

Experts have suspected that endotoxins may explain the farm connection to lower asthma risk, but "these guys showed it," Dr. Scott T. Weiss of Brigham and Women's Hospital in Boston, Massachusetts, told Reuters Health.

Endotoxin exists in the cell wall of certain bacteria, and the feces of larger animals are a major source of endotoxin exposure--although household pets, as well as dust and dirt, offer up their share. Early childhood exposures to farm animals, pets and dust--as well as to other children in places like day care--have all been tied to a lower risk of developing allergies and asthma.

Researchers explain this connection with the so-called "hygiene hypothesis," which holds that exposure to bacteria, viruses and their byproducts early in life helps push the developing immune system toward infection-fighting mode--and away from the tendency to overreact to environmental irritants. Some investigators point to increasingly clean living in industrialized societies as one reason for their growing rates in asthma.

According to Weiss, who wrote an editorial accompanying the new report, the findings "give support to the hygiene hypothesis."

However, they do not provide an excuse for people to throw away their brooms and dust rags.

Weiss said that, even if endotoxin helps ward off allergies and asthma, it is still unclear what "dose" of endotoxin and what time frame of exposure might be helpful. He pointed out that high levels of endotoxin might promote respiratory problems, and research has shown that even at low levels, endotoxin may trigger wheezing in infants.

Moreover, Weiss noted, "a lot of exposures" other than endotoxin may help determine a child's risk of allergies and asthma. Experts believe that a combination of genetic susceptibility and environmental factors are at work.

Braun-Fahrlander and her colleagues looked at 812 children aged 6 to 13 living in rural areas, on farms or not. Higher endotoxin levels in dust samples from the children's mattresses were related to a lower frequency of allergies and asthma, and blood samples from children with greater exposure showed fewer inflammatory immune cells known as cytokines.

Weiss pointed out that a better measure of the impact of endotoxins on children's respiratory health would be to look at their exposure early in life, then follow them to see who developed allergies and asthma.

Source: The New England Journal of Medicine 2002;347:869-877, 930-931.

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Doctor-Patient Dialogue Combats Depression 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Wednesday, September 18, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- Depressed people who talk frequently with their doctors about the antidepressants they are taking are more likely to stay on those drugs long enough for them to help.

"This is nothing too scientific or technical," says Scott Bull, lead author of a Kaiser Permanente study that appears in today's issue of the Journal of the American Medical Association ( news - web sites). "The simple fact is that communication seems to improve adherence to treatment plans."

This would seem to be the case with health issues beyond psychiatry.

"Over the years, studies have looked at what patients remember from their visits with doctors and, in general, patients remember maybe 50 percent of what their doctor says," says Dr. Milton W. Anderson, head of child and adolescent psychiatry at the Ochsner Clinic Foundation in New Orleans.

"People can speculate about the reasons but, as I perceive it, unless they're very medically sophisticated, it's like drinking from a fire hydrant, especially in the modern health-care setting where time is often limited," Anderson says. "It's a tremendous art for a primary-care physician to come across as non-hurried and to give information in a concise manner."

According to the study authors, up to 68 percent of patients discontinue taking antidepressants within three months of starting, even though current guidelines recommend that treatment needs to continue for at least four to nine months to prevent a relapse for depression.

Over the course of about 18 months, Bull and his colleagues conducted 401 telephone interviews with patients being treated with SSRIs (selective serotonin reuptake inhibitors such as Prozac), and also analyzed written surveys from 13 prescribing physicians.

The researchers found significant discrepancies between what doctors said they told patients and what patients remember being told regarding adverse effects and duration of treatment. Patients with three or more follow-up visits were more likely to continue for the prescribed length of time.

The most surprising finding, Bull says, was that 72 percent of doctors said they told patients up front that they would probably need to take the medication for at least six months, while only 34 percent of patients remembered being told this. More than half (56 percent) of patients said they received no instructions.

There may be several explanations for this discrepancy. "I think depression in itself probably makes it more difficult for patients to get out of bed and get into an office for follow-up," Bull says.

People who are depressed also often have lapses in concentration and memory. Anderson points out that parents who are seeking help for their depressed children do not have problems with memory, motivation and concentration, and often have a very good follow-through record.

One issue that was not addressed was the length of the visits. The authors also did not discuss the value of giving out printed educational material, which, Anderson says, can be "quite helpful."

Whether it be printed material or verbal instructions, what's important, Bull says, is that "the message has to be reinforced throughout the course of care. If it's brought up only in the beginning of treatment, patients are probably going to forget."

As always, though, "communication is a two-way street," Bulls says.

What To Do

The American Psychological Association has a host of resources about mental illness and antidepressants. Are you concerned that you might be depressed? Find out by taking this online screening test from New York University School of Medicine.

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Scientists Zero in on Out-Of-Body Experience 

By Patricia Reaney

Reuters

Wednesday, September 18, 2002

LONDON (Reuters) - Swiss scientists think they have pinpointed the area of the brain where out-of-body experiences are triggered.

While they used electrodes to stimulate the brain of a female epilepsy patient during treatment, the woman began describing feeling as though she had left her body and was floating above it.

"I see myself lying in bed, from above," the 43-year-old patient told Olaf Blanke and his colleagues at the University Hospitals of Geneva and Lausanne.

Blanke and his team produced the phenomenon by stimulating an area in the right cortex of the brain called the angular gyrus, which is involved in spatial cognition. How they did it is reported in the journal Nature on Wednesday.

"It suggests that this experience is related to a specific part of the brain," Blanke told Reuters. "It seems to be that this area is important for brain processes that could be related to out-of-body experience."

Scientists suspect that about 10% of people brought back from the brink of death experience something similar, but it has been difficult to prove it actually occurs.

The phenomenon has also been reported by some migraine, epilepsy and stroke patients.

The Swiss researchers produced the sensation, which lasted for about 2 seconds, three times in the patient. She reported feelings of lightness and floating about 2 meters above the bed, close to the ceiling.

When Blanke's team asked the woman to look at a part of her body from the heightened position, her legs for example, she had illusions and reported seeing her legs "becoming shorter."

"She saw this. It was very real. She had the feeling she punched herself in the head if she bent the arm a bit," Blanke said.

The scientists suspect that the angular gyrus matches up visual information, how the body is seen, and touch and balance sensations that create the mind's representation of the body.

They believe an out-of-body experience may occur when the two do not link up.

Blanke does not know why the phenomenon occurs in people who have been near death but he said it could be due to a lack of oxygen or a disconnection or malfunction of certain brain regions.

He hopes his work will stimulate more collaboration between neurologists and scientists who have been involved in the phenomenological approach, to better understand out-of-body experiences.

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E coli is a Very Nasty Bug 

HealthScoutNews

Wednesday, September 18, 2002

(HealthScoutNews) -- Every year, thousands of people in this country are infected by E. coli strain 0157:H7, a very nasty bacterium.

In a word, says John C. Brown, Professor of Microbiology at the University of Kansas, E. coli 0157:H7 is a killer. The toxin, Brown explains, "is a protein which causes severe damage to intestinal epithelial cells (which line the wall of the intestine)." The damage is so severe that if we acquire this bacterial strain, not only do we lose water and salts, blood vessels are damaged, and hemorrhagic bleeding can occur.

"This condition," he continues, "is particularly dangerous to small children -- [it] may be lethal -- [because] children are too small to tolerate much blood and fluid loss. It is for this reason that small children should not be allowed to become dehydrated, even in mild cases of diarrhea."

E. coli, which often is contracted from undercooked meat, eggs and even unwashed vegetables, may cause diarrhea. If it's accompanied by fever and vomiting, or there's any blood in the stool, check immediately with your doctor.

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Pay Attention to Drug Directions 

HealthScoutNews

Wednesday, September 18, 2002

(HealthScoutNews) -- Nearly 80 percent of Americans take an over-the-counter (OTC) pain reliever at least once a week, according to a recent study in the Journal of the American Medical Association ( news - web sites).

While OTC medications are generally considered safe, American Family Physician, an American Academy of Family Physicians ( news - web sites) publication, notes that "a considerable body of evidence indicates that many Americans do not read labels or heed warnings about possible drug interactions or side effects of OTC products."

Intended for physicians, this AFP report stresses the importance for doctors to stay current on information about drug interactions "and educating patients about their options." Physicians also should encourage patients to report the use of OTC medications -- whether the patients are or aren't taking prescription drugs or are suffering from a severe medical condition.

AFP cited as an example of risks OTC drugs may pose the case of a person taking low-dose aspirin because of its potential to reduce the risk of a heart attack. It turns out that ibuprofen, the primary ingredient in many OTC pain relievers, can interfere with the effectiveness of low-dose aspirin, with potential serious consequences.

The AAFP says it's a good idea to have all patients seek their doctors' advice on OTC medications ... before it's too late.

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Predicting the Path of Acute Coronary Syndrome 

HealthScoutNews

Wednesday, September 18, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- A new risk model lets doctors identify people with acute coronary syndrome who have the greatest risk of dying while in the hospital.

Those patients can then be targeted for life-saving interventions, says a study presented at the recent European Society of Cardiology Congress 2002.

The GRACE (Global Registry of Acute Coronary Events) uses eight factors to achieve a cumulative score that the study says is 90 percent accurate in predicting the death risk in patients with the syndrome.

Those factors are:

·         Resuscitated cardiac arrest.

  • Serum levels of creatinine, a biochemical marker of heart damage.
  • Age.
  • Increased heart rate.
  • Elevated systolic (the higher figure) blood pressure.
  • Killip classification of heart failure status.
  • Deviation in the ST segment of the heartbeat.
  • Increased levels of C-reactive protein and troponin protein.

"The GRACE model is effective, regardless of whether the patient presents with a severe or mild heart attack or severe chest pain, and can easily be done on a graph or personal digital assistant (PDA), so it could be a useful tool to guide clinical practice and plan interventions," says GRACE scientific co-chairman Keith A. A. Fox, a professor of cardiology and head of the department of medical and radiological sciences at the University of Edinburgh in Scotland.

The risk model was developed after analyzing data from GRACE, an international registry that collects information on more than 17,500 people from 14 countries who suffer acute coronary syndrome while in the hospital or after being discharged.

More information

The Yale University School of Medicine has more on acute coronary syndrome.

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Women Not Heeding Warnings About Heart Disease 

HealthScoutNews

Wednesday, September 18, 2002

WEDNESDAY, Sept. 18 (HealthScoutNews) -- Cardiovascular disease is the leading killer of American women, but they're failing to take some simple measures to protect themselves.

An American Heart Association ( news - web sites) (AHA) survey conducted earlier this year found that 75 percent of U.S. women don't make healthful choices when it comes to diet and exercise. Physical inactivity and poor nutrition contribute to development of cardiovascular disease.

"Studies have shown that women realize what it takes to reduce their risk for heart disease and want to reduce that risk, but they often aren't equipped with the tools they need to help them do so," says Dr. Rose Marie Robertson, director of the Vanderbilt Women's Heart Institute and AHA past president.

To help women, the AHA has launched "Simple Solutions," a free education program to help them learn how to make lifestyle changes to reduce their risk of heart disease and stroke. "Simple Solutions" offers a variety of information, including health recipes and nutrition and exercise tips.

If you're interested in enrolling in "Simple Solutions," call the AHA at 1-888-MY HEART, or go to Simple Solutions.

Some of the Simple Solutions tips include:

·         Add a handful of walnuts and low-fat dressing to your salad in place of cheese, high-fat salad dressing and croutons. Walnuts contain omega-3 fatty acids, which may help reduce your risk of heart disease.

  • When you have a baked potato, add a tablespoon of low-fat or fat-free sour cream, which is lower in fat and sodium than margarine. Feel free to pile on the chives, but pass on the cheese and bacon.
  • Don't go grocery shopping when you're hungry. Walk around the outside aisles of the grocery store at least once before you begin to do your shopping.
  • When you drop the kids off for soccer practice, get out of your car and walk around the field while your children play their game.
  • Do outdoor yard work such as mowing the lawn, or raking leaves or grass.

More information

The Centers for Disease Control and Prevention ( news - web sites) has some disturbing facts on women and heart disease.

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TUESDAY, SEPTEMBER 17, 2002 

Nurses' Support Alone Does Not Lower C-Section Risk 

By Natalie Engler

Reuters Health

Tuesday, September 17, 2002

NEW YORK (Reuters Health) - A woman in labor who receives empathic counsel from a specially trained nurse is no more likely to deliver her baby vaginally than is a woman who does not receive such care, according to the results of a new study of women giving birth in North American hospitals.

The findings contradict research suggesting that this so-called "continuous labor support" confers many benefits, including a lower risk of cesarean delivery.

Although women appreciate continuous labor support, they should not expect it to protect them from medical interventions, lead author Dr. Ellen Hodnett of the University of Toronto Faculty of Nursing in Ontario said in an interview with Reuters Health.

Medical interventions include using hormones to induce labor, electronically monitoring uterine contractions and the fetal heartbeat, and administering regional anesthesia.

Hodnett told Reuters Health that the total birth environment plays a larger role than caregiver support in determining the outcome of labor and delivery.

To evaluate the effectiveness of nurses trained to provide labor support, Hodnett and her colleagues randomly assigned 6,915 healthy pregnant women to two groups. One group received continuous support from a trained labor support nurse, and the other received the usual nursing care. The study took place in 13 hospitals in the US and Canada.

The researchers discovered no significant differences between the groups. Not only was the rate of cesarean deliveries nearly identical; the labor support had no bearing on the speed of delivery, the women's health during and after delivery, or the health of the newborns, they report in the September 18th issue of The Journal of the American Medical Association ( news - web sites).

In an interview with Reuters Health, Hodnett stressed that the study does not indicate that labor support is superfluous. On the contrary, she said it underscores the importance of the setting in which a woman delivers her baby.

Labor support may, in fact, lower the rate of C-sections in birth centers that involve consumers in policymaking, regularly monitor their practices to improve them, and refrain from routine medical intervention during normal labor, she said.

Therefore, she advises, "Women should find out as much as they can about the place in which they plan to give birth."

Source: The Journal of the American Medical Association 2002;288:1373-1381.

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Experience Counts in Reading Mammograms 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 17, 2002

TUESDAY, Sept. 17 (HealthScoutNews) -- When it comes to reading routine mammograms, young, unseasoned radiologists are more likely than older, experienced ones to be suspicious of lumps that later prove benign, a new study has found.

The study, appearing in tomorrow's Journal of the National Cancer Institute ( news - web sites), showed that women who have their screening mammograms read by greener doctors have about a 50 percent higher chance of being told they might have breast cancer ( news - web sites) than if they see a veteran. While these "false-positive" readings may result from an abundance of caution, they're emotionally jarring, have a steep financial toll, and often lead to painful biopsies.

"There's definitely a high degree of variability among radiologists in how they interpret mammograms," said Dr. Joann Elmore, a University of Washington physician and lead author of the study.

"The best doctors probably get the most challenging patients, and you need to adjust for that," Elmore said. And many doctors quick to call a lump suspicious probably end up catching cancers that other doctors might let pass.

Still, she said, the findings indicate that women face sizable differences in false-positive rates among doctors in their communities, and that could have an impact on the care they receive. "In this case experience might be even more important, because we're talking about a screening test where you're trying to do no harm."

Annual X-ray mammograms are recommended for women over the age of 40 -- meaning tens of millions of the tests are performed each year in this country. Roughly 190,000 women are diagnosed with breast cancer every year.

In their study, Elmore and her colleagues looked at how consistently two dozen New England radiologists read 8,734 routine mammograms taken from nearly 2,170 middle-aged and elderly women.

False-positive rates ranged from 2.6 percent to nearly 16 percent, the researchers found. Doctors in practice longer were less likely to misread a test than those trained recently.

Breast cancer appears in roughly one in 1,000 women. Therefore, a woman called back for further study by a radiologist with a false-positive rate of 10 percent is about 100 times more likely be cancer-free than to truly have a tumor.

When Elmore's group accounted for factors that might exacerbate the gulf -- like the difficulty of patients seen, for example, or how many films the doctor read -- the amount of variability shrank by about half. But enough remained that if a woman were to see two radiologists in her town, her chances of being told she had a tumor were 50 percent higher at the less accurate office.

