The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
November 21, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 October 25 - November 1

  1. Group Finds New Food Poinsoning Items



Relationship Woes Behind Much Insomnia: Survey 

Reuters Health

Friday, November 1, 2002

FLORENCE (Reuters Health) - Relationship problems are a leading cause of insomnia among Italian women, according to the results of a magazine survey published Friday.

The survey, published in "Riza Psicosomatica," involved 1,026 insomniacs between the ages of 18 and 65. It focused on the underlying issues behind sleeplessness. The magazine is published by the Riza Institute in Milan, an association of physicians and psychologists focusing on psychosomatic medicine.

Women, the main sufferers (64% of the cases), complained that "irritation" caused by their partner was the main reason for their insomnia, the survey shows.

Further details revealed that 41% lamented a "total and continuous lack of attention," 19% added that their partner "devotes all his attention to the TV." Some 15% responded that the main cause for insomnia was "worry about the children and the family."

Men's minds also tended to race at night, with respondents saying they think about work problems (33%) and money problems (24%), but also about "unsatisfying sexual life" (22%) and "family tension" (19%).

"Basically, it appears that the main reason for insomnia is linked to life as a couple," the magazine said.

A secret love affair, or just the idea of having one, was greeted by 76% of women as the best remedy to wide-eyed nights.

"It makes it easier to put up with the indifference and lack of attention of a partner. Infidelity doesn't produce the same effects in men. It only makes things worse, adding stress and a feeling of guilt to the causes of sleeplessness," according to the magazine.


Depression and Heart Bypass Surgery 


Friday, November 1, 2002

FRIDAY, Nov. 1 (HealthScoutNews) -- People who suffer from depression a month after they've had coronary artery bypass surgery are more likely to have angina (news - web sites) and other cardiac problems five years later.

Interestingly, this is particularly true of men, according to a new study in the November-December issue of the journal Psychosomatics.

The study included 172 people. They were given questionnaires that assessed their level of depression before they had coronary artery bypass grafting. They were interviewed again at one month, one year, and five years after their surgery.

At the end of the five years, the researchers were able to analyze data for 117 of the original 172 people.

They found that 32 percent of the people were depressed before they had surgery, 28 percent were depressed a month after surgery, 21 percent were depressed a year after surgery, and 16 percent were depressed five years after surgery.

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However, the researchers say that men who suffered from depression a month after the surgery were more likely than women to suffer chest pain five years later. The study found that five years after surgery, both depressed and non-depressed women had about the same, relatively high, level of chest pain.

The researchers say their findings suggest a way to improve long-term results for people who have coronary artery bypass surgery. These patients could be evaluated for depression a month after their surgery and given treatment if they are suffering from depression.

More information

Columbia University has a Web site for people who have undergone heart surgery.


Genital Herpes Infection Could Skyrocket 

Reuters Health

Friday, November 1, 2002

NEW YORK (Reuters Health) - By the year 2025, if no preventive steps are taken, as many as 40% of men and 50% of women aged 15 to 39 in the US could be infected with genital herpes, according to a mathematical model developed by public health experts.

Herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus (HSV). HSV type-1 commonly causes fever blisters on the mouth or face, and is typically known as oral herpes, while HSV type-2 affects the genital area and is called genital herpes.

Currently, experts believe that about 22% of US adults are infected with genital herpes, the most common cause of ulcerative genital disease in the United States, according to the report in the October issue of the journal Sexually Transmitted Diseases.

Genital herpes can be spread with or without the presence of symptoms like open sores, and most people are diagnosed long after becoming infected.

In the new report, Dr. David N. Fisman of McMaster University in Hamilton, Ontario, Canada and colleagues describe a mathematical model they created to estimate the future US prevalence of HSV-2 infection.

They predict that "without intervention, the prevalence of HSV-2 infection among individuals aged 15 to 39 years was projected to increase to 39% among men and 49% among women by 2025."

In addition, the annual cost of new infections could rise from $1.8 billion in 2000 to $2.7 billion in 2025, the report indicates.

Nonetheless, "any prophecy of the future epidemiology of an infectious disease needs to be interpreted with caution," Fisman and colleagues point out.

In an effort to stem the spread of HSV-2, a variety of public health interventions are currently being formulated, the authors note. These include screening with blood tests to identify people who are infected but don't have symptoms, along with programs to increase condom usage. Researchers are also developing drugs to suppress the virus and prevent viral shedding, as well as HSV-2 vaccines.

"Programs incorporating these new technologies are anticipated to be expensive," Fisman's team writes, "but in light of the large costs that the HSV-2 epidemic is projected to impose, such programs may prove to be cost-effective or cost-saving."

Source: Sexually Transmitted Diseases 2002;29:608-620.


Hospital Medicare Payments to Rise  

By Janelle Carter

Associated Press Writer

The Associated Press

Friday, November 1, 2002

WASHINGTON (AP) - Payments to hospitals that serve Medicare patients will increase next year, but doctors pressing Congress to reverse anticipated cuts will have to wait longer to learn their fate.

Payments for each hospital outpatient service will increase an average 3.7 percent, according to figures released Thursday by the Centers for Medicare and Medicaid Services. Rural hospitals will get slightly more.

In all, payments to hospitals for outpatient services are expected to be $18.7 billion in 2003, compared with $17.7 billion in 2002, the government said.

The increase is part of a transition to a new payment system that took effect two years ago, whereby hospitals are paid specific, predetermined rates for outpatient services. Before, as hospital charges rose, a beneficiary's copayments did too.

Congress wrote the new payment system in 1999 to help bring down the costs for beneficiaries, who were often paying up to 50 percent in copayments. The new payment system gradually bring those beneficiary costs down to 20 percent of charges.

Government officials said the data on doctor payments, which is calculated under a different formula from hospitals, was delayed because analysts are reviewing payments to anesthesiologists.

Doctors have lobbied Congress for more money, saying the current Medicare payment formula relies on the state of the economy, which is now struggling.

Physicians have taken a 5.4 percent cut and are facing an additional 12 percent reduction, equaling about $11 billion, over the next three years, according to the American Medical Association.

Lawmakers on both sides have said they want to address the doctor payment problem, and negotiations are under way to try to pass a bill when Congress returns after the elections.

AMA President Dr. Yank Coble said the government was right to delay announcing the payments.

"It is critical that Medicare officials get it right," Coble said. "Physician practices have reached their breaking point."

The government also established guidelines to begin covering drug-eluting stents once they gain approval from the Food and Drug Administration (news - web sites). Drug-eluting stents are metal devices that prop open clogged arteries. They are coated with drugs to help prevent re-clogging. They are expected to be widely used by hospitals once they are approved.

The ruling also includes higher Medicare payments for mammography exams and colonoscopies.

The payment changes are being published Friday's Federal Register but do not take effect until January.