The tests were performed between 1985 and 1993, before radiologists adopted a standardized five-point scale for mammography. So the situation today might be somewhat more even than in decades past, Elmore said.

Elmore said the study doesn't address diagnostic mammography, and she suspects that the variability between physicians in these cases is much narrower. In diagnostic imaging, the volume of tests is much lower.

M. Robyn Andersen, a health psychologist at the Fred Hutchinson Cancer Center in Seattle and a co-author of an editorial accompanying the journal article, said the study highlights a fact of mammography women don't want to hear: It's not a perfect test.

"Many may not know just how many false-positives happen for every cancer found," Andersen said. "If you're called back, the chances are very good that it is indeed a false-positive, so that's not the time to get worried. Get worried at the needle biopsy. Before that it's probably a conservative radiologist trying to do their job."

One way to iron out the variability would be to have two radiologists read each screening film, as is done in many countries outside the United States. Andersen said she's not sure why the United States doesn't use this safety net.

"My guess is it's basically a culture thing," she said. "A lot of physicians and a lot of us as people who go to physicians are really used to believing that any physician we see is more than just competent. They're always right. They don't usually think of second opinions for routine tests." The reality, though, is that reading mammograms is an art, and different doctors have different eyes.

What To Do

For more information on mammography quality, try the Food and Drug Administration. For more on the value of the test, visit the Department of Health and Human Services.

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Stress Hormone Offers Target for Memory-Boost Drugs 

By Merritt McKinney

Reuters Health

Tuesday, September 17, 2002

NEW YORK (Reuters Health) - Levels of the stress hormone cortisol appear to affect memory in the elderly, according to the results of a new study. Researchers believe the findings could point the way to therapies that could help slow or restore failing memory.

In a study of elderly individuals, Dr. Sonia J. Lupien of McGill University's Douglas Hospital Research Center in Verdun, Quebec, Canada, and colleagues found that they could induce temporary changes in memory by manipulating levels of the stress-related hormone cortisol. But the extent of the effect on memory, as well as its direction--helpful or harmful--depended on whether a person had moderate or high levels of the stress hormone at the start of the study.

In an interview with Reuters Health, Lupien explained that she and her colleagues had previously detected an apparent link between high levels of cortisol, which is released in response to stress, and impaired memory in the elderly. But the presence of high cortisol levels in elderly people with memory problems did not prove that the stress hormone directly caused the memory impairment, she added.

"In order to show that it was really involved," she said, "we had to modulate memory by manipulating hormone levels."

To do that, Lupien's team studied two groups of elderly individuals whose cortisol levels had been tracked for 5 years. The study included eight people who had moderate levels of cortisol and nine people with high levels of the hormone who also had impaired memory.

Both groups were first given metyrapone, a steroid hormone that blocks the secretion of cortisol. Then they received a dose of hydrocortisone to restore cortisol levels to what they had been at the start of the study. Researchers evaluated the participants' memory after each phase of the study. Memory after receiving each hormone was compared with memory on another day when they received placebos--treatments that did not contain any active ingredients.

Treatment with the hormones affected the participants' memory, but not in the same way, according to a report in the August issue of the Journal of Clinical Endocrinology and Metabolism.

In the elderly who initially had moderate cortisol levels, suppressing the stress hormone led to memory impairment. This impairment was reversed, however, after cortisol levels were returned to normal.

In people who started with high levels of the stress hormone, however, blocking cortisol secretion did not affect memory, although restoring cortisol levels with hydrocortisone led to even greater memory impairment.

The eventual goal of this sort of research, Lupien said, is to develop a treatment that can stop memory loss in high-risk individuals. She said that the current findings, while not representing a treatment for memory loss, do prove an important point--that it is possible to use hormones to affect memory in the elderly.

According to Lupien, there are two directions that research into treating memory loss can take.

"We can cure with a pill or with social policies," she said.

Lupien said that while a pill that could restore memory might be useful in some elderly individuals, she and her colleagues have found, in a study that has yet to be published, that a low level of social support is the single factor most associated with elevated cortisol in the elderly. This suggests, she said, that providing companionship to socially isolated individuals might be a way to improve memory without drugs, although this approach has not yet been tested.

Source: Journal of Clinical Endocrinology and Metabolism 2002;87:3798-3807.

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Time Wounds All Heels 

HealthScoutNews

Tuesday, September 17, 2002

TUESDAY, Sept. 17 (HealthScoutNews) -- If you like wearing high heels, you may be taking your feet a step in the wrong direction.

Hammertoes, corns, calluses, bunions, and ingrown toenails are among the health problems high heels can inflict on your feet, warns Dr. Mary Ellen Franklin, an exercise physiologist and associate professor of physical therapy at the Medical College of Georgia.

Foot pain, foot deformities, changes in back posture, knee osteoarthritis and balance impairment are additional ills linked to spike heels.

To examine the effects of wearing high heels, Franklin and her students tested 12 older women and 12 college-age women. Their function and balance were tested while they wore 2½ inch heels and again when they wore flat shoes.

The older women lost their balance 12 percent of the time and were nine times more likely to fall when they wore high heels while stepping over a curb-sized platform, compared to when they wore the flat shoes.

Franklin says that when the women wore high heels, "they came down harder off the step than in flats, and the older women came down harder than the younger women."

"Also, when women wear heels, they come down hard on the forefoot, which is where many of the deformities occur over time," she adds.

The women in the study were also subjected to a variety of balance tests while wearing safety harnesses to prevent them from actually falling. The older women "fell" 27 percent more often when they wore high heels, compared to when they wore flat shoes.

"Examples of when older women in high heels might be at greater risk for falls are when they are walking on an uneven surface at night, when their vision is impaired or with cars passing by," Franklin says.

Her recommendation to women is simple: Don't wear high heels.

More information

For more on the health problems posed by high heels, visit Yale-New Haven Hospital.

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Listeria Outbreak in Northeast Puzzles Officials 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 17, 2002

TUESDAY, Sept. 17 (HealthScoutNews) -- Health officials are trying to pinpoint the source of a listeria outbreak being blamed for at least 10 deaths in the Northeast.

Officials in Pennsylvania, New York, Maryland, Michigan, New Jersey and Connecticut are investigating a spree of cases of the typically food-borne illness that have occurred since June.

New Jersey, where four of the deaths occurred, generally sees between 20 and 30 cases of listeriosis -- as the infection is called -- each year. However, over the last three months it has recorded 17 cases, says Marilyn Riley, a spokeswoman for the state's Department of Health and Senior Services.

Riley says germ sleuths at the Centers for Disease Control and Prevention ( news - web sites) are trying to determine if the four fatalities were caused by the outbreak strain of listeria.

Pennsylvania has logged 25 cases of listeria poisoning this summer, the most recent one last Thursday -- as much as it has in a typical year, says Richard McGarvey, spokesman for that state's Department of Health. Four of those were fatal, and all of the deaths occurred in the past two months. "The unfortunate thing is that we don't have a source yet," McGarvey says.

Genetic fingerprinting has determined that 10 of the illnesses in Pennsylvania were definitely connected to the same strain of Listeria monocytogenes bacteria, McGarvey says. The results of tests on the others are pending.

The two other deaths occurred in New York City. City health officials said Monday the bugs implicated in the fatal cases were identical to those in Pennsylvania. In addition, six other patients in the area have contracted the same strain of listeria.

Listeria preys on the old and infirm, people with weakened immune systems. True to form, all of the Pennsylvania and New Jersey deaths involved elderly patients. The New York deaths occurred in people with compromised immunity.

Pregnant women are also a high-risk group, as the infection can lead to miscarriage.

Listeria poisoning can cause high fevers, diarrhea and muscle aches, as well as encephalitis and meningitis, which are infections of the brain and its lining.

The U.S. Food and Drug Administration ( news - web sites) Friday cautioned people particularly vulnerable to listeriosis to avoid eating high-risk foods. These include uncooked or under-heated hot dogs and lunch meats; soft cheeses such as Feta, Brie and Camembert, as well as blue cheeses and Mexican "queso blanco fresco" cheese. Refrigerated smoked fish, like lox or nova, is off limits, too, unless it has been cooked, as are unpasteurized dairy products.

What To Do

For more on the listeria outbreak, try the U.S. Food and Drug Administration. For more on the germ, visit the Centers for Disease Control and Prevention.

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Osteoporosis Screening Urged for Older Women 

By Charnicia E. Huggins

Reuters Health

Tuesday, September 17, 2002

NEW YORK (Reuters Health) - Women aged 65 and older should be routinely screened for osteoporosis, according to new recommendations by the US Preventive Services Task Force.

Sixty-year-old women who are at risk of bone fractures should also be screened for the degenerative bone disease, medical experts advise in the September 17th issue of Annals of Internal Medicine.

"If you're 60 or older, talk with your clinician about screening," Dr. Alfred Berg, chair of the task force, told Reuters Health.

He explained that although some doctors have been screening women for osteoporosis for years, the task force previously reported in 1996 that there was insufficient evidence to recommend such screenings.

Since then, however, the task force has gathered new evidence that suggests a woman's risk of osteoporosis increases with increasing age, and that bone density tests can determine her risk of fractures in the short term. Further, elderly women who do not have any symptoms of the bone condition can receive treatment to reduce their fracture risk, the report indicates.

There seems to be "a pretty good linking between screening, treatment and preventing fractures," Berg said.

Currently, the most commonly prescribed method for treating osteoporosis and preventing fractures is for women to increase their calcium intake, either via calcium supplements or by eating more dairy-rich foods, according to Berg. Other treatment options include hormone replacement therapy and treatment with a class of drugs known as bisphosphonates.

"Clinicians should review with patients the relative benefits and harms of available treatment options, and uncertainties about their efficacy and safety, to facilitate an informed choice," the report states.

Women who weigh less than 70 kilograms (154 pounds) and are not using hormone replacement therapy have the highest risk of both osteoporosis and fracture, the report indicates. Also, white women, who tend to have a lower bone mineral density than their African-American peers, may be more likely to benefit from the screening.

Still, despite the current screening recommendations, it is not known how often women should undergo osteoporosis screenings, or up to what age the screenings remain effective, Berg said. And the benefits and risks of screening in women younger than 60 years or in women aged 60 to 64 who are not at risk of fracture have not yet been determined.

Osteoporosis currently affects an estimated 10 million Americans, including 8 million women, and causes 1.5 million fractures annually, according to the National Osteoporosis Foundation.

Source: Annals of Internal Medicine 2002;137.

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Gene Mutation May be Linked to Prostate Cancer 

By Holly VanScoy
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 17, 2002

TUESDAY, Sept. 17 (HealthScoutNews) -- Scientists have discovered another genetic clue that may eventually help doctors treat or even prevent prostate cancer ( news - web sites).

The researchers have isolated a gene mutation they believe might play a role in the development of prostate cancer following infection of the gland. The gene, MSR1, a macrophage scavenger receptor, shows mutations in a significant percentage of men with prostate cancer, as well as in families where prostate cancer is hereditary, the researchers say.

MSR1 has previously been linked to the formation of arterial plaques that lead to heart disease, although these findings do not yet suggest a conclusive connection between prostate cancer and arterial plaques, the researchers say.

"We don't want to give people the impression this has immediate impact on how we manage prostate cancer," says William Isaacs, professor of urology and oncology at the Brady Urological Institute and Kimmel Cancer Center at Johns Hopkins University.

"However, this broadens our thinking about what may cause prostate cancer and how the body reacts and recognizes the process of prostate cancer formation," he says.

MSR1 helps white blood cells, called macrophages, clean up cellular debris from bacterial infections and damaged fats or lipids. Macrophage activity is known to increase in the early stages of prostate cancer, and the researchers suspected that some MSR1 mutations might inhibit the ability of macrophages to clean up properly after prostate infections, which produce inflammatory lesions that are often early markers of prostate cancer.

The novelty of this finding is that it's the first time this gene has ever been implicated in a cancer, Isaacs says.

In clinical practice, physicians already closely monitor prostate infection as a precursor to prostate cancer.

"Men often have infections in the prostate," says Dr. Timothy Thompson, professor of urology at Baylor College of Medicine in Houston. "However, the way the immune system reaction to infection develops into cancer is not straightforward," he says.

Thompson adds that in previous studies of macrophage activity in prostate cancer, macrophages sometimes seemed to be beneficial, engulfing prostate cancer cells to kill them. At other times, they seemed to assist cancer cells.

"If the macrophages persist in the prostate, it's probably because there are one or more cancer cells that are resistant. The cancer cells can then use factors secreted by the macrophages to survive and grow more virulent. If these interactions between macrophages and cancer cells are allowed to persist, they could set the stage for cancer," Thompson says.

The new findings were the result of collaborative efforts by researchers from Johns Hopkins University, Wake Forest University, and the National Human Genome ( news - web sites) Research Institute.

The study was published online yesterday in the journal Nature Genetics.

The study set out to look for gene variations in 159 families with hereditary prostate cancer, and found seven separate mutations of the MSR1 gene in 8 percent of those families.

The study then expanded to men with non-hereditary prostate cancer and found even more significant results. Researchers screened 731 men, 365 with prostate cancer and 366 without. Overall, the research team found that MSR1 mutations were about seven times more common in men with prostate cancer than in those without.

According to the National Cancer Institute ( news - web sites), prostate cancer is found mainly in American men over age 55. The average age of patients at the time of diagnosis is 70. It is much more common in African-American men than in white men, and less common in Asian and Native American men. A man's risk for developing prostate cancer is higher if his father or brother has had the disease.

The collaborators in the new research found mutations in 12.5 percent of African-American men with prostate cancer, compared to 1.8 percent of African-Americans without the disease. In men of European descent, 4.4 percent of men with prostate cancer and less than 1 percent without prostate cancer had MSR1 mutations.

"We think that even independent of a family history, MSR1 mutations may be an important risk factor," says Isaacs. "The heredity portion of the study looks interesting, but it's not conclusive."

Isaacs also notes that the current research looked only at men of African and European descent, leaving open future inquiry into Hispanics, Asians, and other populations.

What To Do

Learn more about prostate cancer from the National Cancer Institute or the American Cancer Society.

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Poll Confirms Seniors' Commitment to HMOs 

By Karen Pallarito

Reuters Health

Tuesday, September 17, 2002

NEW YORK (Reuters Health) - Seniors enrolled in Medicare HMOs express overwhelming support for their health plans and worry that the potential demise of the Medicare+Choice program would have unwelcome health and financial consequences, according to a poll commissioned by the Blue Cross and Blue Shield Association.

A majority of enrollees, by a margin of more than 3 to 1, also said they would blame Congress--not their health plan sponsor--if the M+C program were eliminated.

"The respondents clearly indicated that they would hold Congress directly accountable if inadequate funding caused this program to dissolve, or if individual plans had to depart from their markets leaving current M+C enrollees without coverage," noted Mary Nell Lehnhard, senior vice president of the association's office of policy and representation.

The poll, conducted by Hickman-Brown Public Opinion Research, reflects responses from a total of 800 M+C beneficiaries in California, Florida, New Jersey and New York. The findings come amid heavy politicking over Medicare provider payments as well as recent data pointing to continuing erosion of the M+C program.

Since Congress' recent return from summer recess, providers have turned up the heat on legislators to consider a "giveback" bill that would boost Medicare rates to health plans as well as doctors and hospitals. Consumer advocacy groups, in turn, have blasted providers for putting their own financial needs ahead of seniors' need for a Medicare drug benefit.

It remains unclear whether the Senate Finance Committee, which has jurisdiction over Medicare payment issues, will take up any broad healthcare measure before adjourning for the year.

Since 1999, health plans have been exiting the M+C program in droves, blaming inadequate government reimbursement for the decision to pull out. As many as 200,000 Medicare beneficiaries will be dropped from their Medicare HMOs in 2003, the American Association of Health Plans estimates.

Blues spokesman John Parker said the poll "paints a better picture for Congress on the value and the benefits of the program." It also underscores the need to stabilize the program with increased federal funding, he said.

Ninety-one percent of seniors participating in the Blue Cross and Blue Shield poll said their M+C plan is valuable, considering their monthly premiums and the benefits they receive. Without access to their plans, many indicated that they would worry about how to pay for medical bills (84%), prescription drugs (82%) and doctor visits (79%).

However, few seniors realize that their health plan might change or disappear, the poll found. Only 37% consider it "likely" that their plan, or plans like theirs, would be eliminated.

Once Medicare enrollees are officially notified of their health plans' intention to drop out next year, many seniors will choose traditional Medicare instead, some consumer advocates are predicting.

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Tighter Fire Safety Standards Prove Matchless for Kids 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 17, 2002

TUESDAY, Sept. 17 (HealthScoutNews) -- Steps taken almost a decade ago to make it more difficult for small children to play with fire are paying off.

A safety standard introduced by the U.S. Consumer Product Safety Commission ( news - web sites) (CPSC) in 1994 reduced cigarette-lighter fires caused by children under the age of 5 by a blazing 58 percent, says a study in the September issue of Injury Prevention.

"It's just a remarkable reduction. This proves that safety standards save lives," says CPSC spokesman Ken Giles.

"The study results are certainly very exciting," adds Todd LeDuc, assistant fire rescue chief for Broward County Fire Rescue in Florida. With 1.6 million residents, Broward County encompasses the greater Fort Lauderdale area.

"They yielded a significant reduction in fire usage by younger children of these lighters, which dramatically not only decreases fire but also injuries, death and associated financial losses with property as well," he adds.

The CPSC's Safety Standard for Cigarette Lighters requires disposable and novelty cigarette lighters to be outfitted with a child-resistant mechanism making the tool difficult for children under the age of 5 to operate.

The need for some sort of standard seemed clear.

At the time it was adopted, the CPSC estimated that children younger than 5 playing with cigarette lighters started 5,900 residential fires that resulted in 170 deaths and 1,150 injuries each year between 1986 and 1988. Disposable lighters were involved in the overwhelming majority -- 97 percent -- of those fires.

The current study compared that data to more recent data covering the period 1997 to 1999 collected from various U.S. fire departments.

In the later period, 48 percent of cigarette-lighter fires were started by children under the age of 5, compared with 71 percent before the standard was introduced, a reduction of 58 percent.

In 1988, children under the age of 5 caused an estimated 2,400 cigarette-lighter fires that resulted in 70 deaths, 480 injuries and $38.2 million property losses.

The CPSC estimates the new standard prevented 3,300 fires, 100 deaths, 660 injuries and $52.5 million in property losses in 1998, or a total of $566.8 million in societal savings.

"I think the impact is a tremendous one, both nationally as well as for local fire departments," LeDuc says. "It's an issue that fire departments struggle to deal with on a daily basis. There is a tendency for small children to be naturally inquisitive -- and fire being one of the things that draw their attention, certainly validating for us that more stringent standards has had a demonstrable impact on safety."

Still, Giles points out, it doesn't mean these cigarette lighters are childproof, just child-resistant. "It means that some kids are going to be able to light the lighter, so parents still need to keep lighters out of the reach of children," he says.

In 2000, the CPSC introduced newer standards requiring that multipurpose lighters, like those used to light grills and fireplaces, be child-resistant. The impact of those standards have not yet been measured.

What To Do

For more information on the Broward County Fire Rescue Department, which includes programs for children, go here.

The National Fire Protection Association has a wealth information on all aspects of fire prevention.

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Premenstrual Disorder Tied to Brain Chemical Shift 

By Keith Mulvihill

Reuters Health

Tuesday, September 17, 2002

NEW YORK (Reuters Health) - A new study provides additional clues about a possible underlying cause of premenstrual dysphoric disorder (PMDD).

While many women experience premenstrual syndrome (PMS), characterized by mood changes, bloating and other symptoms, about 3% to 7% of women suffer from PMDD, a much more serious condition.

Symptoms of PMDD include clinical depression, anxiety and irritability, and are so severe that they can interfere with a woman's interpersonal relationships during the second half of her menstrual cycle.

Now, findings from a small study provide evidence that PMDD may be due, in part, to the effects of changes in hormone levels on the brain chemical gamma-aminobutyric acid (GABA).

GABA is believed to prevent feelings of anxiety by blunting communication between nerve cells associated with mood. Sudden changes in levels of another hormone called allopregnanolone can also affect GABA activity, explained the study's lead author, Dr. C. Neill Epperson of Yale University in New Haven, Connecticut.

While previous research using animals and human blood samples has suggested that GABA plays a role in PMDD, the new study is the first to measure actual levels of GABA, as well as certain hormones, in the brain, Epperson explained in an interview with Reuters Health.

In the study, Epperson's team evaluated brain scans and blood samples from 14 healthy women and 9 women with PMDD. The volunteers underwent analysis two or three times over the course of their menstrual cycles.

The women with PMDD had much lower levels of GABA during the follicular phase of their menstrual cycle (days 1 to 14) compared with the healthy women, according to the report published in the September issue of the journal Archives of General Psychiatry.

"What is coming to light is that women have fluctuations in this one neurotransmitter (GABA) and we should look at other neurotransmitter systems for menstrual cycle effects," Epperson told Reuters Health.

The findings show, Epperson added, "that we are on the right track when it comes to PMDD."

In the development of PMDD, chemicals in the brain such as steroids and GABA are "likely culprits" in the manifestation of symptoms, the researcher noted.

"I think that women should know that, yes, there is a biological cause for this and that they should talk to their clinicians about whether they should get into treatment for it," she added.

Epperson noted that ongoing studies are evaluating the usefulness of antidepressant drugs for treating PMDD.

Source: Archives of General Psychiatry 2002;59:851-858.

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New Chart Plots Outlook for Children With Cerebral Palsy 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 17, 2002

TUESDAY, Sept. 17 (HealthScoutNews) -- Doctors now have a new tool to assess cerebral palsy, a crippling birth defect that afflicts about 550,000 people in the United States.

The condition -- really an umbrella term for a brain injury that typically occurs before birth -- causes a wide range of mental and motor defects with an equally broad spectrum of severity. As a result, it's difficult for doctors and physical therapists to counsel parents of children with cerebral palsy (CP) on what to expect.

However, Canadian researchers have developed new motor development charts for babies with the condition. These trajectories should give parents a better sense of their child's outlook, at least for the muscular aspects of their ailment such as walking.

When they hear their child has CP, parents almost invariably ask two questions, says lead study author Dr. Peter L. Rosenbaum, a pediatrician at McMaster University in Hamilton, Ontario: "How bad is it?" and "Will they walk?"

In earlier research, Rosenbaum and his colleagues developed guidelines for the first question, with a system similar to cancer typing. Before that measure, doctors and parents had to contend with "meaningless" words like moderate, mild and severe, Rosenbaum says.

With the new tool, "because the curves describe motor function by level, we can have a reasonable guess of the child's pattern of mobility," he explains. On the five-track chart, "if it's one or two, you can be pretty sure they're going to walk, but for a child who's a four we would probably be recommending early in therapy that they should get some wheels" (a wheelchair) in addition to other interventions, he says.

Experts caution, however, that the charts aren't iron-clad. A child heading down one path might do better or worse than expected. What's more, they plot motor function only, not emotional, behavioral or social development.

Rosenbaum's group report their findings in tomorrow's Journal of the American Medical Association ( news - web sites). They created the charts with data from 657 children with CP, aged 1 to 13, who were followed for up to four years.

Dr. Murray Goldstein, medical director of the United Cerebral Palsy Research Foundation, says the curves will also help scientists developing therapies for CP.

Many treatments are widely used without solid evidence that they work, Goldstein says. However, having a baseline trajectory of motor development can help researchers compare the effect of an intervention with what would otherwise happen naturally.

Treatment planning will also benefit from the new curves, says Dr. Stephen L. Kinsman, director of pediatric neurology at the University of Maryland School of Medicine. "If somebody isn't likely to ever walk, it doesn't make sense to put them in a study" of an experimental drug designed to help children with a better prognosis.

Yet, Kinsman is wary of making too much of the new tool, especially since some children won't follow the precise path of the curve they're on -- and because they (the charts) only describe one aspect of CP. "Let's be careful how we use this," he adds.

What To Do

For more on cerebral palsy, try United Cerebral Palsy Research Foundation or the National Institute of Neurological Disorders and Stroke.

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Measles, Flu Possibly Linked to Kids' Brain Cancer 

By Patricia Reaney

Reuters Health

Tuesday, September 17, 2002

LONDON (Reuters) - British scientists suspect there could be a link between childhood brain cancer and exposure to the measles or influenza virus around the time of birth.

In the first study to suggest that particular infections could be associated with brain cancer, Cancer Research UK found children had twice the normal risk of developing the disease if they had been born when measles was common in their area.

Early exposure to the influenza virus more than tripled the normal risk of brain cancer, according to the British research charity.

"There's increasing interest in the possibility that exposure to infections very early on in life might contribute to the incidence of children's brain cancer and our study is certainly consistent with that possibility," Professor Louise Parker, the lead researcher from the University of Newcastle in northeast England, said on Tuesday.

The scientists stressed that the findings are preliminary but they support the theory that cancer is caused by a complex mix of factors including genetics and environment. Viruses are also known to play a role in some cancers.

"It is difficult to produce strong evidence on the causes of childhood brain cancer because the disease is rare and even when you look at large numbers of children, in our case 100,000, the number of cancers will be quite small," Parker said.

"But our results do suggest that measles and flu could be associated with increased risk of the disease, and therefore that avoiding these infections might be one way of reducing cancer rates," she added in a statement.

Child Cancers

Childhood cancers are comparatively rare and affect about one in 600 children before the age of 15. Leukemia makes up about one third of the cancer cases and brain tumors account for about a quarter.

In Britain, brain tumors affect an estimated 290 children each year and cause about 100 deaths. Treatment usually involves surgery followed by radiotherapy.

Parker and her colleagues examined all birth records in the county of Cumbria, in northern England, from 1975 to 1992. There were a total of 24 brain and spinal tumors in children under 15 in that time, 18 of them in children under 7. Their research is published in the British Journal of Cancer.

The scientists assessed the levels of infections around the time of the birth of the children who developed brain cancer. They estimated exposure levels before birth, in the three months around and after birth and in the following three months.

"This is the first study to pinpoint measles and influenza as being possible culprits," Sara Hiom, a scientific adviser at Cancer Research UK, said in an interview.

Exposure to other kinds of infection, apart from measles and flu, did not seem to have any effect on brain cancer rates.

Although the number of brain cancers found in the study were small, Hiom said the scientists felt there was enough evidence and clustering to show they were not just chance.

"It is yet another piece to the puzzle," Hiom added.

Further studies will be needed to confirm the findings but scientists believe that recognizing the link between viruses and cancers could pave the way to prevention through the use of vaccines.

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Bah-uns of Steel 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Tuesday, September 17, 2002

TUESDAY, Sept. 17 (HealthScoutNews) -- How would you like to eat whatever you want, and have your body convert almost all of it directly to muscle?

No problem -- as long as you're a callipyge (cal-ah-PEEJ) sheep. Humans, sadly, will have to wait awhile.

After more than 10 years of searching, scientists have discovered the mutated gene that causes callipyge (which means beautiful buttocks) sheep to have large, muscular rear ends.

This discovery has scientists excited for several reasons. First, they hope that by studying the mutation, they can learn more about how muscle and fat are deposited in the sheep, which might provide clues to how fat and muscle are metabolized in humans. They're also excited because it's given them a whole new way to search for elusive gene defects. Their findings appear in the October issue of Genome Research.

It all started 20 years ago when a Nebraska farmer noticed one of his sheep had a very muscular bottom. "Callipyge sheep are like Arnold Schwarzenegger. They have huge muscles with virtually no fat," says one of the researchers, Randy Jirtle, a professor of radiation oncology at Duke University Medical Center. The animals convert food into muscle 30 percent more efficiently than normal sheep do, he says.

Once the farmer started breeding the sheep, he noticed that only those born to large-bottomed males carried the unusual trait. Because of this, scientists knew they were searching for an imprinted gene -- rare genes that are literally stamped with markings that turn off one parent's gene. Normally, two copies of each gene are inherited -- one from the mother and one from the father. One copy will be dominant and the other recessive, but both will be present. This isn't so with imprinted genes.

Jirtle, along with Brad Freking, a geneticist with the U.S. Department of Agriculture ( news - web sites), and their colleagues searched through all of the known genes and turned up nothing that could be responsible for the muscular mutation. Then Freking and his team compared DNA from normal sheep to DNA from the large-bottomed callipyge.

They found 600 distinct markers, which are minute variations, in the gene sequence they examined. Only one, however, was unique to callipyge sheep. What was truly unusual, says Jirtle, is that they found this marker in an area scientists had thought contained no genes, and that such a minor mutation could have such a dramatic effect.

Jirtle says this is the first time scientists have identified a gene through its mutation. Usually, scientists look for genes, and only after a gene is identified do they start searching for its mutations.

This new method of searching for genetic mutations may help scientists solve the mystery of certain disorders, such as autism or bipolar disorder, Jirtle says. By comparing gene sequences in people who have the disorder to people who don't, researchers may be able to zero in on where the mutation is occurring.

"So, we're at the end of the beginning," explains Jirtle, who says the researchers now hope to figure out how this gene causes the change in metabolism, which could ultimately be important in treating obesity.

"[This study] is intriguing from several points of view," says Dr. Richard Re, director of research for the Ochsner Clinic Foundation in New Orleans. "The methodology appears to be atypical, and the sheep have a very interesting system for fat-muscle balance." However, he says it's too soon to know what impact this discovery might have on obesity research in the future.

What To Do

This article from the Harvard University Gazette and this one from the Medical College of Wisconsin look at ways genes may affect human obesity.

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Clot-Busters, Angioplasty Equally Effective: Study 

By Linda Carroll

Reuters Health

Tuesday, September 17, 2002

NEW YORK (Reuters Health) - Heart attack patients who undergo immediate treatment with clot-busting drugs may fare just as well as those given an artery-clearing procedure called angioplasty, according to French researchers.

Patients who received drug therapy before being admitted to the hospital were no more likely to die from a heart attack than those treated with angioplasty after arriving in the hospital, according to the report published in The Lancet. In angioplasty, a balloon-tipped catheter is threaded into the blocked artery and expanded to flatten the fatty blockage against the artery wall and allow the blood to flow through freely.

"Our findings indicate that primary angioplasty is no better than pre-hospital (treatment with clot-busting drugs) followed by transfer for possible emergency coronary angioplasty in patients presenting within 6 hours of an acute (heart attack)," Dr. Eric Bonnefoy, a researcher from the Hopital Cardio-Vasculaire et Pneumologique Louis Pradel in Lyon, and colleagues write.

But in an editorial accompanying the article, Dr. Gregg Stone argues that the study did not include enough patients to prove that angioplasty saved as many lives.

Further, patients treated with clot-busting drugs instead of immediate angioplasty were more likely to suffer a second heart attack or a stroke, Stone, director of cardiovascular research and education at the Lenox Hill Heart and Vascular Institute in New York, told Reuters Health in an interview.

In the current study, the researchers followed 764 patients who had been picked up by an ambulance within 6 hours of having a heart attack. Of the study patients, 400 were treated with clot-busting drugs while in the ambulance.

All 764 patients were treated with heparin and aspirin while on the way to a hospital that could perform angioplasty.

Once at the hospital, angioplasty was performed on the 364 patients who did not receive treatment with the clot-busting drug, alteplase. Among those treated with alteplase, 26% ended up needing further treatment with angioplasty.

Thirty days later, death rates between the two groups were essentially the same, according to Bonnefoy. But there was a trend toward more second heart attacks and more strokes in the medication-treated group, he added.

"I think at this point, the evidence is very strong that the best way to treat a heart attack is with angioplasty," Stone said. "This article shows that the group of patients treated with angioplasty had fewer strokes and second heart attacks."

The only problem for heart attack patients, Stone said, is that not all hospitals are set up to offer angioplasty. And if the ambulance takes patients only to the nearest hospital, patients may not have a choice.

"In the US, only about one in five hospitals offer angioplasty for patients with a heart attack," Stone said. "We need to re-examine the way ambulances treat heart attack patients. They should treat a heart attack patient like a trauma patient and go to a hospital that is a chest pain center of excellence that offers angioplasty on a 24/7 basis."