On the Net:

Centers for Medicare and Medicaid Services:


New Function Discovered for Breast Cancer Gene 

By Alison McCook

Reuters Health

Friday, November 1, 2002

NEW YORK (Reuters Health) - Researchers know that women who carry a defective copy of the BRCA1 gene have a higher-than-average risk of developing breast and ovarian cancer. And they have also long suspected that BRCA1 normally has a role in repairing damaged DNA and cells that lose the ability are more likely to become cancerous.

Now, a surprising new study suggests that BRCA1 also plays a role in a body process that appears to be totally unrelated to cancer. How these findings will help researchers understand more about the role of BRCA1 in that disease remains unclear, but Dr. Robert Weinberg of Massachusetts Institute of Technology (news - web sites) in Boston told Reuters Health that many great discoveries originate from seemingly surprising findings.

"We thought we understood what BRCA1 is doing, and now we understand that we don't really understand what it does," he said.

In the new study, published in the November 1st issue of the journal Cell, Dr. David M. Livingston of The Dana-Farber Cancer Institute in Boston and colleagues report that BRCA1 may play a role in how a woman's genetic information is expressed.

Weinberg, who was not involved in the study, explained that girls are born with the sex chromosomes XX, while boys have XY. In principle, for every gene on the X chromosome, girls have two copies, while boys have only one. In order to equalize the sexes, Weinberg said, the body undergoes a process of so-called "inactivation" of one of the girl's X chromosomes, during which one of her X chromosomes becomes "shut-down."

In the current study, Livingston's team found that a defect in the BRCA1 gene may also lead to a defect in the inactivation of one of a female's X chromosomes. During the study, the investigators found that cancer cells extracted from women that contain defective BRCA1 also show changes in the normal structure of the inactivated X chromosome. Furthermore, the researchers demonstrated that inhibiting a normal copy of BRCA1 increases the likelihood that a gene located on the inactive X chromosome will become activated.

The effect of having two functional--or one functional and one semi-functional--X chromosome remains unclear, Weinberg noted. "It's a very unusual biological situation," he said. Cells that contain two activated X chromosomes will also likely contain higher than the normal number of activated genes, a scenario that could potentially encourage the growth of breast cancer (news - web sites) cells.

Dr. Bruce Stillman of Cold Spring Harbor Laboratory in New York told Reuters Health that the discovery in the current study "opens up a door that we never even thought of before."

Although it is too early to say how this new information about BRCA1 will help, Stillman speculated that it could be used to develop new ways to diagnose or even treat breast cancer.

"It's an interesting finding, and it raises a bunch of issues, which is what basic science does," he said.

Source: Cell 2002;111:393-405.


Prayer May Heal Depression 


Friday, November 1, 2002

FRIDAY, Nov. 1 (HealthScoutNews) -- It seems prayer really may have the power to heal.

Moderate levels of prayer and other types of religious coping may help combat depression among spouses of people with lung cancer, says a study in the November-December issue of Psychosomatics.

The study included 156 spouses of people with various stages of lung cancer. The spouses were 26 to 85 years old (mean age 63.9 years), and 78 percent of them were women. Researchers assessed the spouses' levels of religious coping and depression, along with their sense of control over events and level of social support.

The researchers define religious coping as a person's use of religious beliefs or practices to manage stressful life events. Religious coping includes prayer, drawing comfort from faith, and having support from church members.

The study found that spouses who used moderate levels of religious coping were less depressed than spouses who used lower or higher levels of religious coping.

The connection between depression and high levels of religious coping may reflect an over-reliance on less adaptive religious coping strategies and neglect of other important coping strategies, the researchers say. They also say that spouses who feel the most desperate may be more likely to turn to religion for comfort. That means those people may already be depressed before they begin using religious coping.

More information

Learn more about coping with cancer at the National Cancer Institute.


Americans May Be More Image-Obsessed Than Germans 

Reuters Health

Friday, November 1, 2002

NEW YORK (Reuters Health) - American college students are more likely than German students to be overly concerned about their appearance and their body image, new study findings show.

"Our findings are consistent with prior findings that Americans are more likely to be concerned with their appearance and to place greater value on physical attractiveness in their judgement of others than do individuals of other cultures (such as Asians or Germans)," write lead study author Antje Bohne of Massachusetts General Hospital in Boston and colleagues.

Still, the American students were not more likely than their German peers to suffer from psychological illness associated with those body concerns, the report indicates.

The findings are based on survey responses from 101 American students aged 17 to 29 and 133 German students 19 to 37 years old.

Altogether, roughly three out of every four American students expressed concerns about their appearance, in comparison to less than half (46.6%) of the German students, the investigators report in the November-December issue of the journal Psychosomatics.

Further, nearly 30% of the Americans were preoccupied with concerns about their appearance, in comparison to just 15% of the Germans.

Yet, those concerns did not seem to put the American students at a higher risk for body dysmorphic disorder, which appeared to affect both groups in similar proportions, the investigators found.

Body dysmorphic disorder is characterized by excessive concerns about slight defects--either real or imagined--in one's appearance, which causes great distress or impairment in everyday functioning. To satisfy the criteria for that disorder, a person's concerns about their appearance cannot be accounted for by an eating disorder or any other mental health condition.

Overall, 5% of the German students and 4% of the American students seemed to have body dysmorphic disorder.

The American and German students also had similar levels of self-esteem and anxiety, and neither group exhibited a higher level of obsessive-compulsive symptoms than the other.

"Thus, although Americans were more likely to develop body image concerns and to be preoccupied with them than their German counterparts, in many cases, these symptoms were not severe enough to cause significant distress or impairment in daily functioning," the authors write.

Source: Psychosomatics 2002;43.


Selenium May Cut Bladder Cancer Risk in Ex-Smokers 

By Serena Gordon
HealthScoutNews Reporter


Friday, November 1, 2002

FRIDAY, Nov. 1 (HealthScoutNews) -- If you're a former smoker and want to protect yourself against bladder cancer, you might want to include selenium-rich foods in your diet.

A new study, published in the November issue of Cancer Epidemiology, Biomarkers and Prevention, found that ex-smokers who had high levels of selenium had a decreased risk of bladder cancer.

This effect didn't hold true for current smokers or non-smokers. The study authors suggest this is because non-smokers have not exposed their bodies to the same oxidative stress that former smokers have, and current smokers are overwhelming any positive effects from selenium due to the toxic chemicals found in tobacco.

Selenium is an essential trace mineral and antioxidant. It helps keep the immune system and the thyroid gland working properly. It is found in plant foods, meat, fish, cereal, dairy products, eggs and some nuts, particularly Brazil nuts. The selenium content of food varies, depending on how much selenium is present in the soil the food is grown in.

Selenium deficiency is unusual in the United States, but not so in other parts of the world. In places such as China and Russia, where the selenium content of the soil is low, selenium deficiency is more common. The recommended daily intake of selenium is around 55 micrograms. Doses higher than 400 micrograms daily could lead to side effects such as gastrointestinal problems, hair loss and mild nerve damage, according to the National Institutes of Health (news - web sites).

More than 50,000 Americans are diagnosed with bladder cancer every year, according to the National Cancer Institute (news - web sites). Worldwide, about 200,000 new cases occur annually, reports the study. Those at greatest risk for the disease include smokers, males, people over 40, whites and people who work with chemicals.

For the new study, researchers in the Netherlands studied data on more than 3,000 men and women who had participated in the larger Netherlands Cohort Study. The average age of the study volunteers was between 55 and 69 at the start of the study. Just over 400 of those studied developed bladder cancer during the six years of research.

All of the participants completed a questionnaire that helped the researchers assess and control for other possible cancer risk factors, such as alcohol use, diet, chemical exposure and a family history of bladder cancer. The volunteers also provided a toenail clipping, because analysis of toenail clippings gave the researchers an estimate of the average selenium intake during a year.

People who had at least 30 percent more selenium in their toenails had a slightly decreased risk of bladder cancer. However, the decrease in risk was greatest for ex-smokers. The researchers also found that higher selenium levels only seemed to affect invasive forms of bladder cancer.

None of the other known antioxidants, such as vitamin C, E and beta carotene, appeared to have any effect on bladder cancer rates in the study.

Commenting on the study, nutritionist Samantha Heller of New York University Medical Center says one possible reason smokers don't seem to get any benefit from selenium is that smoking might be depleting the mineral in their bodies.

She adds that if you want to prevent bladder and other cancers, supplementing with selenium isn't the answer.

"All of these healthy things work together as a team," Heller explains. So, if you supplement with selenium and a couple of other vitamins, you could still be missing out on essential nutrients. "It's like trying to play in the World Series (news - web sites) without a pitcher or a third baseman," she adds.

The key, she says, is keeping everything in balance. That means stop smoking and start eating a balanced diet that includes lots of vegetables, nuts and legumes, Heller says.

The authors of the study conclude that more research needs to be done, and they don't recommend taking selenium supplements until more conclusive proof of its benefits is available.

What To Do

For more information on bladder cancer, visit the National Cancer Institute. To learn more about selenium, check with the National Institutes of Health or the University of Texas Health Science Center at Houston.


Fibroid Procedure May Complicate Pregnancy 

Reuters Health

Friday, November 1, 2002

NEW YORK (Reuters Health) - Uterine artery embolization (UAE), a procedure used to shrink benign uterine tumors called fibroids, may cause complications in women who later become pregnant, researchers report.

Uterine fibroids can cause excessive menstrual bleeding, pelvic pain and frequent urination. The tumors occur in about 25% of all women and are the leading cause of hysterectomy, or removal of the uterus, in the US.

UAE is a minimally invasive treatment that usually requires an overnight stay in the hospital. The procedure involves inserting catheters into the arteries that supply blood to the uterus and injecting materials to permanently block these blood vessels.

According to the new analysis of 50 case studies, women who became pregnant after UAE may be at increased risk of miscarriage, breech presentation, cesarean section or preterm delivery and postpartum hemorrhage. The findings are published in the November issue of Obstetrics and Gynecology.

"Before uterine artery embolization can be regarded as a safe procedure for women desiring future fertility, as it is now commonly being directly marketed to the public, additional studies must be performed," Dr. Jay Goldberg from Jefferson Medical College in Philadelphia told Reuters Health.

In an analysis of all 50 published cases of pregnancy after UAE, Goldberg and colleagues found that 22% resulted in miscarriage and 17% were affected by malpresentation, such as breech birth. In addition, 28% of women delivered prematurely, 7% delivered small for gestational age infants, 58% delivered by cesarean section and 13% had postpartum hemorrhage.

Except for the number of small for gestational age infants, the rates of all complications were significantly higher than rates reported for women who have not undergone UAE, the authors note in the paper.

"These findings were surprising to me," Goldberg told Reuters Health. "I did not expect the complication rate to be as high as calculated. I did, however, expect there to be an increased rate of growth-restricted babies, but this was not found."

Goldberg and colleagues conclude that future studies must be performed before the procedure can be considered safe for women who plan to become pregnant in the future.

Source: Obstetrics and Gynecology 2002;100.


FDA Approves Nicotine Lozenge  

The Associated Press

Friday, November 1, 2002

WASHINGTON (AP) - Smokers trying to quit will soon be able to try a nicotine-containing lozenge to help reduce their cigarette cravings.

The Food and Drug Administration (news - web sites) approved GlaxoSmithKline's Commit lozenge for over-the-counter sales Thursday. It marks the first nicotine-containing lozenge to win the agency's approval.

The FDA last spring forced off the market nicotine lollipops that a number of pharmacists were manufacturing as an alternative to nicotine patches or gum for smoking cessation. The FDA has maintained that smoking cessation products are drugs that require its approval to sell.

Another company, Star Scientific, sells a lozenge made of compressed tobacco that delivers a dose of nicotine equal to a cigarette. Because that product is sold not for smoking cessation but as an alternative to cigarettes when smokers can't puff — such as during an airplane flight — it argues the FDA can't regulate the product. At the request of attorneys general of 42 states, the FDA is reviewing that issue.

Glaxo's Commit lozenges come in varying amounts of nicotine. How long a smoker goes between cigarettes determines the recommended strength. Suck a lozenge when a craving hits, gradually lowering the number and strength ingested over a 12-week weaning period, the company says.

The lozenges, available without a prescription, will be available next month, in 72-lozenge packs for $39.95.


Folic Acid May Help Prevent Pregnancy Complication 

By Alison McCook

Reuters Health

Friday, November 1, 2002 

NEW YORK (Reuters Health) - Women who take supplemental folic acid appear to be almost half as likely as others to develop high blood pressure during each month of pregnancy, according to new study findings.

High blood pressure during pregnancy can be a symptom of preeclampsia, a condition also marked by swelling, visual changes and other symptoms. The complication affects as many as 1 in 10 first pregnancies. If left untreated, preeclampsia can develop into eclampsia, a life-threatening condition in which a woman has convulsive seizures in late pregnancy or during the first week after delivery.

The reduced risk of high blood pressure was seen in women who took multivitamins that contain folic acid during their pregnancy. The authors, led by Dr. Sonia Hernandez-Diaz of Boston University School of Public Health in Massachusetts admit that they cannot be sure that the protective effect stems from folic acid, and not some other ingredient in the multivitamin.

However, Hernandez-Diaz told Reuters Health in an interview that, biologically, it makes sense that folic acid might combat high blood pressure in pregnancy: previous studies have shown that folic acid can help reduce levels of the substance homocysteine, high levels of which are often linked to preeclampsia.

Doctors have long encouraged women to take supplements with folic acid before conceiving and during the first trimester of pregnancy in order to prevent certain birth defects. Hernandez-Diaz noted that the current study findings, if validated by further research, might extend the time during which women should take the supplement.

"Then we will have to recommend folic acid during the whole pregnancy, and not just in the first trimester," she said.

In their study, the investigators discovered the relationship between folic acid and high blood pressure in pregnancy from surveys of more than 2,000 women conducted no later than 6 months after they delivered their babies. The mothers were asked if they took multivitamins containing folic acid or folic acid supplements alone starting 2 months before conceiving, and throughout the entire pregnancy.