Source: The Lancet 2002;360:825-829.

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Vegetable Oils as Lubricants? 

HealthScoutNews

Tuesday, September 17, 2002

(HealthScoutNews) -- Put a little too much oil in your salad? Never mind: Recycle it as a lubricant for a skateboard, bike or even a door hinge. That was the conclusion of Joseph Mazzella earlier this year, when he experimented with uncommon uses for cooking oils as a project for the California State Science Fair.

Meanwhile, a doctoral candidate at Penn State University was reporting that many vegetable-derived cooking and salad oils, such as corn, sunflower and canola, "can be made to perform as well or better than the commercial standard for car, boat and machine lubricants," according to a University press release.

Mazzella, an eighth grade student at Maris Academy, La Jolla, CA, noted in the abstract for his project that cooking oils used to be used as lubricants, but because they broke down "under immense heat and pressure," that usage was halted during the 19th century.

The Penn State study aimed at reviving that use found that, to make the cooking oils more stable under heat and pressure, it was necessary to blend them with "a proprietary additive developed at Penn State." When the formulation was right, the cooking oil concoctions would "perform as well or better than the commercial standard, 10W-30 SG" under many standard tests, doctoral candidate Svajus Asadauskas reported.

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Buzz on Cholesterol-Lowering Beeswax Is Promising 

By Anne Harding

Reuters Health

Tuesday, September 17, 2002

BOSTON (Reuters Health) - A powder extracted from beeswax could one day offer a cheap, non-toxic way to reduce cholesterol, reported researchers from a Colorado company at the recent American Chemical Society meeting here.

But one expert argues that findings on the effectiveness of the extract must be independently confirmed, and that his own research has found no cholesterol-lowering benefit for similar substances.

The beeswax powder contains a mix of long alcohol molecules known as policosanol, which is found in virtually all waxy plant materials. Rod Lenoble, technical director of natural products company Hauser Inc. in Longmont, Colorado, described his company's development of the beeswax extract, along with promising data from a similar product made in Cuba from sugar cane wax. Due to trade restrictions, the Cuban extract cannot be sold in the US.

To date, Cuban scientists have conducted 15 trials of the sugar cane wax product with more than 1,000 patients, and have also compared the product to statins, the powerful cholesterol-lowering drugs prescribed to millions of people with heart disease.

People given 5 to 20 milligrams (mg) of the extract daily saw their total cholesterol drop 17% to 19%, with LDL ("bad") cholesterol dropping by roughly 25%, Lenoble reported. While most of the studies found no effect on HDL ("good") cholesterol, the two largest studies, both lasting a year, found the extract increased good cholesterol by nearly 30%, he said.

And when Cuban researchers compared the product to five commercially available statins, they found the sugar cane wax extract compared favorably when it came to lowering both total and LDL cholesterol, Lenoble said.

To date, trials of the Cuban product have found no toxic effects, he added.

Lenoble and his colleagues have developed a policosanol extract from beeswax with a chemical profile similar to that of the Cuban extract, he said. The beeswax extract would be sold as a dietary supplement, he told Reuters Health, and would cost from $10 to $30 a month.

While research on policosanol is "very impressive and seems convincing," said Dr. Heiner K. Berthold, a professor of clinical pharmacology at the University of Bonn in Germany, it has been performed in only a few centers, and must be confirmed independently.

Berthold, who wrote a review of the evidence on policosanol and cholesterol published earlier this year, is also the executive secretary of the Drug Commission of the German Medical Association.

Berthold conducted a study, not yet published, that found policosanol did not lower blood lipids. "It will take us a while to discuss the possible explanations," he told Reuters Health in an interview, but noted he has more faith in his own data than that of other researchers.

While Berthold said he still believes policosanol might help reduce the risk of cardiovascular disease through other effects, more independent studies of such effects are also needed, he added. If mild cholesterol-lowering effects of policosanol could be confirmed, he said, the extracts could indeed be helpful for patients with mild high cholesterol. "A lot of research is still required to get a clearer picture," he added.

Meanwhile, Lenoble and his colleagues are planning a 50-patient trial of the beeswax product. Patients will take 10 mg of the extract or an inactive placebo daily for 8 weeks. Data should be available within 6 months, Lenoble said.

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Evacuation Plan Should Include Pets 

HealthScoutNews

Tuesday, September 17, 2002

(HealthScoutNews) -- How ready are you to evacuate your home in the event of an emergency? How much thought have you given to your pets' needs in this case?

 A comprehensive plan covering domestic and farm animals has been prepared by the Animal Rescue Foundation (ARF) in Milledgeville, Ga., because, as they note, "any disaster than threatens human life threatens animals, too."

But evacuation centers, they note, "don't accept pets." So it is very important that you have a safe place in mind where they -- with or without you -- can stay.

One of your first steps toward protecting household pets is to ensure they have collars and name tags. You also should have photos available to identify any who get lost.

Special thought needs to be given exotic pets, which should be placed in a zoo or a similar safe place if you have to leave your home.

Livestock, who generally can't be evacuated, also require special thought -- to ensure their safe haven is truly safe, that their feed is protected from contaminants, that they will have sufficient water, and that they are protected from debris.

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Living With Brain Tumors 

HealthScoutNews

Tuesday, September 17, 2002

TUESDAY, Sept. 17 (HealthScoutNews) -- A national symposium for brain tumor patients, survivors, their families and health-care professionals will be held this weekend at the Boston Marriott Quincy Hotel.

The event is the fifth national symposium of The Brain Tumor Society, and it offers direct access to experts from across the country.

Presentation topics include updates on stem cell research, radiosurgery and management and treatment of brain tumors in children and adults. There will be sessions to discuss issues such as cognitive and behavioral changes caused by brain tumors, alternative therapies and long-term survivorship.

There will also be sessions on medulloblastoma, the most frequently diagnosed tumor in children and adolescents.

Everyone attending the symposium will be invited to be part of the Hands of Hope collage -- a collection of hand outlines with messages of hope for people struggling with a brain tumor.

For more information about symposium registration, go to the The Brain Tumor Society or call 1-800-770-8287. The cost is $65 for the first registrant, and $50 for additional family members.

Each year, more than 185,000 American adults and children are diagnosed with primary or metastatic brain tumors. Brain tumors are the leading cause of solid tumor death in children under age 20 and they're the third leading cause of cancer death in people aged 20 to 39.

More information

Here's more on brain tumors.

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MONDAY, SEPTEMBER 16, 2002 

Wine Drinking Linked to Lower Lymphoma Risk

By Keith Mulvihill

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Men who consume moderate amounts of wine on a regular basis seem to have a reduced chance of developing non-Hodgkin's lymphoma, researchers report.

However, it is not clear if the wine itself--or some other lifestyle-related factor--is responsible for the risk reduction.

Non-Hodgkin's lymphoma refers to several types of cancer that start in the lymphatic system but often spread throughout the body. It is the fifth most common cause of cancer in the US, according to the study's lead author Dr. Nathaniel C. Briggs of Meharry Medical College in Nashville, Tennessee.

Although a weakened immune system and exposure to certain chemicals on the job are linked to non-Hodgkin's lymphoma, overall risk factors for the disease are "obscure," Briggs told Reuters Health.

"Because so few risk factors have been identified, efforts to prevent non-Hodgkin's lymphoma need to take protective factors into consideration," added Briggs.

While several studies have found that wine drinkers seem to be less likely to develop the disease, the research is inconclusive.

In a new study, Briggs and colleagues looked at 960 men between the ages of 32 and 60 who were diagnosed with non-Hodgkin's lymphoma between 1984 and 1988. They compared the men's lifestyle habits with 1,717 similarly aged men who were cancer-free.

The investigators found that men who regularly drank an average of one or more glasses of wine daily, and who had been regular drinkers--averaging one or more alcoholic beverages per week from the time they were teenagers--had a more than threefold decrease in non-Hodgkin's lymphoma risk compared with nondrinkers, Briggs explained.

Among wine drinkers who started drinking at older ages, the protective effect against non-Hodgkin's lymphoma was less pronounced--a 30% reduction in non-Hodgkin's lymphoma risk with consumption of one or more glass of wine daily, the researcher added.

There was no link between consumption of beer or spirits and a higher or lower risk for non-Hodgkin's lymphoma, according to the report in the September issue of the American Journal of Epidemiology.

Although wine drinkers in the US tend to be wealthier than those who consume other types of beverages, the researchers tried to take that into account by correcting for education. However, there may have been other factors associated with higher income--such as a healthier lifestyle in general--which could not be taken into account because the researchers did not have that information.

"In no way do we endorse underage drinking," said Briggs. "In fact the absence of any protective effect for consumption of beer or spirits suggests that alcohol itself is not the protective factor."

Instead, Briggs noted that a chemical called resveratrol, which is "a phytoestrogen produced by grapes, and a natural ingredient in wine, has been shown to inhibit the initiation, as well as promotion and progression of cancer."

According to Briggs, "If the association is real, non-toxic non-Hodgkin's lymphoma prevention strategies might be possible, such as resveratrol-enriched table grapes or grape jelly." Red wine has higher levels of resveratrol, but the researchers did not determine if the men drank red or white wine, or a combination of both.

Briggs pointed out that the findings can't be extrapolated to consumption of more than one glass of wine per day, because there were too few heavier wine drinkers to investigate risk at higher levels. And, Briggs noted that because the study population was restricted to men, the findings may not be generalizable to women.

Source: American Journal of Epidemiology 2002;156:454-462.

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Fat Abnormalities Hold Gehrig's Clue  

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, September 16, 2002

Mark Mattson examined the spinal cords of victims of Lou Gehrig's disease ( news - web sites) and spotted something surprising — abnormal buildup of fat-like substances in the very cells the deadly disease targets.

Could somehow blocking that fatty buildup slow the inexorable paralysis of the disease? The National Institutes of Health ( news - web sites) neuroscientist is trying to find out, injecting mice genetically destined to get Lou Gehrig's with an experimental drug that appears to block the abnormal lipids.

It's a novel theory, and the drug is years away from being tested in people. But no one knows what causes Lou Gehrig's and several recent treatment attempts have failed — so every new clue is welcome, and scientists are awaiting Mattson's results with both hope and caution.

"It really looks like a very interesting thing, but there've been false leads before," says Dr. Daniel Newman of Henry Ford Hospital in Detroit, who treats patients with Lou Gehrig's, formally known as amyotrophic lateral sclerosis or ALS.

But the theory already is generating speculation among patients about whether diet plays a role in ALS. Researchers recently found links between a high-fat diet and another neurologic disease, Alzheimer's. The NIH does plan to study whether eating certain fatty acids might affect ALS, but skeptical specialists are telling patients not to make drastic dietary changes yet.

"Patients are starting to jump to the conclusion that diet makes a difference. That's leaping to a conclusion," warns Lucie Bruijn, science director of the ALS Association.

Some 30,000 Americans have ALS, which results in a creeping paralysis as movement-controlling neurons, or nerve cells, in the spinal cord and brain are progressively destroyed. It typically strikes in the 50s, and patients often die within five years of the first symptoms, as paralysis leaves them unable to eat or breathe. The only treatment prolongs life about three months.

A small proportion of ALS is inherited, but what causes most cases is a mystery.

Lipids are building blocks of fat, and Mattson, neuroscience chief at NIH's National Institute on Aging, knew that the way people metabolize lipids changes with age. Also, changes in lipids inside cells play a role in cell death. So Mattson's lab examined lipid levels in ALS.

The scientists discovered that the spinal cords of ALS patients harbor significantly higher levels of several lipids than do healthy people's spinal cords. While cholesterol was somewhat elevated inside the cells, of greater concern were lipids called ceramides, the byproduct of a fat important in the normal insulation of nerve cells.

Studying autopsy tissue doesn't reveal when the abnormal fats appeared. So Mattson next studied mice genetically engineered to get ALS — and found ceramide levels rose before the mice ever showed ALS symptoms.

That suggests ceramides play a crucial role in neuron degeneration. But what causes the buildup in the first place?

Mattson exposed mouse nerve cells to free radicals, chemicals produced during metabolism that are thought to damage cells. Free radicals have long been thought to play a role in ALS, and some ALS specialists advise taking antioxidant vitamins in hopes of curbing them. In Mattson's experiment, published in this month's Annals of Neurology, free radicals caused ceramides to rise inside those crucial nerve cells.

Finally, Mattson knew that cancer researchers were experimenting with a drug called ISP-1 that blocks production of the fat that in turn produces ceramides. He borrowed some, treated mouse nerve cells and then exposed them to free radicals — and the drug-treated cells stayed healthy, with low lipid levels.

Now Mattson is giving ISP-1 to ALS-prone mice, to see if it delays paralysis.

Even if Mattson's theory is right, it's far too soon to know if diet could play any role in ALS. After all, millions of Americans have high cholesterol but relatively few get ALS, and no one knows what effect diet has on the ceramides that Mattson pinpointed as the worrisome lipid.

Indeed, doctors like Newman expect medications, not diet, to ultimately hold the key. For now, Newman advises patients just to eat the moderate-fat diet the government already recommends for a healthy heart and take antioxidants such as vitamin E as a precaution.

Editor’s Note: Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Scientists Discover Secret of Tylenol's Success 

By Merritt McKinney

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Acetaminophen, better known as the active ingredient in Tylenol and certain cold remedies, has been used for more than a century to relieve pain and fever, but exactly how the drug worked was a bit of a mystery. Now, Utah researchers have found that the drug seems to target a variant form of an inflammation-related enzyme.

Ibuprofen, aspirin and other so-called nonsteroidal anti-inflammatory drugs, or NSAIDs, work in part by targeting a pair of enzymes called COX-1 and COX-2. Although acetaminophen relieves pain and fever, unlike NSAIDs it does not have a strong anti-inflammatory effect nor does it target COX-1 and COX-2.

Acetaminophen has "never had a clearly defined mechanism of action," Dr. Daniel L. Simmons, of Brigham Young University in Provo, who led the new research, told Reuters Health in an interview.

But according to Simmons, scientists have suspected that there might be a type of COX enzyme in the brain that is more sensitive to acetaminophen. In experiments in dogs, Simmons and his colleagues seemed to detect two different types of COX-1. This variation of COX-1, which the researchers dubbed COX-3, was most abundant in the brains of the dogs.

Unlike COX-1 and COX-2, this newly discovered enzyme, COX-3, was strongly inhibited by acetaminophen.

"Thus, inhibition of COX-3 in the brain and the spinal cord may be the long sought-after mechanism of action of acetaminophen," Simmons and his colleagues state in a report that is published in the advance online edition of the journal Proceedings of the National Academy of Sciences ( news - web sites).

What's more, Simmons said in the interview, "not only was it sensitive to acetaminophen, it was sensitive to other drugs that have a similar sort of action."

Besides shedding light on the workings of a drug that is a staple of the modern medicine cabinet, the discovery of COX-3 could advance research on pain in general, according to the report. Since the newly identified enzyme is a variant form of COX-1, the fact that COX-3 is blocked by acetaminophen, a pain and fever reliever, suggests that the gene for COX-1 may play an important role in pain and fever.

Simmons and his colleagues also found that besides acetaminophen, several types of NSAIDs inhibited COX-3. This raises the possibility, according to the report, that some of the pain-relieving effects of these drugs might stem from their effect on the newly identified enzyme.

The findings represent a "very interesting and exciting start," according to Simmons, but much more research needs to be done. One of the next steps, he said, is to identify COX-3 in humans and prove that acetaminophen blocks it.

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.162468699.

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Proposal for Dying Patients Expected  

By Tom Cohen

Associated Press Writer

The Associated Press

Monday, September 16, 2002

Doctors in intensive care units can face a troubling choice — whether to let dying patients suffer in pain or prescribe high levels of painkillers or sedatives that could hasten death, raising suspicions of euthanasia or mercy killing.

Proposed guidelines to be announced Monday by researchers at the University of Toronto Joint Center for Bioethics are intended to remove any fear of misinterpreted intent by drawing a clear definition between palliative care and euthanasia, center director Dr. Peter Singer says.