Almost 10% of the women included in the study said they had been diagnosed with high blood pressure at least 20 weeks into their pregnancies. However, during each month of pregnancy, those who took supplements that contained folic acid appeared to be 45% less likely than those who didn't to develop high blood pressure.

The authors, who report their findings in the November issue of the American Journal of Epidemiology, write that these results suggest that folic acid may lower blood pressure in non-pregnant women as well. Women who develop preeclampsia during a first pregnancy often have heart disease later in life, they note, and increased levels of homocysteine have also been linked to stroke and heart attacks in non-pregnant adults.

Researchers are currently debating the value of folic acid in non-pregnant adults, and in women who do not plan to become pregnant, for preventing high blood pressure. Although the current study did not measure whether the supplement helps prevent high blood pressure in that group, Hernandez-Diaz told Reuters Health that "indirectly, it may support that hypothesis."

Source: American Journal of Epidemiology 2002;156:806-812.


Can a Used Mattress Cause SIDS? 

By Ed Edelson
HealthScoutNews Reporter


Friday, November 1, 2002

FRIDAY, Nov. 1 (HealthScoutNews) -- A baby who sleeps on a mattress that was used by another child may be at increased risk of Sudden Infant Death Syndrome (SIDS), a Scottish study finds.

"Insufficient evidence is available to judge whether this relationship is cause and effect," say the authors of the study, which appears in tomorrow's issue of the British Medical Journal.

And an American pediatrician says the findings should be viewed with skepticism.

However, the researcher who led the study says there's a strong suspicion that previously used infant mattresses can be breeding grounds for dangerous bacteria. And those germs could contribute to an infection that might be tied to SIDS.

"Saliva basically sits in the foam block and builds up," says Dr. David Tappin, a senior lecturer in pediatrics at the Hospital for Sick Children in Glasgow. "We feel that bacteria can remain in the mattress for a long time. And a mattress can provide a good culture medium for other bacteria."

The study compared 131 babies who died of SIDS in Scotland between 1996 and 2000, and 278 healthy infants. It was based on a questionnaire that controlled for the effects of socioeconomic status and other factors that could affect the risk of sudden infant death.

Overall, there was a threefold increase in SIDS deaths associated with a used infant mattress. A more detailed analysis of the questionnaires found that the risk was greatest if the mattress came from another home, the study says.

This is the second study to show an association between a used mattress and SIDS, Tappin says. He was involved in the previous study, which was published in 1997.

"If you find something like this, you want to repeat it to show the finding was not due to chance," he says. "We've done that and found the same potential risk factor."

Research to determine whether virulent bacteria can thrive in used mattresses is being done at the University of Leicester in England, but the results are not yet available, Tappin says.

Dr. Michael H. Malloy is a professor of pediatrics at the University of Texas Medical Branch in Galveston and a spokesman for the American Academy of Pediatrics. He says he's cautious about the study's conclusion because data in the study indicate that factors other than a used mattress could be to blame for the SIDS deaths.

"The authors say they controlled for socioeconomic status. But if you look at the distribution [of the deaths], there is no question that the cases [deaths] were in a more deprived group than the controls [the healthy infants]," Malloy says.

While the Scottish researchers made a diligent effort to account for all factors that might affect SIDS risk, Malloy says, "it is possible that they were not able to completely do away with the bias. If the cases [deaths] were in a more deprived group, the likelihood of a higher risk is not terribly surprising."

Malloy says parents should concentrate on practices that have clearly been shown to help prevent SIDS, such as not allowing infants to sleep face down, but rather on their back.

"My advice would be to provide the infant with a firm mattress, put it [the infant] in a supine position to sleep, use no quilts or bulky pillows, refrain from smoking and breast-feed," Malloy says.

What To Do

For more information about the risk factors for SIDS and how to avoid them, visit the American Academy of Pediatrics. To learn more about SIDS, check with the American SIDS Institute.


Many Gene Research Consent Forms Misleading: Study 

By Vicki Brower

Reuters Health

Friday, November 1, 2002

BALTIMORE (Reuters Health) - Informed consent forms now in use may confuse people participating in gene transfer research experiments about what they can expect from the experimental procedure, according to preliminary results of a new study.

Dr. Nancy M.P. King told attendees at the American Society of Bioethics and the Medical Humanities' annual meeting here that investigators and institutional review boards (IRBs) still have a way to go to make the forms less vague and confusing, and eradicate the misconception that such experiments have therapeutic value. King, a professor of social medicine at the University of North Carolina at Chapel Hill, is a former member of the Recombinant DNA Advisory Committee.

King and colleagues found that important information about risks, a blurring of the distinction between research and treatment, and the use of inconsistent or contradictory terminology are some of the main problems in consent forms currently in use. The researchers examined consent forms for 322 gene transfer trials conducted between 1990 and 2000.

Ironically, "gene transfer trials' consent forms may actually be among the best because they are subject to higher levels of scrutiny than other clinical trials," King said.

The study, begun soon after the gene therapy death of Jesse Gelsinger in September 1999, recommends a number of simple changes to the consent form "to tighten up terminology to more accurately reflect that all gene transfer trials are still experimental and not proven treatments," King told Reuters Health.

While there has been research into what people think about the potential benefits of participating in experimental trials, little attention has been paid to what the consent forms they sign say about the benefits of research for them.

"Unless we are certain of the information that consent forms actually contain, we cannot conclude that they don't influence people's beliefs about research, or their decisions about participating in research," King said. She noted that the study's goal was to move beyond critiques of the informed consent process and improve it so that expectations of both patients and investigators are more realistic.

"Gene transfer research consent forms need to find good terms and descriptions to explain unfamiliar concepts," King said. Language should be chosen carefully to avoid promoting the notion that experimental research will be therapeutic, and that the subject is a patient in the trial. Language should be adapted to each trial, but in general, should convey explicitly that "this medical research project is not expected to benefit you," King said. Words such as "treat" and "treatment" should also be avoided, she added.

Over half of the trials the group examined were early-stage, or Phase I, trials, designed to determine an intervention's safety, not its effectiveness, and most involved cancer research. Only 1% of trials examined stated that "you will not benefit."


Blood Clots: What You Don't Know Can Kill You 

By Amanda Gardner
HealthScoutNews Reporter


Friday, November 1, 2002

FRIDAY, Nov. 1 (HealthScoutNews) -- Along with the public service signs denouncing smoking and promoting blood donations, the corridors of the Ochsner Clinic Foundation in New Orleans are now plastered with posters warning of two little-known dangers: Deep vein thrombosis and pulmonary embolisms.

It's part of a new initiative by health-care experts across the country to increase awareness about two conditions that are responsible for 10 percent of all hospital deaths each year.

Deep vein thrombosis (DVT) occurs when a blood clot forms in the leg and blocks the flow of blood. This can lead to potentially life-threatening pulmonary embolisms (PE), which is when a clot breaks free, travels north and lodges in a lung. If the clot is large enough, it can cause sudden death.

About 600,000 Americans develop pulmonary embolisms every year, and 200,000 people die from them. The American College of Chest Physicians says this may be the most preventable cause of hospital death.

Until now, DVT and PE have fallen through the cracks.

"Everybody assumes that someone else is going to be taking the lead on it and because no group 'owns' the condition, it wasn't happening," says Dr. Steven Deitelzweig, Ochsner's section head of hospital-based internal medicine.

Deitelzweig is spearheading the initiative at his clinic to raise the public profile of the problem, until now overshadowed by "celebrity" conditions such as stroke and heart attack.

However, he's not the only one. In February, a group of medical experts formed the Council for Leadership on Thrombosis (CLOT) Awareness and Management, which is sponsoring free screening programs at 185 hospitals nationwide. It has also established the ClotAlert Resource Center, which includes a Web site that provides information and services.

"There's a lot more now in the medical literature than ever before alerting physicians and other health-care providers about the risk of pulmonary embolism and deep vein thrombosis and, importantly, the effective ways that are available to prevent these conditions from occurring in the first place," says Dr. Samuel Goldhaber.

Goldhaber is co-chairman of CLOT, as well as director of the Venous Thromboembolism Research Group at Brigham and Women's Hospital in Boston and an associate professor of medicine at Harvard University Medical School.

People hospitalized for long periods of time are particularly at risk because blood can collect in the legs and increase the probability of a clot forming. Air travelers can also be prone to the condition -- in this case, dubbed "economy-class syndrome" -- thanks to long hours spent cramped in a seat, experts say.

Those with cancer, chronic heart or respiratory failure, inherited or acquired predisposition to clotting, and varicose veins also have an increased risk. So do people who are obese, as well as women who are pregnant or are taking birth control pills or hormone replacement therapy.

Symptoms of DVT can include leg pain, swelling, tenderness, discoloration or redness. Often, though, there are no symptoms.

"It's a very difficult diagnosis to make. Half of DVTs have no symptoms or signs and PE can mimic many other conditions such as heart attack or anxiety or pneumonia or heart failure," Goldhaber says.

"Unless you think about it as a diagnosis, it can be very difficult to make," he adds. "The lay public is not really aware of PE. You rarely have someone calling an ambulance and saying, 'I think he's having a PE.'"

Deitelzweig and his colleagues have developed a "clinical assessment tool" to help identify people at risk of DVT. The various risk factors -- obesity, heart failure, infections, lung problems, prolonged immobility -- are put on a grid and everyone admitted to the hospital is assessed and put in a category of low, medium or high risk.

"It's part of the intake," Deitelzweig says.

People with two risk factors get treated with non-pharmacological devices, such as compression stockings. If a person has three or more risk factors, or if he or she has two risk factors and has also had a stroke or cancer, they get at least one blood-thinning drug.

Ochsner also has a multidisciplinary "thrombosis consult services" unit, which can be sent anywhere in the hospital to provide a more specific assessment of a patient's risk.

There's no data yet on the effectiveness of the program, but "a member of the [services] team gets called every day now to help manage patients," Deitelzweig says. "Now, we have the structure and it appears to be working for us."

In addition to encouraging hospitals to develop programs for preventing blood clots, the CLOT group is also focusing on outpatient practices.

"These days, many of the patients who would traditionally be in the hospital are managed at home," Goldhaber says. "These patients may, ironically, be at an even greater risk because they're not getting the intensive physical therapy they might get in the hospital."

What To Do

For more information on the Council for Leadership on Thrombosis, visit Thrombosis Online or call 1-800-CLOT-FREE. For more on deep vein thrombosis, visit the University of Massachusetts Medical School.


Many Parents Lack Info About Hepatitis A: Survey 

By Charnicia E. Huggins

Reuters Health

Friday, November 1, 2002

NEW YORK (Reuters Health) - Many parents do not know much about hepatitis A, even though the infection is relatively common in children, according to new survey findings released this week by the American Liver Foundation.

Hepatitis A is a liver-infecting virus spread through contaminated food and water. It is rarely fatal and most often causes jaundice, a yellowing of the skin due to reduced liver function, and flu-like symptoms that can persist for weeks. Unlike other forms of hepatitis, such as hepatitis B and hepatitis C, it does not cause a chronic, lingering infection.

Symptoms in children are often nonexistent or unrecognizable. For example, symptoms such as fever and diarrhea are typical of many types of illnesses, and may not even warrant a doctor's visit. However, the infection tends to be more serious in adults.

According to Dr. Mitchell Shub, who is an associate professor at the University of Arizona College of Medicine, the "real issue" at hand is that although hepatitis A is primarily a childhood disease, "children become a great way of passing the disease on to adults and adults get really sick."

"This is a serious illness that we have the means to prevent," said Shub, who is also director of pediatric gastroenterology at Phoenix Children's Hospital in Arizona. "If we can target the patients that are most likely to spread it, we might be able to stop the disease in its tracks."

The findings are based on a nationwide telephone survey of 500 parents with children under the age of 18 years. A grant from GlaxoSmithKline funded the survey.

Most of the parents surveyed said they had heard of hepatitis B and hepatitis C, but only 55% were similarly familiar with hepatitis A, the findings indicate.

More than one quarter (27%) of the parents were not aware of how the disease is spread, namely via the fecal-oral route. Further, although many (52%) parents said they were concerned about their children contracting hepatitis A, only about half of the parents who were aware of the disease knew that a vaccine was available to prevent it.

"By effectively increasing awareness and understanding of this highly contagious liver disease, parents will be encouraged to vaccinate their children and themselves," Alan P. Brownstein, president of the American Liver Foundation said in a statement. "As a result, we will see a decrease in the number of reported hepatitis A cases in the country."

According to a recent study by researchers at the US Centers for Disease Control and Prevention (news - web sites) (CDC) in Atlanta, Georgia, a quarter of a million people in the US may become infected with hepatitis A every year and the majority of these cases may occur in children under the age of 10.

The CDC notes that improved sanitation and personal hygiene, such as washing the hands after using the toilet or changing a diaper, can help prevent transmission of the virus. A vaccine is available to people aged 2 and older, and the federal agency suggests that children who live in communities with higher-than-average hepatitis A rates be routinely vaccinated (20 or more cases per 100,000 population).

Most such communities are in the Western US. See for more information on hepatitis A and a breakdown of hepatitis A rates in various US regions.


Surgery Smarts 


Friday, November 1, 2002

(HealthScoutNews) --All surgery carries risks, so it's best to know as much as you can before hopping onto an operating table.

In addition to getting a second opinion, the U.S. Agency for Healthcare Research and Quality suggests you ask your physician these questions:

  • Why do I need the operation?
  • Are there alternatives to surgery?
  • How will surgery benefit me?
  • What are the risks?
  • What are the risks for not having the surgery?
  • How many of these operations have you performed before?
  • What kind of anesthesia will I need?
  • Where will the surgery be done?
  • How long will it take me to recover?
  • How much will it cost?