He wants the 16 guidelines to be adopted by professional organizations, critical care societies, regulatory authorities and medical examiners as a uniform system for intensive care doctors who deal with the dying.

While pain management guidelines exist in U.S. hospitals, the study by the Toronto center is considered a first step toward addressing the issue of dying patients in intensive care units.

Making distinctions between care for the dying and assisting in death — euthanasia — is most difficult in treatment given in intensive care units where rapid decisions have to be made, Singer said.

The guidelines would provide clarity and protection for doctors trying to stop the pain of dying patients, even if that means prescribing such high levels of medication that it hastens death, according to Singer.

"If the amount of narcotics/sedatives required to relieve pain and suffering at the end of life may foreseeably cause hastening of death, although the physician's intent is solely to relieve suffering, this should be considered palliative care," reads one guideline involving what doctors refer to as the "double effect" of high doses of painkillers.

Singer said showing the doctor's intent was to alleviate pain and suffering was crucial to the guidelines, which call for physicians to document all information concerning prescribed painkillers to demonstrate they were responding to the patient's needs.

The guidelines say "terminal sedation," in which a dying patient is sedated intravenously until becoming unconscious until death ensues from the underlying illness, also is palliative care and not euthanasia.

Such a practice could make detecting assisted suicide more difficult, the report said, adding: "Once again, the intent of the physician is crucial."

The guidelines also oppose setting any figure for maximum dosage, to prevent a threshold that doctors could cross in trying to assist patients in severe pain.

"All we're saying is that this fear that someone is crossing the line and getting into euthanasia is really detracting from a far more important issue, which is that people shouldn't die in pain," Singer said.

Dr. Kathleen Foley of Memorial Sloan-Kettering Cancer Center in New York, director of the Project on Death in America for the Open Society Institute, welcomed the proposed guidelines for adding to the discussion of a topical issue.

"It's important to have national guidelines to provide transparency on the intent of the physician," Foley said. "Everyone is trying to improve the quality of the life of patients before they die."

Documenting all the decisions for prescribing medication protected "the moral integrity" of everyone in an intensive care unit by showing the desire was "not to kill the patient, but provide comfort," she said.

Dr. Laura Hawryluck of the University of Toronto, who led the study that compiled the guidelines, said the goal was to allow doctors to treat each patient as an individual without fear of getting in trouble for trying to eliminate pain and suffering.

"In caring for dying people, we don't always document why we're going up on a drug," said Hawryluck, an intensive care physician. "It may be clear to us. It may not be clear to other people."

Dying without pain or debilitating symptoms of illness such as breathing problems is a major component of quality end-of-life care, Singer said. Patients also want a say in whether to be helped by life-sustaining treatment, and seek a culturally sensitive environment where they can be with their loved ones, he said.

"If you're in pain, you're not going to feel very comfortable about making decisions on life-sustaining equipment or saying goodbye to your children," Singer said.

On the Net:

University of Toronto Joint Center for Bioethics at http://www.utoronto.ca/jcb/

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Beer May Boost 'Good' Cholesterol in Older Women 

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Moderate beer consumption appears to raise levels of "good" cholesterol in healthy older women and may decrease their risk of heart disease, according to the results of a small study.

HDL (or "good") cholesterol levels rose by an average of nearly 12% by the end of the 3-week study, in which men consumed four glasses of beer with dinner and women consumed three glasses. Previous research has shown that increasing HDL by just 2% can lower the risk of heart disease.

The protein component of HDL that is associated with its heart-healthy effects, as well as activity levels of an enzyme that provides a measure of protection against coronary artery disease, also increased during the drinking phase of the study, the researchers report in the September issue of Alcoholism: Clinical and Experimental Research.

The findings support those of several studies showing a relationship between moderate alcohol consumption and decreased risk of heart disease in men. To investigate the relationship in older women, the researchers enrolled nine women aged 49 to 62 and 10 men aged 45 to 64.

The investigators measured levels of HDL and apolipoprotein A-1, the protein portion of HDL that carries cholesterol in the blood. Activity levels of paraoxonase (PON) were also recorded during the drinking and non-drinking phases of the study. The volunteers' overall diet did not change at any time.

In addition to higher levels of HDL cholesterol, levels of apolipoprotein A-1 rose by nearly 9% by the end of the drinking phase. PON activity also increased by about 4% after 2 weeks, compared with levels during the non-drinking phase of the study.

"Increased serum HDL cholesterol level and PON activity may be a mechanism of action not only in healthy middle-aged men, but also in postmenopausal women, underlying the reduced coronary heart disease risk in moderate drinkers," according to Dr. Henk F.J. Hendriks from TNO Nutrition and Food Research in the Netherlands and colleagues.

However, larger studies will need to confirm the findings, the researchers conclude.

Source: Alcoholism: Clinical and Experimental Research 2002;26:1430-1435.

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Chest Pain Is Nothing To Sneeze At 

HealthScoutNews

Monday, September 16, 2002

(HealthScoutNews) -- Many people get a little chest pain once in a while. Others get a lot of chest pain too often.

Pain in the chest, especially when it involves your heart, is called angina ( news - web sites) pectoris. Because it could indicate that a heart attack is imminent, doctors consider all serious chest pain complaints to be angina pectoris until proven otherwise.

Fortunately, the majority of chest pain complaints stem from something other than arterial blockages severe enough to cause angina pectoris and a heart attack.

Other causes can include:

  • a pinched nerve in the neck,
  • viral inflammation of the rib and cartilage,
  • diseases of the ribs, the lungs (pneumonia, other infections, cancer, etc.) and their covering (pleurisy and cancer),
  • diseases of the breathing pipe,
  • diseases of the esophagus (food pipe),
  • chest muscle spasm,
  • muscle contusion or injury,
  • arthritis of the spine or almost any joints in the chest area, and
  • diseases of the diaphragm (the muscular "tent" that divides the chest cavity from the abdominal cavity into two separate airtight compartments).

If your chest pain feels serious, it may well be. Don't take chances -- check with your physician.

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Gene Therapy Aims to Fight Artery Re-Clogging 

By Jacqueline Stenson

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Results of an animal study suggest that an experimental gene therapy technique may help prevent heart arteries from re-clogging after angioplasty has been performed to open them up.

The researchers are hopeful that the approach may one day be used in heart patients to keep their arteries clear and prevent heart attacks and additional surgeries. In as many as 20% of angioplasty patients, the treated artery narrows again within 6 months of the procedure, according to the American Heart Association ( news - web sites). Patients may then need a repeat angioplasty or bypass surgery.

"These findings could lead to a simple, new treatment against post-angioplasty restenosis--narrowing of the coronary arteries," study author Dr. Seppo Yla-Herttuala of the University of Kuopio in Finland told Reuters Health. "One of the most important points is that this treatment can lead to the positive effect with just a single administration given at the time of angioplasty."

When a person undergoes angioplasty, a balloon-tipped catheter is inserted into the artery and then expanded to flatten the fatty blockage against the artery wall and allow the blood to flow through freely. Oftentimes, a metal tube called a stent is inserted to prop the artery open. But the procedure can cause damage to the lining of the artery.

This damage can lead to the rapid growth of new cells in the artery wall, which can contribute to re-clogging of the vessel, according to Yla-Herttuala.

In Tuesday's rapid access issue of Circulation: Journal of the American Heart Association, Yla-Herttuala and colleagues noted that the damage is significantly worsened by the production of harmful free radicals, particularly one known as superoxide anion. And at the same time that free radicals are proliferating, production of a beneficial antioxidant known as vascular superoxide dismutase, or SOD, falls. Antioxidants work to wipe out free radicals.

So the researchers theorized that by delivering a gene that makes extracellular SOD, or EC-SOD, into arteries that have been treated with angioplasty they could destroy free radicals, counter the damage and keep the arteries from re-clogging.

The investigators tested their theory in a rabbit model. They used a modified virus to deliver EC-SOD into the arteries of 18 rabbits, while another 18 rabbits received inactive placebo treatment.

During examinations 2 weeks and 4 weeks later, the researchers observed that the production of the free radical superoxide anion was significantly reduced in the arteries of the rabbits that received the gene therapy. The treated arteries also had less inflammation.

What's more, the arteries of the treated rabbits showed less re-clogging, the study authors reported. Yla-Herttuala said human studies of the treatment could start in a couple of years.

Source: Circulation 2002;106.

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Retired Seniors Gain Lots From Volunteering 

HealthScoutNews

Monday, September 16, 2002

(HealthScoutNews) -- Retired seniors often have more time than money to give to worthy causes. Those who contribute their time get a wonderful reward: a heightened sense of psychological and physical well-being, according to a Cornell University study.

Reporting on the study, SeniorMag.com concluded that volunteering works for retired older folks because it connects them socially and provides routines, rituals and new or expanded roles in lives now largely devoid of them.

"The fact that the still-employed do not reap the same kind of benefits from volunteering as do the retired suggests that community participation compensates for the social and psychological benefits of employment among retirees," says Cornell sociologist Phyllis Moen, who led the study.

"Since paid work seems to give workers a sense of purpose and well-being in the prime adult years, our study suggests that volunteering in community organizations does the same for retirees," she adds.

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HIV Meds May Carry Small Risk of Heart Arrhythmias 

By Anthony J. Brown, MD

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Recent reports have suggested that certain types of anti-HIV ( news - web sites) drugs can cause abnormal heart rhythms, or arrhythmias, but if this is indeed true, the risk appears to be incredibly low, according to infectious disease experts.

The reports have concerned protease inhibitors, an essential component of the drug cocktail used to fight HIV infection. While prescribing information for these drugs warns that they can cause arrhythmias when given with certain other drugs, it is unclear whether protease inhibitors can cause such disturbances on their own.

Three years ago, Drs. Paul E. Sax and Raphael J. Landovitz of Brigham and Women's Hospital in Boston, Massachusetts published a case report suggesting a link between use of nelfinavir (Viracept) and the development of an arrhythmia.

The case involved a 45-year-old HIV-infected man who was switched from a regimen containing indinavir to one containing nelfinavir. Twelve hours after changing to the new regimen, the patient began experiencing palpitations and testing revealed a type of abnormal heart rhythm called bradycardia. The patient had no personal or family history of cardiac problems, including arrhythmias.

After stopping all antiretroviral drugs, the rhythm disturbance resolved. But when the patient was given nelfinavir alone a few weeks later, the arrhythmia returned immediately.

"I am convinced, without a doubt, that nelfinavir caused the patient's bradycardia," Sax told Reuters Health. "Since then, however, I have seen no other cases of arrhythmia possibly related to protease inhibitor use; and I work at a center that sees a lot of HIV-infected patients," he added.

Sax noted that he had heard anecdotal reports of protease inhibitor-related arrhythmias from other physicians, but acknowledged that the risk of such rhythm disturbances with these drugs is probably extremely low.

More recently, Dr. Shinichi Oka from the International Medical Center of Japan in Tokyo and colleagues reported two cases of serious arrhythmias possibly related to use of lopinavir-ritonavir. Both patients had hemophilia and were also infected with hepatitis C virus (HCV), the authors note.

Shortly after starting lopinavir-ritonavir for the first time, arrhythmias were observed in both patients. The rhythm disturbances resolved after lopinavir-ritonavir was discontinued. When one patient was given lopinavir-ritonavir several days later, the arrhythmia returned.

"After submitting our paper, we have (encountered) another two patients who were treated with lopinavir-ritonavir and had bradycardia," Oka told Reuters Health.

It is unclear if lopinavir-ritonavir actually caused these arrhythmias, according to Dr. Scott Brun, a researcher for Abbott Park, Illinois-based Abbott Laboratories, which produces the drug under the trade name Kaletra.

"There were a number of confounding factors that may explain the association," Scott told Reuters Health. "HCV infection can affect cardiac conduction and the patients were on a number of concomitant medications that may have played a role," he added. Also, he noted, levels of certain immune-system cells were very low, suggesting that the patients might have HIV-related heart damage.

After becoming aware of the case reports, "we reviewed our data of more than 10,000 patients treated with Kaletra and we were unable to identify any patients who experienced serious bradyarrhythmias," Scott stated.

While protease inhibitors appear to have little or no rhythm disturbance-producing effect, recent findings suggest that they do affect cardiac anatomy and dynamics.

In a study reported in July, researchers from Johns Hopkins University in Baltimore used echocardiography to assess the cardiac structure and function of HIV-infected patients treated with or without protease inhibitors. The findings suggest that use of the drugs is associated with certain changes in the heart's structure and function.

Lead researcher Dr. Shenghan Lai told Reuters Health that his group is planning a study with MRI scans to further investigate the drugs' effects. In the meantime, he recommends that patients taking protease inhibitors be evaluated with echocardiography, an ultrasound scan of the heart, every 6 months.

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Wives of Alcoholics Also Tend to Drink a Lot 

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Monday, September 16, 2002

MONDAY, Sept. 16 (HealthScoutNews) -- Women married to alcoholics drink more than those married to non-alcoholics, are less likely to be full-time homemakers, yet overall manage their lives pretty well.

This unique window into the lives of functioning alcoholics and their wives provides valuable data rarely gathered in alcoholism research, say professionals who treat the disease.

Dr. Marc Schuckit, director of the Alcohol Research Center in the Veterans Affairs San Diego Healthcare System, based his findings on personal interviews with 327 women who were the first wives of men whose fathers were alcoholics. The study is an offshoot of a long-term genetic study Schuckit and his colleagues are conducting on 453 sons of alcoholics. The results appear in the September issue of the journal Alcoholism: Clinical and Experimental Research.

Since 1978, when the men were in recruited in college, most have married and had families. Ninety-two have become alcoholics. Schuckit continues to follow their lives to trace the prevalence of alcoholism in their children as well. As part of his study of the children, Schuckit thought it important to learn more about their mothers.

"There are assumptions that people make about women who are married to alcoholics, and I thought we could test those assumptions among women whose husbands are alcoholics and compare them to women whose husbands are not," says Schuckit, who is also a professor of psychiatry at the San Diego Veterans Hospital and at the University of California at San Diego.

Significant to the study is that its participants were drawn not from those in treatment for alcoholism, but from a middle-class population that was not ill at the outset of the study, Shuckit says.

"The usual alcoholic in the United States looks like these women's husbands. They have a lot of trouble, but they live fairly normal lives with a job and family," he says.

In the study, Schuckit found that women married to alcoholics were three times more likely to be abusing alcohol than the women in the study who were not married to alcoholics. They drank more often and more heavily than the women whose husbands were not alcoholics.

"This replicates what other studies have reported," Schuckit says. "People who drink a lot tend to congregate with other people who drink a lot, which tends to magnify the probability that drinking will lead to severe problems."

In addition, the women married to alcoholics were three times less likely to be full-time homemakers than the women who were not married to alcoholics and were more likely to have careers. They were "pretty highly functioning people," Schuckit says.

Some studies have suggested women married to alcoholics have a higher rate of psychiatric disorders, Schuckit says. However, his research found that women married to alcoholics had no higher rates for major depression or bipolar disorder than did the women who were married to non-alcoholic men.

"Whatever it is that is going on in these marriages, it's not that the woman is impaired," he says.

Her competence could be contributing to her husband's disease, however, suggests Dr. Jeffrey Roth, a Chicago psychiatrist who specializes in alcoholism and other addictions. "If the woman is very competent and takes over for the husband, she is enabling his behavior to continue."

However, Roth and another specialist in alcoholism say that Schuckit's study is important because it provides information about the general population.

"Most research about alcoholism is based on the treatment population, because we want to help people in treatment, but what Schuckit is doing has a bigger sociological focus," says William Fals-Stewart, a scientist at the Research Institute on Addictions, which is part of the State University of New York at Buffalo.

"It's important because he's looking at a population that is not often recognized in the research literature, and we often extrapolate our information from treatment populations and assume that it's applicable to the world," he says.

"This is a great study to break through the denial as a society that thinks that alcoholics are only the people you find in the gutter. It isn't confined to the gutter. You find alcoholism in people's homes," says Roth.

According to the National Institute on Alcohol Abuse and Alcoholism, 14 million Americans abuse alcohol.