Mental Health System 'Dysfunctional': Panel

By Todd Zwillich

Reuters Health

Friday, November 1, 2002

WASHINGTON (Reuters Health) - America's system for treating and rehabilitating people with mental illness is in financial and bureaucratic disarray and is plagued by complexities that make it nearly impossible for many patients to receive needed care, according to a report issued Friday by a presidential mental health commission.

The commission's chairman, who called the report an "indictment" of the nation's mental health care system, said that a massive shift in priorities was needed to improve care for mentally ill adults and children. The report paints a picture of a system plagued by fragmented services and inadequate funding, often losing patients in a maze of complexity.

Between 5% and 7% of Americans are believed to suffer from a serious mental illness in any given year, according to federal figures. While some patients have private insurance coverage, most receive care through a patchwork of federal and state programs.

The report is an interim step for the New Freedom Initiative, a comprehensive review of the nation's mental health system ordered by President Bush (news - web sites) last April. It was written by a panel of policy experts from the government and the private sector, who are later expected to recommend ways to repair the system.

Dr. Michael Hogan, the commission's chair, said that the panel's deliberations lead it to conclude that the nation's mental health delivery system is "maddeningly complex and dysfunctional."

The report criticizes child mental health systems that often cut adolescents' benefits as soon as they turn 18, forcing them to navigate a new system of care geared toward adults.

Adults with a combination of mental illness and drug or alcohol abuse, which according to the government number 3 million, often cannot get care for both problems in the same clinic or with the same government benefits.

"Because mental illness and substance abuse disorders are often long-term in nature, the inconsistencies of the system play out day-to-day, week-to-week, and year-to-year," the report states.

The commission also pointed to studies showing that mental illness and substance abuse are the two leading causes of disability in North America and Europe, together accounting for more than one third of all claims. But disabled--and usually unemployed--persons who seek care in the US often risk their Medicaid healthcare benefits if they get well enough to rejoin the work force.

"They can't afford to get back to work because they lose their health insurance. We have trapped people in a system that is at least as dysfunctional as the old welfare system," said Hogan, who is the director of the Ohio Department of Mental Health.

Hogan made an example of the problem of suicide, which takes the lives of approximately 30,000 Americans each year, twice the number that die annually from AIDS (news - web sites).

Serious mental illness is implicated in upwards of 90% of all suicide cases, though the government spends some $3.2 billion per year on AIDS research and prevention and only about $40 million studying suicide, he said.

The commission is due to release a final report within 6 months giving the president recommendations on how to repair the mental health system.

The American Psychiatric Association released a statement criticizing the effort, saying that the commission has "unreasonably limited" its evaluation of the mental health care delivery system to budget-neutral solutions and did not look at disparities in privately funded insurance.

"The public at large, the media, opinion makers, and political leaders must be made aware of the perilous state of financing for mental health care today," read a statement from Dr. Paul Appelbaum, the organization's president.


Aging Feet


Friday, November 1, 2002

(HealthScoutNews) -- As your feet grow older, they develop more problems. Wearing the right shoes will help prevent many foot woes.

The National Institute on Aging offers these tips for buying shoes that fit properly:

  • Your foot size changes as you age so always have your feet measured before buying shoes.
  • Shop for shoes at the end of the day when your feet are their largest.
  • How the shoe feels on your foot, not the size marked on the sole, is your best guide.
  • Choose shoes shaped like your foot.
  • Stand up in the shoes you're trying on.
  • There should be 3/8" to 1/2" space for your longest toe.
  • Your heel shouldn't ride up and down in the shoe when you walk.
  • Don't buy a pair that is too tight with the hope that they'll stretch.


FDA Issues Caution Regarding Use of Bone Cement

Reuters Health

Friday, November 1, 2002

WASHINGTON (Reuters Health) - The US Food and Drug Administration (news - web sites) (FDA) has issued a caution concerning the use of a type of bone cement to treat osteoporosis-related fractures of the spine during procedures known as vertebroplasty and kyphoplasty.

The agency said in a statement that there have been reports both to the FDA and in the published literature linking complications to leakage of polymethylmethacrylate cement. Complications include soft-tissue damage and nerve-root pain and compression.

Other reported problems include blood clots in the lungs, respiratory and cardiac failure, and death, according to the FDA.

In vertebroplasty, the bone cement is injected into fractured vertebrae to stabilize it and prevent further collapse. In kyphoplasty, a surgical instrument is used to expand the space between the vertebra. The space is then filled with bone cement.

The long-term safety and efficacy of the use of polymethylmethacrylate bone cement in these specific procedures has not been tested in prospective, randomized, controlled trials, the FDA said.

The agency also noted that the procedures involve modifications to the cement that have not been well studied and for which standardized formulations and safety guidelines do not exist.

"FDA is currently working with appropriate professional organizations and manufacturers of orthopedic devices to consider the regulatory options available to evaluate the long-term safety and effectiveness of bone cement in vertebroplasty and kyphoplasty procedures," the agency said.

In the meantime, the FDA's statement advises surgeons "to be aware of considerations and recommendations regarding patient selection, vertebroplasty and kyphoplasty techniques, complications, and patient monitoring described in the literature when considering these procedures to treat osteoporotic compression fractures of the spine."

The FDA listed a dozen medical journal citations regarding the issue.

A full copy of the FDA notice can be obtained on the agency's Web site at


Region, Not Race, Key In Cancer Screening

By Jennifer Thomas
HealthScoutNews Reporter


Friday, November 1, 2002

FRIDAY, Nov. 1 (HealthScoutNews) --When it comes to cancer screening, the region where you live is more important than your race in determining whether you'll get the tests done, new research says.

Residents of the rural Southern United States were less likely to get important screening tests for colorectal or breast cancer (news - web sites) than people who lived in small towns or suburbia.

The regional disparities in cancer screening were more pronounced than racial disparities between whites and blacks, according to the study appearing in the Nov. 15 issue of the journal Cancer.

"The take-home message underscores the need for continued efforts to make sure adults in the rural South receive educational messages, outreach and provider recommendations about the importance of routine cancer screening," says Steven Coughlin, lead author of the study and an epidemiologist at the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC).

Still, racial disparities in cancer screening do persist, Coughlin adds.

The rural South includes certain counties in the 11 historically impoverished states that range contiguously from Virginia to Florida to Texas.

Researchers used data from the CDC's Behavioral Risk Factor Surveillance System, a telephone survey that collected health information on nearly 6,000 U.S. residents nationwide from 1997 to 2000.

Researchers found 69 percent of white women and 66 percent of black women in rural southern U.S. counties had a mammography for breast cancer screening in the past two years.

About 75 percent of whites and blacks who lived in non-rural counties of the South had mammographies.

Even more striking was the regional differences in colorectal cancer screening. Federal government guidelines say men and women over age 50 should have a fecal occult blood test (to test for blood in the stool) yearly and a sigmoidoscopy or colonoscopy every five years. People at high risk of the disease due to family history or a history of polyps should have those tests more often.