What To Do

To see if you have an alcohol problem, you can visit the Medical Library. If you are concerned about someone else's drinking, go to Al-Anon/Alateen.

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Cigarettes, Coffee Tied to Lower Parkinson's Risk 

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - A review of medical studies confirms previously reported associations between smoking, coffee drinking and a lower risk of Parkinson's disease ( news - web sites).

The results do not suggest that smoking cigarettes or drinking coffee will prevent Parkinson's, which is marked by a loss of certain brain cells that leads to tremor, rigidity and problems with balance and coordination. Any benefit of smoking, the authors stress, "would be overwhelmed by its effects on cancer, heart disease, respiratory disease, and overall mortality."

But understanding the nature of the relationship can help to identify the cause of Parkinson's and help researchers to discover ways to prevent it.

"Further research on the specific mechanisms involved in either case might lead to advances in the prevention and treatment of Parkinson's disease," Dr. Miguel A. Hernan from Harvard School of Public Health in Boston, Massachusetts and colleagues conclude.

Their analysis included 48 studies on cigarette smoking and Parkinson's disease and 13 studies on coffee drinking and Parkinson's. The review found a 60% lower risk of the disorder among current smokers. Previous smokers were also protected, although less so than current smokers, report researchers in the September issue of the Annals of Neurology.

Drinking coffee was associated with a 30% lower risk of the disease. In general, each additional cup of coffee lowered the likelihood of having Parkinson's by 10%, although the effects differed by gender. In women, moderate coffee intake appeared to provide the greatest protection, whereas greater amounts were the most protective in men.

The findings are not surprising, Dr. Karen Marder from Columbia University in New York City and colleagues note in an accompanying editorial. But a biological explanation for the connection has remained elusive, and some researchers have suggested that smoking itself is not protective. Rather, they say, some genetic characteristics may underlie both Parkinson's and the tendency to smoke.

"The major issue is whether smoking and coffee are solely responsible for the observed protective effects or whether they are merely intermediates in the causal pathway," Marder and colleagues write.

They suggest that studies investigating the effect of the age of disease onset and gender--particularly the influences of hormones--may provide clues about genetic or environmental factors that influence the development of Parkinson's disease.

"It is unlikely that either smoking or coffee alone protect against the development of Parkinson's disease. However, that they play a role in the complex gene environment interaction that result in Parkinson's disease appears to be quite plausible," the editorialists conclude.

Source: Annals of Neurology 2002;52:261-262, 276-284.

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'Beating Heart' Bypass May Be Better for Old, Obese 

By Alison McCook

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Elderly people and obese individuals fare better after coronary artery bypass surgery if doctors operate on their beating hearts, rather than stopping the heart and using a machine to keep the blood and oxygen flowing through the body, according to the results of two new studies.

During bypass surgery, doctors attach a blood vessel from another part of the body to the heart to re-direct blood flow around an artery blockage. In the traditional procedure, the patient's heart is stopped and doctors use a heart-lung machine to supply the body with blood and oxygen.

However, use of the heart-lung machine has been linked to some potentially fatal complications, such as body-wide inflammation that can cause damage to multiple organs.

In addition, recent research has shown that people who spent time on a heart-lung machine may have an increased risk of later complications, such as bleeding, longer hospital stays and mental impairment.

In one of the present studies, Dr. R. Ascione and colleagues at the University of Bristol in the UK found that obese people who undergo bypass surgery do better with the "off-pump" technique than with the traditional procedure. During the off-pump procedure, surgeons stabilize a small portion of the heart so they can operate, but the organ continues to pump.

Specifically, Ascione's team found that off-pump surgery was associated with a reduced risk of death, less time spent in intensive care and in the hospital, and a lowered risk of stroke and need for blood transfusions. They report their findings Monday in the rapid access issue of Circulation: Journal of the American Heart Association ( news - web sites).

In the other study, Dr. Roland G. Demaria of the Montreal Heart Institute in Quebec and the Arnaud de Villeneuve Teaching Hospital in Montpellier, France, and colleagues found that people over 80 years old also appeared to fare better with the off-pump procedure. Reporting in the special surgery issue of Circulation, the researchers write that off-pump bypass surgery reduced the risk of stroke and the need for blood transfusions, and also increased the chance of survival during the 30 days after the procedure.

Ascione and colleagues based their findings on the results of bypass surgery in 4,321 patients, more than three quarters of whom underwent the traditional procedure. More than half of the patients were overweight.

Demaria and his team developed their results from a review of hospital records from 125 patients who underwent bypass surgery, all of whom were over age 80. Approximately half of the patients received the off-pump procedure.

In an interview with Reuters Health, study author Dr. Gianni Angelini, who contributed to the study involving obese patients, explained that "the heart-lung machine is not a natural way to perfuse the body." Consequently, in people with pre-existing conditions at the time of bypass surgery, such as obesity or old age, the heart-lung machine may aggravate the effects of those problems, he noted.

People have only begun to use the off-pump procedure, because tools have just recently become available that enable surgeons to keep a small portion of the heart stable while the rest of the heart beats, a necessary step when performing the intricate surgery, Angelini said.

As with any new technique, there will be a "learning curve" during which surgeons who are used to traditional bypass will have to master the new procedure, Angelini said. However, he noted that some of the patients included in his study were operated on when the doctors were first learning the technique, and these early procedures showed no higher risk of complications than later reports.

"We believe that this learning curve is not that difficult," he said.

Source: Circulation 2002;10.1161/01.CIR.0000032259.35784.BF; CIR0000032891.55215.6C.

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Cyber Classes Help Docs Brush Up On Herbs 

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Monday, September 16, 2002

MONDAY, Sept. 16 (HealthScoutNews) -- Doctors, dieticians and pharmacists still have a long way to go when it comes to learning about herbal supplements.

That's the conclusion of a new survey of more than 500 healthcare professionals who were quizzed on their knowledge of herbs and other dietary supplements. On average, they were only able to answer 67 percent of the questions correctly at the start of the study. After 10 weeks of cyber class, their scores went up to 80 percent, according to the study published in the current issue of Academic Medicine.

"[The study participants] had received far more education about herbs than I'd have expected," says study author Dr. Kathi Kemper, a professor of pediatrics at Wake Forest University School of Medicine. "Despite their education, their baseline scores generally left a lot of room for improvement."

Plus, Kemper says that because these professionals volunteered for this study, they proably have a greater interest in herbs and dietary supplements than the average healthcare professional who may know even less about such products.

But, it's increasingly important that physicians and other healthcare professionals learn more about herbs because many of their patients are taking them. According to the study, as many as 50 percent of all people with a chronic illness take herbs or dietary supplements. And, half of those people never mention this to their physician.

Both consumers and their physicians need to understand that these products can be dangerous, health experts say.

For example, people with aspirin allergies should not take any supplement containing willow bark because it may trigger a reaction, but few people -- even doctors -- know this, says New York University Medical Center nutritionist Samantha Heller.

"People think if something is sold over-the-counter or it's all natural that it's safe, and that's not necessarily true. Hemlock and arsenic are natural," adds Heller.

To address this lack of knowledge, Kemper, working with doctors from the Massachusetts-based Longwood Herbal Task Force, designed a series of e-mail "classes" that presented a clinical situation with a question about herb use, as well as information about the supplements and links to reputable Internet sites where more information could be found.

For 10 weeks, 537 healthcare professionals took part in the series. Three hundred and fifty were registered dieticians, 111 were physicians -- mostly specializing in pediatrics, family medicine or internal medicine -- 46 were pharmacists and 30 were advanced practice nurses. Almost 90 percent of the participants were women.

Kemper says the response to the program was overwhelming. The researchers had originally planned on only 200 participants. She says her results are encouraging because it means healthcare professionals are interested in learning more about these products.

"Doctors are notoriously poorly informed about herbs," confirms Heller. One reason is that it's difficult to locate the information. She says she uses five or six reference books and the Internet to locate information on herbs. But because many of these products are new or poorly studied, it's difficult to find accurate information.

Heller says medical schools should add classes on nutrition and dietary supplements to their curriculum, but notes that the Internet classes are a great way to get information out to busy professionals who have already completed school.

Kemper says consumers shouldn't be afraid to ask their doctor or dietician about herbal supplements, but not to be disappointed if they don't know the answer. She suggests working as a team to learn more about which preparations could help your condition and which could be dangerous for you.

What To Do

To learn more about taking supplements safely, read the U.S. Food and Drug Administration ( news - web sites)'s "Tips for the Savvy Supplement User." For information about specific herbs or supplements, go to Wake Forest University Baptist Medical Center's Best Health site.

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Researchers Fix Muscular Dystrophy Damage in Mice 

By Linda Carroll

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Researchers may have found a way to treat one of the most common forms of muscular dystrophy by using a stripped-down version of a cold virus to carry gene therapy to damaged muscles.

A month after researchers injected the modified virus into adult mice with a condition similar to Duchenne muscular dystrophy, the mice showed significant improvements in muscle strength, according to the study published in the Proceedings of the National Academy of Sciences ( news - web sites).

"Now we know that there is a great potential to reverse muscle damage in boys who have already developed significant weakness," study co-author Jeffrey S. Chamberlain, a professor in the department of neurology at the University of Washington School of Medicine in Seattle, said in an interview with Reuters Health.

Duchenne muscular dystrophy is a fatal muscle-wasting disease that strikes approximately 1 in every 3,500 boys. The disease is caused by defects in the dystrophin gene, which is found on the X chromosome.

Previous attempts to treat the disorder with gene therapy have failed because of immune responses to the virus carrying the corrected copy of the dystrophin gene, Chamberlain noted.

For the new study, researchers created a "gutted" version of the cold virus. "The only thing remaining from the original virus is a piece of DNA that is required for both replication--making more of it--and assembling the viral DNA into an infectious shell of proteins," Chamberlain explained. "This shell allows the vector to enter the cell, as it binds to specific proteins on the surface of the muscle cells and allows it to be pulled inside the cell."

Once inside the cell, the corrected gene for dystrophin is transported into the cell's nucleus and the cell begins making the dystrophin protein, Chamberlain said.

"By removing the viral genes, we created a 'stealth' virus that no longer triggers an immune response," Chamberlain said.

Chamberlain and his colleagues injected the gutted virus carrying the dystrophy gene into a leg muscle in each mouse in the study. Within a month, the researchers found dystrophin production in the treated muscle was up by 25% to 30%. They also found an improvement in symptoms related to the disease.

And the effects of the therapy seem to be relatively long-lasting. "So far, we see persistence for 6 months," Chamberlain said. "But I suspect it will slowly go away over 2 years. Thus, we need to either find a way to repeat the injections, or get the dystrophin gene to remain stable in the muscle. We are pursuing both approaches."

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.202300099.

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Off-Job Drinking Means On-Job Injuries 

HealthScoutNews

Monday, September 16, 2002

MONDAY, Sept. 16 (HealthScoutNews) -- Urban transit drivers who are heavy off-the-job drinkers are more likely to suffer workplace injuries, new research shows.

"In general, the job of urban transit operator is one of the most stressful jobs in the United States," says David R. Ragland, a research professor of epidemiology at the University of California, Berkeley, and lead author of a study in the September issue of Alcoholism: Clinical & Experimental Research.

"We found in a previous study that some bus drivers use after-hours alcohol to cope with work-related stress. In this study, our findings imply that off-the-job drinking can have costly impacts for the worker and the transit agency," Ragland says.

He and his colleagues looked at three sources of data on transit operators at the San Francisco Municipal Railway: information about their alcohol consumption, medical histories and workers' compensation claims.

They found that over a five-year period, transit operators who drank more alcohol off the job were more likely to have a workers' compensation claim.

"This means, that after holding constant those factors that might be associated with both drinking and injury -- that is, being male, having more years of driving and greater job stress -- the results indicate that the more one drinks, the more likely one is to have an injury," Ragland says.

"These findings have implications for prevention, including not only changing at-work factors that affect off-work drinking but also strategies for decreasing off-work drinking," he says.

More information

The National Institute of Alcohol Abuse and Alcoholism has all the facts on alcoholism.

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Before-Birth Pollen Exposure May Raise Asthma Risk 

Reuters

Monday, September 16, 2002

STOCKHOLM (Reuters) - Babies are more likely to suffer from asthma if their mothers were exposed to pollen during the last three months of pregnancy, Swedish scientists said Monday.

Scientists have already linked asthma, which has a strong allergic component, to changes in the immune system. A study at the University of Umea showed that environmental factors such as pollen could be equally important for babies even before birth.

Epidemiologist Bertil Forsberg and his colleagues studied 111,702 babies conceived between 1988 and 1995 and born in the Stockholm region. The study monitored them for the first year after birth, during which 923 were hospitalized for asthma.

"From a comparison of babies who early in life become asthmatic and those who do not, it is clear that maternal pollen exposure in the last 12 weeks of pregnancy plays a major role," Forsberg told Reuters.

Pollen levels vary during different months of the year. The researchers did not specifically look at the impact of the month of birth on asthma risk, but said it could also be a factor.

"The exposure level seems to be more important than the time of year (the baby was born)," Forsberg said.

This is partly because pollen levels vary from year to year as well, and exposure can be extremely heavy in some years but modest in others.

After the initial study, researchers monitored the children up to their second birthday and came up with similar results, he said.

The team plans to study children up to the ages of four or six years to see if the pollen exposure was still a risk factor.

Forsberg said childhood asthma could be linked to other factors such as the length of pregnancy and exposure to other allergens both during pregnancy and after birth.

The study is due to be presented to the 12th annual Congress of the European Respiratory Society in Stockholm Monday.

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Car Wrecks Take Toll on the Unborn 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, September 16, 2002

MONDAY, Sept. 16 (HealthScoutNews) -- Even before you're born, you have between a 1 percent and 2 percent chance of being in an auto accident.

That's the conclusion of a new study from Pittsburgh researchers, who found that between 33,000 and 66,000 pregnant women in this country are involved in car wrecks each year.

Fortunately, the vast majority of these incidents don't involve serious injuries or deaths. However, in earlier work, the scientists estimated that 370 fetuses die in accidents every year on American roads, more than twice as many as the 180 infants killed annually in crashes.

For women 20 weeks or more into gestation, collisions account for about 80 percent of all lost pregnancies, that study found. Direct trauma to the fetus is rarely responsible for the fatalities, experts say. Rather, the deaths typically occur when the placenta is torn from the uterus or is otherwise damaged by the force of impact.

Dr. Harold Weiss, a University of Pittsburgh traffic safety expert, led the new study, which appears in the September issue of Injury Prevention, as well as the earlier research on the topic.

Weiss says he didn't look at the impact of a crash on the health of the fetus. However, previous studies have hinted that pregnant women who aren't belted in during a collision are more likely than those who are restrained to deliver an underweight baby. Other evidence suggests fetuses involved in crashes may suffer head injuries and movement disorders. More studies are needed to address this issue, Weiss says.

Weiss and a colleague analyzed accidents reported to police between 1995 and 1999 involving women aged 15 to 39. They found 427 with a pregnant driver or passenger, leading to an overall incidence estimate of 32,810 per year. Accidents were distributed roughly equally across the three trimesters of pregnancy, with a slight bulge in the second trimester.

The highest rate of crashes among pregnant women occurred in the youngest age group, those who were 15 to 19. Among women of peak childbearing age, 20 to 29, 3 percent or more were involved in accidents, the researchers estimate.

Pregnant women appear to be about half as likely as non-pregnant women to be involved in accidents, the researchers found. However, since many accident victims may be newly pregnant without knowing it, the actual difference is probably slimmer.

The number of women in auto accidents each year jumped 60 percent between 1975 and 1990, as the number of miles they drove rose.

While pregnancy didn't affect seat belt use or severity of the accidents, pregnant women were more likely to be treated at the scene or taken to the hospital. Weiss says that's probably because they were concerned about the potential risk to their unborn baby and wanted medical attention. "Most crashes are minor, and there's probably not too much to worry about," he adds.

Weiss advised pregnant women to take fewer and shorter car trips, and try to use public transportation. "If you must go by car, drive during daylight hours and in good weather," he says.