In the rural South, 38 percent of white women and 29 percent of black women said they had a flexible sigmoidoscopy or colonoscopy at least once. In non-rural counties of the South, 44 percent of whites and 37 percent of blacks had the test.

About 45 percent of white women and 43 percent of black women had the screenings throughout the United States.

The same pattern held true for fecal occult blood test. Women in the rural South were the least likely of anyone to have that test done.

Men in the rural South, particularly black men, were also the least likely to get tested for colorectal cancer. When asked if they'd ever had a fecal occult blood test, only about 28 percent of white men and 22 percent of black men said "yes."

In the remainder of the United States, about 37 percent of white men and 36 percent of black men had at least fecal occult blood test.

Steve Wilhide, executive director of the National Rural Health Association, says the findings don't surprise him.

There are many barriers to health care in the rural South, he says, from no health insurance or inadequate health insurance to a mistrust of modern medicine.

"There are much higher concentrations of poverty in these regions, and there is a direct correlation between all kinds of chronic disease and poverty," Wilhide says.

Rosemary McKenzie, minority affairs director for the association, says cultural barriers also contribute. Many people believe the only time you go to the doctor is when you're very, very ill and all other home remedies have failed, she explains.

Cancer in particular is seen as a death sentence. "They think, 'I'm going to die anyway so I don't want to know that I have it,'" McKenzie says.

"Especially in the deep South, you have people that are illiterate. Some don't believe in modern medicine. They believe in a lot of old folk home remedies. Providers have to take the religious and cultural factors into account or I don't think we're going to make a dent."

Educational efforts to teach people about the importance of early cancer detection are important, Wilhide says, but so is funding for free or low-cost screenings.

"Doing preventive health education is important, but it can be like having a library card and no books in the library," he says. "If people can't afford the health care, they're not going to get it."

What To Do

To read more about rural health care issues, visit the National Rural Health Association. Or read more about colorectal or breast cancer at the American Cancer Society (news - web sites).


Being Fit Doesn't Cancel Out Risks of Excess Fat

By Jacqueline Stenson

Reuters Health

Friday, November 1, 2002

NEW YORK (Reuters Health) - As long as you're fit, does it matter if you're carrying around excess fat? It's the subject of ongoing debate among health experts. Now a new study says that weight matters, even if you put in time at the gym.

Regular exercise does not cancel out all the health risks of being overweight, according to study results in the TK issue of the American Journal of Epidemiology. It's the normal-weight people who are in shape who can expect to live the longest.

"It is important not to be overweight, but it also important to be fit," said study author Dr. June Stevens, a professor of nutrition and epidemiology at the University of North Carolina in Chapel Hill. "Just being slender is not enough. Just being fit is not enough. In order to enjoy the best life expectancy, you need to be both."

The new findings are based on data from 2,506 women and 2,860 men in eight U.S. cities who participated in a study that began in 1972, when their average age was about 45. At baseline, subjects had their fitness levels assessed by treadmill tests and their body mass index -- a standardized measure that takes into account height and weight -- calculated. Subjects were grouped into the following categories: fit, not fit, fat and not fat. They were followed until 1998.

In both women and men, the unfit-fat group faced the greatest risk of death. But while exercise helped boost longevity in the overweight group, it did not erase all the negative effects of the excess weight. Likewise, people who were thin but unfit also faced a shortened life span, results showed.

Compared with the fit-not fat women, the increased risk of death was 32% among the fit-fat women, 30% among the unfit-not fat women and 57% in the unfit-fat women.

Similarly, compared with the fit-not fat men, the increased risk of death was 25% among the fit-fat men, 44% in the unfit-not fat men and 49% in the unfit-fat group.

The investigators took into account age, cigarette use and other factors that may have influenced the results.

The findings underscore the importance of both maintaining a healthy weight and getting regular exercise, Stevens said. But for people who exercise regularly yet still can't seem to shed those extra pounds, don't give up. "Keep exercising," she said. "And if you can't lose weight, work hard not to gain weight."

Source: American Journal of Epidemiology 2002;156:832-841.


Natural Hormone Leads to Less Bleeding

By Amanda Gardner
HealthScoutNews Reporter


Friday, November 1, 2002

FRIDAY, Nov. 1 (HealthScoutNews) -- Women taking natural progesterone have far less bleeding than women taking a synthetic version of the same hormone, new research finds.

Not only does this vastly improve the quality of life for postmenopausal women, it may also have far-reaching implications for the future of hormone replacement therapy (HRT).

Excessive bleeding is cited as a prime reason why many women choose to discontinue hormone therapy. HRT, which protects against cancer of the uterine lining in women who have gone through menopause, has been a particularly hot issue since the U.S. government halted a large trial earlier this year. The trial was stopped after it was discovered that women on one kind of HRT had a higher incidence of breast cancer (news - web sites), heart attack and stroke.

What many accounts of that episode failed to mention, however, is that the progesterone used in that trial -- medroxyprogesterone acetate, or MPA -- is only one type of progesterone available.

The current research, from the Postmenopausal Estrogen/Progesterone Interventions (PEPI) study, appears in the November issue of the Journal of Obstetrics and Gynecology. In it, researchers used micronized progesterone (MP), which is chemically identical to naturally produced progesterone.

"MP is really the same hormone as that a woman makes herself before menopause," says study author Dr. Robert D. Langer, a professor of family and preventive medicine at the University of California, San Diego, School of Medicine. "It is chemically identical in all respects to the progesterone that the woman makes herself."

MPA, on the other hand, is a synthetic version of the hormone that is 35 times stronger than natural progesterone. Because the MPA was so strong, it essentially nullified the beneficial effects provided by the estrogen. So far, all indications are that MP would not have the same negative effect.

The current study looked at 875 women at seven sites around the United States over a three-year-period. The women, all 45 to 64 years of age, were divided into five groups: one that took a placebo; one that got estrogen alone; one that took estrogen plus a continuous (taken throughout the month) form of MPA; one that got estrogen plus a cyclical (taken for the first 12 days of a 28-day cycle) form of MPA; and one that took estrogen plus a cyclical form of MP.

When the results were tallied, the women taking micronized progesterone had fewer days of bleeding and less intense bleeding than women taking traditional MPA. The MP was just as good in protecting against endometrial cancer.

"MP was as effective for endometrial protection as any other of the other combinations so that was all fine across the board, but the number of bleeding problems was strikingly lower with MP," Langer says. And the MP had another benefit: Bleeding was also unexpectedly less in the crucial first six months of therapy, the time when most women decide whether or not to continue treatment. That effect carried through the next two-and-a-half years.

"It's a quality-of-life issue, and what's more important than the menstrual flow is getting caught by surprise. That's the big issue," says Dr. Philip Sarrel, professor emeritus of obstetrics and gynecology and psychiatry at Yale University School of Medicine. "If a woman is getting progesterone the first 12 days of each calendar month, she can expect that if she's going to get bleeding, it will happen on the 11th through 15th day like clockwork. It's not going to be 'unscheduled bleeding.' That's the problem we want to avoid. It really is an issue of what is going to work best in the life of a woman."