You don't have to shun cars altogether -- though of course, that's the best way to avoid being in an accident. When you do drive, always wear your seatbelt: "All the evidence points that way," Weiss says. Also, keep the air bag connected, and you can reduce your risk of harm by letting someone else drive, since the steering wheel can be dangerous in a crash.

What To Do

For more information on how to drive safely during pregnancy, try ePregnancy.com.

For more traffic safety tips, try the National Highway Traffic Safety Administration. And for more on injury prevention, try San Diego State University.

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Carpal Tunnel Can Be Problem for Dental Hygienists 

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Dental hygienists are at risk of developing carpal tunnel syndrome, a painful and sometimes debilitating wrist condition, according to researchers.

Their survey of 95 dental hygienists found that 93% reported at least one musculoskeletal disorder in the past year, particularly in the region of the wrist and hand, the neck, and the upper back.

About 44% reported symptoms of carpal tunnel syndrome such as numbness or tingling. Nerve conduction studies, which are used to make a more clinical diagnosis of the disorder, found that more than 8% had the condition, researchers report in the September issue of the American Journal of Industrial Medicine.

Carpal tunnel syndrome occurs when one of the nerves that passes through the wrist becomes compressed, causing numbness, weakness, tingling and pain in the fingers and hand. Typists, construction workers, golfers, and others who frequently make repeated motions with their hands, are at risk.

The finding of a high prevalence among dental hygienists is not surprising, given that dental hygienists repeatedly and forcefully grip small instruments when they are cleaning teeth, note Dr. Dan Anton from the University of Iowa in Iowa City, and colleagues.

However, the study underscores the need for ergonomic interventions such as a redesign of the hygienist's workstation, and educational measures about the importance of taking breaks and the risk of working in certain positions. At least one survey has found that dental hygienists had the highest rates of carpal tunnel syndrome of all occupations, the researchers note.

"Carpal tunnel syndrome is a significant health problem in the dental hygiene profession," Anton and colleagues write.

Source: American Journal of Industrial Medicine 2002;42:248-257.

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Alcohol Can Help Post-Menopausal Women 

HealthScoutNews

Monday, September 16, 2002

MONDAY, Sept. 16 (HealthScoutNews) -- Moderate amounts of alcohol may help protect post-menopausal women against heart disease by raising levels of good cholesterol and prompting other changes in the blood.

 That's the conclusion of a study in the September issue of Alcoholism: Clinical and Experimental Research.

Dutch researchers found that post-menopausal women who are moderate alcohol consumers get the same heart protection benefits as those found in previous research on middle-age men.

Moderate drinking results in higher levels of good cholesterol, high density lipoproteins (HDL), shown to predict a low risk of coronary artery disease and heart attacks. Alcohol also increases activity levels of an HDL-associated enzyme called paraoxonase (PON) and of apolipoprotein A-1, which is a protein component of HDL that supports its heart benefits, the researchers say.

"Increased serum HDL-cholesterol and PON activity may be a mechanism of action not only in healthy middle-aged men, but also in post-menopausal women, underlying the reduced heart disease risk in moderate drinkers," says Henk F.J. Hendriks of TNO Nutrition and Food Research in the Netherlands.

The study included nine post-menopausal women, aged 49 to 62, and 10 men aged 45 to 64. They all did beer drinking and non-drinking phases, each lasting three weeks. The men had four glasses of beer or "near-beer" with dinner while the women had three glasses.

After 10 days of the drinking phase, there was an average 7 percent increase in the subjects' HDL-cholesterol levels and an average 12 percent increase by the end of the three-week drinking phase. There was no such increase during the non-drinking phase.

Protein component levels increased by just under 4 percent five days into the alcohol phase and were up almost 9 percent by the end of the drinking phase, the study found. PON levels also increased during the drinking phase.

Findings from previous studies indicate that a 2 percent increase in HDL cholesterol is linked with a 2 percent to 4 percent reduction in coronary heart disease risk.

More information

You can check out The National Institute on Alcohol Abuse and Alcoholism to learn more about the effect of alcohol on women's health.

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Retirees Will Shoulder More Health Benefit Costs 

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Many large employers are coming to grips with escalating medical costs by cutting back--or even eliminating--retiree health benefits, according to study findings released on Monday by the benefits consulting firm Watson Wyatt Worldwide.

By 2031, large employers will scale back financial support for retiree medical expenses to less than 10% of the total cost of providing that benefit, the study found. That's down from today's typical employer contribution of more than 50%.

Sylvester Schieber, the study's co-author and vice president and director of research at Watson Wyatt, says the financial burden on future retirees is rising dramatically, yet many employees are unprepared for the changes ahead.

Watson Wyatt said the study is based on a detailed analysis of data from nationally representative surveys of the population and employers and on findings from a sample of 56 large employers with at least 5,000 employees.

Future retirees will feel the pinch in several ways, it said. The study shows that employers are shrinking benefits by limiting minimum service requirements for workers to receive benefits, linking the employer's premium contribution to the worker's length of service at retirement and reducing the average employer premium contribution from 80% for current employees to 60% for future retirees.

Employers are also limiting their financial exposure through caps on the annual amount they contribute in premiums for retiree medical plans. Forty-five percent cap premium contributions for new hires and 39% do it for current employees, while only one in four have taken that step for current retirees, the study found.

The median cap is $2,000 for current retirees over 65, but that drops to $1,740 for future retirees. For current pre-65 retirees, the median cap is $4,450, but in the future, people who retire before 65 can expect to encounter a cap of $3,900.

With healthcare inflation on the rise, "virtually all" capped contribution plans will hit those limits within 5 years, forcing retirees to pay a much larger share of their premiums out of pocket, the benefits consulting firm predicts.

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The ABC's of a Bone Density Test 

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Monday, September 16, 2002

MONDAY, Sept. 16 (HealthScoutNews) -- As medical tests go, a bone mineral density test or BMD, is one of the simplest.

There's no pre-test fasting or other preparation. No poking or prodding or needles involved. The technician records your weight and height, and might ask you to remove clothing with zippers or metal parts, such as your bra.

Then, you simply lie flat and still on a table during the "gold standard" bone density test, called a DEXA (dualenergy x-ray absorptiometry) while a machine that uses small amounts of radiation passes overhead.

"The test tells you how much bone mineral, the stuff that absorbs the X-ray, is there," says Dr. Robert Heaney, professor of medicine at Creighton University and a scientist at its Osteoporosis Research Center. And it can give you a good idea of your risk for osteoporosis, the "fragile bone" disease that can result in painful, costly fractures of the hip, spine and other areas.

It's all over in 10 minutes or less.

Then comes the more difficult part: interpreting the results and figuring out what to do next.

Your results are compared with those of healthy young women of your ethnicity at their peak bone mass, at age 30. And you are also compared to women of your ethnicity in your age bracket. The results may be expressed in a variety of ways: as a percentile, as a percent or as a standard deviation.

Ask for your results to be given to you in standard deviation form, experts say.

"The standard deviation result may be the most useful," says Lynn Chard-Petrinjak, spokeswoman for the National Osteoporosis Foundation. And probably the easiest for consumers to interpret.

The World Health Organization ( news - web sites) has established categories based on standard deviations of what is normal and what is not for bone mineral density, she says, and the NOF and others use these categories. In medical literature, when treatment is discussed, it is described for various standard deviations, she adds.

The result you should pay the closest attention to is how your bones compare to those of a healthy young woman of your ethnicity, says Dr. J. Michael Uszler, a nuclear medicine physician on staff at Santa Monica-UCLA Medical Center and an expert in bone mineral density testing.

"Forget about age-matched controls," he says, because many of them, especially if they are 50-plus, already have reduced bone mass density. Your fracture risk is more relative when you compare the quality of your bones to those of younger women of your own ethnicity, he says.

The result compared to younger women is often called the T-score; the result compared to women your own age is the Z-score.

So what's normal and what's not so good? According to the WHO categories, widely accepted by other experts, a normal bone density is within one standard deviation (SD) of the young adult mean, which means plus 1 or minus 1 SD.

Low bone mass is defined as 1 to 2.5 SD below the young adult, which means an SD of minus 1 to minus 2.5.

Bone density that is 2.5 SD or more below the young adult mean is defined as osteoporosis. So a result of minus 2.5 SD or greater is osteoporosis.

What you do next depends on the results and your doctor's judgment. If osteoporosis is present, you may be prescribed several of the bone-building drugs such as alendronate, raloxifene or risedronate. Hormone replacement therapy also builds bone.

If you pass the test without evidence of bone mass loss, your doctor may recommend repeating the test in four or five years, Uszler says, depending on a variety of factors such as your age and other risk factors. If your bone mass is not as good as it should be but you have no evidence of osteoporosis, he may suggest a repeat test in two years or so.

Requests for DEXA tests, which cost about $125 to $300, have increased at some centers in the wake of the release of the Women's Health Initiative study, which found that using hormone replacement therapy more than 5.2 years increases the risk of breast cancer ( news - web sites), heart attack and stroke but protects against fractures.

While HRT builds bone, some women who decided to go off hormones are now wondering about their bone mineral density status, and asking for bone density tests. One California center says requests are up by about 20 percent since the WHI study results were released.

What To Do

For more information on bone density testing, see the National Osteoporosis Foundation, which also has information on bone-building treatments.

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New Test Picks Up for More Embryo Defects 

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - A new technique appears to be a promising way to test embryos for more genetic defects, increasing the chance that a woman undergoing in vitro fertilization (IVF) can achieve a healthy pregnancy.

Currently, IVF patients may undergo preimplantation genetic diagnosis (PGD) including a test in which a single cell is removed from the embryo and examined. The test can detect certain genetic defects or can be used to pick up chromosomal abnormalities, which increase the risk of miscarriage.

Preimplantation genetic diagnosis allows doctors to select the embryos that are most likely to result in a normal pregnancy and a healthy baby. However, the testing process is somewhat limited--doctors can usually only check out 6 to 9 chromosomes per cell, although cells typically contain 23 pairs of chromosomes.

Although a more comprehensive test can be done called comparative genomic hybridization (CGH), it takes too long--once an egg and sperm are mixed in a laboratory dish, the resulting embryos must be transferred into a woman's uterus within 4 days.

According to a report in the journal Fertility and Sterility, doctors at St. Barnabas Medical Center in West Orange, New Jersey, were able to cut the time by testing polar bodies--packets of chromosomes left over after an egg cell divides--using a quicker version of CGH. While half of the egg cell's contents go on to mix with the DNA of sperm and form an embryo, the other half is discarded into the polar body.

If an abnormal number of chromosomes are present in the polar body, it's a good bet that the developing embryo is abnormal as well--and likely to end in miscarriage, or conditions such as Down syndrome. What's more, polar bodies can be tested right away, allowing all chromosomes to be examined, while an embryo can be tested only 3 days after fertilization.

In the study, the researchers used polar body testing combined with traditional embryo analysis in a single 40-year-old woman undergoing IVF but having difficulty becoming pregnant.

The study authors retrieved 12 eggs from the woman. Testing of 10 polar bodies showed that 9 of the 10 were abnormal, having either too many or not enough chromosomes. Only 7 of the 12 eggs developed into embryos, and traditional testing confirmed the results of the polar body testing.

Only one resulting embryo was deemed normal, according to the test. Although the embryo was transferred, the woman did not become pregnant. The findings are not unusual, given that only half of all human conceptions are thought to result in a live birth. And in IVF, only 5% to 30% of embryos transferred into the uterus result in a live birth.

The researchers note that the testing process is labor intensive, and "more advances will be required before comparative genomic hybridization can be offered to a larger population of infertile patients."

Still, the technique "could help to extend the improvements in IVF success rates already achieved using the limited chromosomal tests currently available," Dr. Dagan Wells and colleagues conclude.

The technique "requires further development before wider clinical application can be considered but holds great promise for the future," the researchers add.

Source: Fertility and Sterility 2002;78:543-549.

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Girls Have Higher Death Rates After Heart Surgery 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, September 16, 2002

MONDAY, Sept. 16 (HealthScoutNews) -- A California study adds emphasis to a major medical puzzle about heart surgery: Why should being female substantially increase the risk of death?

A study of almost 7,000 patients who had heart surgery in 20 California hospitals over a three-year period shows that females under the age of 21 had a 51 percent higher death rate than young males, researchers at the Harbor-UCLA Medical Center report in tomorrow's issue of Circulation: Journal of the American Heart Association ( news - web sites).

One reason the study was done is that the risk of death was known to be highly imbalanced for adult women who have cardiac surgery, with their death rate at least 50 percent higher than for male patients, says Dr. Ruey-Kang R. Chang, a principal investigator at the Harbor-UCLA Research and Education Institute and lead author of the report.

"We wanted to find out if such a difference as seen in adults occurs in children," Chang says. "It came out as a surprise that the difference is so dramatic."

There are two possible explanations for the difference, Chang says. One is biological, with hormones or some other sex-related characteristics accounting for the increased risk. The other is that utilization of health-care services is different.

If it is a health-care difference, what happens in the hospital at the time of surgery is not the cause, Chang says. "We found that the delivery of services in the hospital was similar for both sexes," he says. "That suggests the difference might come from biological factors, but we're not sure about it."

"It's a mystery," agrees Dr. Catherine Webb, a pediatric cardiologist at Children's Memorial Hospital in Chicago and a spokeswoman for the American Heart Association. But there are a few suggestions about a solution to the mystery, she says.

One is that "females tend to have more co-morbid conditions," Webb says, medical problems such as pulmonary hypertension that make them more vulnerable. Still, there is no definitive answer to the question, she adds.

Finding an answer could help future female heart patients, Chang says. "If we know where the differences are coming from, we can change the way we practice," he says. "The next step is to find the reasons."

Chang and his colleagues have gotten financial support for a new study that will examine the causes of the gender difference. "That could change the way we treat patients," he says.

But Webb says one group of heart surgery candidates probably will not be affected by any new findings. These are the very young, children under the age of 1, in whom the death rate was especially high. In that vulnerable group, she says, "we do not recommend surgery unless it is absolutely necessary. And the younger you are, the more chance you run of not surviving."

What To Do

Get statistics on heart surgery from the American Heart Association, which also has a page on heart disease in children.

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Many Drunk Drivers Not Problem Drinkers 

By Charnicia E. Huggins

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - Many drunk drivers who are fatally injured in car accidents do not have a history of problem drinking, according to new study findings.

Therefore, efforts to reduce drunk driving deaths should target a wide spectrum of alcohol drinkers, in addition to those who repeatedly drink and drive, the researchers say.

"Focusing on 'hard core' drinking drivers will not solve the problem," lead study author Susan P. Baker of Johns Hopkins University's Bloomberg School of Public Health in Maryland told Reuters Health.

Using 1993 survey data, Baker and her colleagues investigated the drinking histories of 818 fatally injured drivers and compared the information with their blood alcohol levels at the time of death.

Nearly 70% of the drivers with very high blood alcohol concentrations of 0.15 or more grams of alcohol per deciliter (g/dL) of blood had a history suggestive of problem drinking, they report in the September issue of Injury Prevention.

Yet, 41% of fatally injured drivers with blood alcohol concentrations of 0.10-0.14 g/dL, one third of drivers with low to moderate blood alcohol concentrations of 0.01-0.09 g/dL, and even 7% of drivers with zero blood alcohol concentrations had a similar history, exhibiting one or more signs of potential problem drinking, study findings indicate.

In fact, "reasonable estimates of problem drinking among drivers with very high blood alcohol concentrations range from 22% to 57%," Baker and her team write.

According to reports from the spouses of the deceased, less than one quarter (22%) of drivers with very high blood alcohol concentrations exhibited the two strongest signs of problem drinking--problem drinking during the last month of life and frequently driving after consuming five or more drinks, the researchers note. Fifty-seven percent of drivers with very high blood alcohol concentrations satisfied only one of these two criteria.

"Many of the drivers who were drinking prior to their fatal crashes were problem drinkers, (yet,) even among those with very high blood alcohol concentrations (0.15% or higher), more than 40% did not have major indicators of problem drinking," Baker said.

In light of the findings, "we need to make sure that the battle against drunk driving encompasses a wide range of people who drink and drive," Baker said. For example, "reducing the legal limit threshold to 0.08% (g/dL) and expanding the use of sobriety checkpoints will help to deter more drivers from driving after drinking," she said.

Standards for gauging intoxication vary by state. Thirty-three states already set the limit at 0.08 g/dL or higher, while in other states the limit is 0.10 g/dL or above.

Supported by the Insurance Institute for Highway Safety ( news - web sites), the study was partially funded by the US Centers for Disease Control and Prevention ( news - web sites).

Source: Injury Prevention 2002;8:221-226.

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Breath Test Has Potential for Lung Cancer Detection 

By Tudor Toma, MD

Reuters Health

Monday, September 16, 2002

STOCKHOLM (Reuters Health) - Tests of breath condensate can identify mutations of a cancer-suppressing gene in patients with lung cancer, a study presented here Sunday at the Annual Congress of the European Respiratory Society demonstrates.

This suggests that the method could one day be used to help identify lung cancer in its early stages, said Dr. Christian Gessner of the University of Leipzig, who presented the research at the meeting.

Breath condensate is the mist that issues from the mouth and nose when a person breathes in cold weather. The condensate fluid comes from deep inside the airways and contains water and many different types of molecules.

Analysis of the DNA from exhaled breath condensate samples was able to identify mutations in the p53 gene in patients with cancer, Gessner and colleagues found. This gene, when functioning normally, acts to help suppress the development of cancer.

The researchers tested breath condensate from 30 healthy volunteers and 13 with biopsy-confirmed non-small-cell lung cancer.

To produce the sample, patients blow into a glass chilled by a special machine for about 5 minutes.

Gessner's team found mutations of the p53 gene in 4 of the 13 patients (31%). "These are small numbers and it is early days for this method, but still it demonstrates that gene expression analysis in exhaled breath condensate is feasible," Gessner said.

A surgical cure for lung cancer may be possible only if the tumour is detected early. Early diagnosis, however, remains a major problem, as symptoms occur mostly in late stages of cancer development.

"Finding a mutated gene in breath condensates can be a very early indicator of lung cancers," said Gessner. The gene p53 is mutated in most cells of the patients with non-small-cell lung cancer.

Other molecules in breath condensate, such as 8-isoprostane, are already considered promising noninvasive markers of inflammatory respiratory diseases. Human structural genes like beta-actin do exist in a majority of exhaled breath condensate samples, but the significance of this finding is not yet clear.

"Further investigations are under way to evaluate expression analysis of tumour suppressor genes or oncogenes in high-risk patients. This may be warranted for screening of follow-up reasons," Gessner concluded.

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Cocaine Linked to Early Signs of Artery Disease 

By Alison McCook

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - People who use cocaine appear to have a higher than average risk of developing the first stages of artery disease, even before they have symptoms of the condition, US researchers report.

Dr. Sheghan Lai of the Johns Hopkins School of Hygiene and Public Health in Baltimore, Maryland and colleagues found that cocaine users of all ages were more likely than others to exhibit tiny calcium deposits in their arteries, known as calcification--one of the first signs of atherosclerosis.

Based on these findings, Lai told Reuters Health that doctors may wish to consider screening cocaine users for cardiovascular problems. The earlier a disease is found, the researcher noted, the easier it is to treat.

"I think doctors may want to investigate the cardiovascular complications of cocaine use. One of the long-term effects of cocaine use is atherosclerosis. Calcification is an early marker of atherosclerosis. Thus, screening calcification may be important for the long-term users," Lai said.

"When a disease is at subclinical stage--without symptoms and signs--the disease process may be able to be stopped or reversed," Lai added.

Atherosclerosis is defined as the build-up of fatty plaques in arteries that inhibit blood flow, raising the risk of heart attack and stroke.

Lai told Reuters Health that previous studies have linked cocaine use to an acceleration in the development of atherosclerosis and an increased risk of other cardiovascular problems, such as heart attack and stroke.

In the current study, Lai and colleagues examined 139 people as part of an ongoing study into the course of HIV ( news - web sites) infection among people who used injection drugs. Ninety-five of the participants used both cocaine and heroin, 16 opted for cocaine only, 7 heroin only and 21 did not use either drug. More than half were also HIV positive.

During the examination, the investigators performed a number of tests, including a spiral computed tomography (CT) scan to measure the level of calcification of the coronary arteries, which supply blood to the heart.

All of the study participants were black Americans, in order to minimize the influence of ethnicity on the results.

Using statistical analysis to eliminate the effects of other influences on cardiovascular disease--such as gender and age--the authors found that people who used cocaine were still more likely than others to show early signs of atherosclerosis. Past research has suggested that heroin use has no impact on levels of calcium in coronary arteries.

No previous study has examined the effect of cocaine use on artery calcification in members of other ethnicities, Lai told Reuters Health in an interview, so it was impossible to say whether the same results would also apply to people other than black Americans.

Lai and colleagues report their findings in the August issue of The American Journal of Cardiology.

"The findings suggest that cocaine use may have an important effect on the natural history of subclinical atherosclerosis and that strategies to reduce drug abuse may be critical in early prevention of cardiovascular disease in the United States," the authors conclude.

Source: The American Journal of Cardiology 2002;90:326-328.

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Hormone Therapy Shows Promise as Male Contraceptive 

By Merritt McKinney

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - For any woman who's ever wondered why the burden of birth control always seems to fall on her, the latest research on male contraceptives should come as encouraging news. In two studies, hormone combinations effectively suppressed sperm production.

Whether the drop in sperm supply can actually prevent pregnancy remains to be seen, but researchers are encouraged by the results, saying that the next step is to refine the combinations to make them more convenient and long-lasting.

The quest for an effective, convenient male contraceptive has not been easy, in part because of the rapid rate at which men produce sperm. Over the course of a month, when the ovaries release a single egg, on average, millions of sperm are produced.

Though testosterone is often linked with virility, treatment with the hormone actually suppresses the production of sperm, a process called spermatogenesis, by reducing levels of hormones called gonadotropins that are involved in sperm production.

But raising testosterone levels can have unwanted effects, such as decreasing levels of HDL, the "good" form of cholesterol. To counteract these side effects, as well as to block sperm production by lowering gonadotropins, many experimental male contraceptives include not only testosterone but also another hormone, often a type used in female contraceptives.

A team led by Dr. Christina Wang of Harbor-UCLA Medical Center in Torrance, California, tested the sperm-suppressing abilities of several combinations that included testosterone and levonorgestrel, the hormone used in the female contraceptive implant Norplant II.

The researchers started with a group of 39 healthy men who were given daily testosterone patches. Half of the men also received levonorgestrel implants. When neither of these approaches proved very effective at suppressing sperm production, the researchers took another tack.

This time, another 29 healthy men were randomly assigned to receive either an oral form of levonorgestrel in combination with testosterone patches or the levonorgestrel implant plus weekly injections of a form of the male hormone called testosterone enanthate (TE).

In three of the groups--testosterone alone, with levonorgestrel implants or with oral levonorgestrel--most men did not achieve azoospermia, which is a complete lack of sperm in semen. But 93% of men in the fourth group--hormone implants plus testosterone injections--did reach azoospermia, according to a report in the August issue of the Journal of Clinical Endocrinology and Metabolism.

And 100% of men in the injection/implant group had their sperm suppressed to extremely low levels.

"The hormonal male contraceptive that we are testing in trials works," Wang told Reuters Health. Despite the encouraging results of the study, though, Wang said that the aim is to develop a male contraceptive that would not have to be given so often.

"Our goal is to develop a long-acting, implantable, more user-friendly male contraceptive that will last for a year or more," she said. Right now, according to the California researcher, her team is testing out different preparations of androgens, a class of hormones that includes testosterone.

In a second study published in the same journal, a team in the UK reports that another hormone combination also resulted in substantial suppression of sperm production. In the study, Dr. Richard A. Anderson of the University of Edinburgh in Scotland and colleagues randomly assigned 28 healthy men to receive either one or two implants of the hormone etonogestrel.

The implants were removed after 24 weeks. At the start of the study and 12 weeks later, all men also had testosterone pellets placed under the skin in the abdomen. These pellets dissolved and did not have to be removed.

Sperm production plummeted in both groups of men, according to the report. Sixty-four percent of the men who received a single implant and 75% of those who received two achieved complete suppression of sperm production. This suppression was not accompanied by major side effects, such as changes in body weight or drops in HDL cholesterol.

The study "demonstrates the potential use and value of long-acting implants to provide reliable contraception over a significant period of time without the need for frequent injections," Anderson told Reuters Health.

"By using a slow-release preparation," Anderson explained, "you get a greater effect for the total dose administered." By using a lower overall dose of testosterone, this slow-release approach minimizes significant side effects, he said.

The next step, according to Anderson, is to improve the administration of testosterone even more, making it easier to use but at least as long-lasting.

Source: Journal of Clinical Endocrinology and Metabolism 2002;87:3562-3572, 3640-3649.

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Half of College Clinics Offer 'Morning-After' Pill 

Reuters Health

Monday, September 16, 2002

NEW YORK (Reuters Health) - A survey of university-based health clinics in the US suggests that only one-half offer emergency contraceptive pills to students.

Many clinics that provide students with emergency contraception say they do so in order to prevent pregnancy and to respond to students' desires, according to Dr. Susan K. McCarthy of Eastern Michigan University in Ypsilanti.

Universities that decline to offer emergency contraception often cited religious reasons, objections from school staff, fear of liability and the fact that students had not expressed the need for the treatment as reasons, the researcher adds.

Emergency contraception is also called the "morning-after" pill because women take it after unprotected sex. The treatment consists of higher-than-usual doses of ordinary oral contraceptives. The pills work by interrupting fertilization or by preventing a fertilized egg from implanting in the uterus. Because of the latter effect, emergency contraception is controversial. While doctors define pregnancy as beginning with implantation, religious groups and others often see things differently.

During the present study, reported in a recent issue of the Journal of American College Health, McCarthy reviewed surveys from 358 US college and university health clinics designed to determine if a clinic offered emergency contraception, and the reasons for and against making it available to students.

The researcher found that 52% of the participating clinics provided students with emergency contraception. Of those that offered the treatment, 60% said they publicized its availability to students, mostly through peer educators and brochures.

McCarthy notes that student health clinics were more likely to offer emergency contraception if the college or university was located in the Northeast, as opposed to the Midwest or South of the US. Furthermore, the bigger the school, the more likely it was to provide the treatment.

Many of the schools started supplying students with emergency contraception fairly recently, McCarthy writes. Half of the clinics that provided the treatment said they had not been doing so for more than 5 years, and almost one third of the suppliers had only started in 1999, the year the surveys were conducted.

Among clinics that declined to offer students emergency contraception, only 8% said they were considering changing the policy or planning to provide the treatment within the next year. However, more than 70% said that they refer students to other health centers that provide emergency contraception.

"Researchers need to determine the underpinnings of these barriers (to supplying emergency contraception) in order to develop appropriate interventions for change," McCarthy writes. "Similar efforts that target those schools that offer emergency contraception pills but do not publicize their availability should also be undertaken," she adds.

Source: Journal of American College Health 2002;51:15-22.

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SUNDAY, SEPTEMBER 15, 2002 

Know the Score for Dangerous Drugs Like Steroids 

HealthScoutNews

Sunday, September 15, 2002

SUNDAY, Sept. 15 (HealthScoutNews) -- Anabolic steroids, human growth hormones and nutritional supplements can be all too tempting for young athletes trying to maximize their performance.

Now, the National Collegiate Athletic Association has adopted a Web-based drug education and wellness program for student athletes to help them make the right decisions.

It's called "Choices in Sports" and was developed by Oregon State University faculty members. The project was directed by Ray Tricker, an associate professor in OSU's College of Health and Human Sciences, and is an extension of his teaching and research for the past 16 years.

"The NCAA ( news - web sites) is confident this site will provide student athletes and athletic staff alike with a trusted resource that will be maintained by the National Center for Drug Free Sport, the company selected by the NCAA to administer its drug-testing collections process," says Mary E. Wilfert, NCAA program coordinator for education outreach.

"With this effort, the NCAA reinforces its programming to prevent drug abuse and promote the health and well-being of its student athletes," Wilfert says.

More information

To visit the "Choices in Sports" Web site, click here.

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SATURDAY, SEPTEMBER 14, 2002 

Taking the Sting out of Bug Bites 

HealthScoutNews

Saturday, September 14, 2002

SATURDAY, Sept. 14 (HealthScoutNews) -- Forget about the Ides of March. It's the wasps of fall that you need to guard against right now.

Yellow jacket hives have been getting larger all summer, and are at their biggest size now. That means there are more of them. And they're getting more ornery and likely to sting as the days grow shorter, the weather cools and their food supplies start to run low.

Yellow jacket stings can be more than painful, they can be deadly for people who suffer allergic reactions to insect stings.

Here are some safety tips from pediatric allergist Dr. Dan Atkins and patient education expert Ann Mullen, both from the National Jewish Medical Research Center.

They say that more than 1 million Americans report allergic reactions to insect stings each year, and about 50 people die after being stung. Yellow jackets, yellow hornets, white-faced hornets, wasps and honeybees are the insects most likely to put the sting on you.

People who are sensitive to insect stings may have an immediate or a delayed reaction. An immediate reaction happens within four hours of a sting. It includes localized pain, swelling and skin redness that lasts for several hours at the sting site.

Some people experience a large, local reaction that includes swelling in a larger area around the sting area and may also include low-grade fever, mild nausea, tiredness and aches.

The most severe form of immediate reaction is anaphylaxis. In these cases, the person turns red and suffers itching, hives, swelling, sneezing, runny nose, throat swelling, breathing problems, abdominal cramping, nausea, vomiting and diarrhea.

Anaphylaxis can be so severe that it results in irregular heartbeat, shock and death.

A delayed reaction to a sting occurs more than four hours later -- sometimes it can happen a week after the sting. Symptoms include hives, fever, joint pain and fatigue. People who suffer a delayed reaction may be at risk for anaphylaxis if they're stung again at a later date.

Atkins and Mullen offer the following advice for treating insect stings:

·         If you have no history of allergic reactions, take aspirin for pain and use ice to reduce swelling.

  • If you've had a previous reaction to a sting, take an oral antihistamine that doesn't cause drowsiness.
  • If you have a history of severe reactions or anaphylaxis, wear a bracelet that identifies your sensitivity to insect stings. Learn to give yourself injections of epinephrine. Keep epinephrine and antihistamines with you. Call 911 after you take the medications.
  • If you've had a delayed reaction to a sting, you might consider immunotherapy -- a series of shots against allergies to insect venom that can protect you against future reactions to stings.

Do your best to avoid stings by wearing long pants and long-sleeved shirts while you do outdoor activities such as hiking or mowing the lawn. Wear gloves when you garden. Choose shoes instead of sandals.

Don't wear dark clothes or clothing with flowery designs. They're more likely to attract insects than white or light-colored clothing. Use unscented deodorant and avoid strongly-scented perfume, cologne, hair products or lotions. Wash off sweat after you exercise and use insect repellant.

If you have a picnic or barbecue, cover your food and garbage so they don't attract insects.

More information

Here's some stinging details about bees and wasps.

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Cholesterol Licked? You're Not Done Yet 

HealthScoutNews

Saturday, September 14, 2002

SATURDAY, Sept.14 (HealthScoutNews) -- Even if you have your cholesterol levels under control, you may still be in danger of heart disease from another type of blood fat called triglycerides.

High triglyceride levels increase your risk of diabetes, heart disease and stroke, says the September issue of the Mayo Health Clinic Letter.

Extremely high levels of triglycerides also increase your risk of pancreatititis, a dangerous inflammation of the pancreas.

Lifestyle and diet changes can reduce triglyceride levels. The Mayo Health Clinic Letter offers ideas on how to reduce your triglycerides:

·         Lower your consumption of sugary foods, such as cookies and soda pop.

  • Reduce your alcohol intake.
  • Lose weight and exercise at least 30 minutes each day.
  • Eat fish that contain high levels of omega-3 fatty acids. Examples include mackerel, lake trout, herring, sardines, albacore tuna and salmon.
  • If diet and lifestyle changes don't help, talk to your doctor about medications to lower your triglycerides.

More Information

The American Heart Association has more on triglycerides.

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