The results also add to a growing body of evidence that MP might be a good replacement for MPA, and that the halting of the trail earlier this year might not have sounded the death knell for HRT. In fact, earlier research from the PEPI study is the reason why MP was approved by the U.S. Food and Drug Administration (news - web sites) in the first place. In that initial trial, MP was shown to have the same effect on HDL or "good" cholesterol as estrogen by itself.

"It's my contention that MP could be used more easily. I think Women's Health Initiative results said that MPA-based treatments are at best neutral and maybe in some cases have a poor benefit-to-risk ratio, whereas this treatment has greater promise and a better benefit balance," Langer says.

Sarrel first learned to use MP when he worked in London in the early 1980s. Now it's the only type of progesterone he uses in his stateside practice. "I have patients who cannot tolerate MPA. Within two to three days of starting, they get flushes or chest pains or irritability or angry outbursts, all of which are adverse affects of too much progestin," he says. "What's awful for women after menopause is to think they're all done with that. With MP, it's really minimized. It's not perfect, but it's a lot better from an everyday clinical practice point of view. It's what works best. It's the only thing I use."

What To Do

For more on postmenopausal hormone therapy, visit the National Heart, Lung, and Blood Institute or the Women's Health Initiative.



World's Top Health Hazards Ranked

By Emma Ross

AP Medical Writer

The Associated Press

Thursday, October 31, 2002

LONDON (AP) - Governments may have to consider legislation to reduce the salt, fat, sugar and other unhealthy ingredients in manufactured foods, according to a new report by the World Health Organization (news - web sites).

The recommendation is in this year's annual World Health Report, which for the first time tries to rank the major threats to health worldwide and examine ways to reduce them.

The report examines the 20 biggest risks to human health and their impact on disease, disability and death. It estimates that if these threats were tackled, at least an extra decade of healthy life could be achieved in even the poorest countries, and people in the richest nations could gain another five years of healthy life.

Food and drink play a central role in many of the health risks examined, from the top-ranked problem of underweight to the scourge of overweight, ranked 10th.

"Bold policies are required," the report says. "A mixture of public and private sector agreements and legislation are required to create the social milieu for health gains resulting from tobacco taxation or gradual changes to food manufacturing."

WHO Director General Dr. Gro Brundtland noted that Britain had successfully reduced the salt content in bread and many processed foods, "and I'm sure with sugar it could be the same. You could obviously get a code of conduct where certain products should not have a sugar level over X."

Detailed, accurate and easily understandable labels about fat content also are needed so that people know what they are eating and have a choice, she said.

The report, one of largest research projects ever undertaken by the U.N. health agency, also concluded that alcohol is responsible for far more deaths and disease than previously thought.

Malnutrition is still the worst health problem, accounting for one in 14 deaths globally.

A summary of the findings was published Wednesday in the online version of The Lancet medical journal, accompanied by a critique by two Cambridge University experts who cautioned against placing too much emphasis on the relative rankings of the different health hazards.

They said the estimates depend on the quality of the studies underlying them and that some hazards, such as high blood pressure, have been extensively studied and are well understood, while others, such as exercise and diet, are less understood and their importance has likely been underestimated.

"Public health surveillance on this scale is a new and immature, science," said the scientists, Dr. John Powles and Nicholas Day from the Institute of Public Health at Cambridge. "This exercise ... should still be regarded as a report of work in progress."

The top 10 health hazards worldwide, in terms of how much disease and death they cause, are, in order of danger: underweight, unsafe sex, high blood pressure, tobacco, alcohol, contaminated water, sanitation and hygiene, iron deficiency, indoor pollution, high cholesterol and obesity.

"This report brings out for the first time that 40 percent of the global deaths are due to just the 10 biggest risk factors, while the next 10 risk factors add less than 10 percent," said Alan Lopez, a WHO senior science adviser.

The report also ranks the hazards separately for three groups: the poorest regions such as sub-Saharan Africa and parts of South Asia, other developing countries and the developed world. No individual country listings are given.

In the poorest group, malnutrition was by far the worst health hazard, followed by unsafe sex — which reflects the massive HIV (news - web sites)/AIDS (news - web sites) burden in those areas.

Researchers were surprised to find that indoor pollution from the burning of manure and charcoal for cooking causes much illness and death. It was the fourth-leading health hazard in that region, after unsafe water, sanitation and hygiene, but had never been noticed before, said the report's lead author, Dr. Christopher Murray, executive director of WHO's global program on evidence for health policy.

In other developing countries, alcohol turned out to be the biggest menace to health, followed by high blood pressure and tobacco. Underweight and overweight jostled for position in fourth and fifth places respectively. Cholesterol came next, then low fruit and vegetable intake.

In rich nations, the biggest peril was tobacco, closely followed by high blood pressure, alcohol, cholesterol, overweight, low fruit and vegetable intake and inadequate exercise.

On the Net:

World Health Report 2002,


US Teen Dies After Following High-Protein Diet

By Dana Frisch

Reuters Health

Thursday, October 31, 2002

NEW YORK (Reuters Health) - Missouri doctors describe the case of an apparently healthy 16-year-old girl who collapsed suddenly and died after spending one to two weeks on a high-protein, low-carbohydrate diet.

Electrolyte imbalances due to the diet, and the resulting damage to her heart function, were likely responsible, the physicians who cared for her report in a recent issue of the Southern Medical Journal. The girl had no known illnesses or medical conditions.

The teen had low potassium and calcium levels when she arrived at the University of Missouri Health Sciences Center, most likely as a consequence of the diet, the doctors state in their report. This disrupted the normal electrical function of her heart, leading it to stop and causing her to collapse, they write.

Dietitians and proponents of the Atkins diet, one example of a low-carbohydrate/high-protein diet, say that other weight-loss measures including eating disorders like bulimia or the use of diuretics were far more likely to have contributed to the low electrolyte levels found in the teen's blood.

Dr. D. Paul Robinson, a co-author of the paper, said in an interview that while there might be other explanations for the teen's death, including an abnormal heart rhythm, interviews with her parents did not suggest that she had a history of bulimia or diuretic use. Robinson is an assistant professor of child health in the division of adolescent medicine at the University of Missouri, Columbia.

"Most kids with eating disorders, even if they're able to hide the bulimia, they're constantly talking about being fat or needing to lose weight and exercise," Robinson said. "My indication, from what I understand of the interview with this girl's family, is that none of these things were the case."

Colette Heimowitz, director of education and research at Atkins Health and Medical Information Services, told Reuters Health that the Atkins approach has been used by millions of Americans for 30 years now, and there have been no documented cases of serious reactions or fatalities.

"The actual dietary approaches or practices that this particular teenager followed for days or weeks couldn't possibly account for what (the physicians are) attributing it to," said Heimowitz. She noted that the irregular chemical levels detected during the autopsy could be associated with drugs emergency medical personnel and doctors administered to resuscitate the teen, or with other weight-loss efforts.

Robinson disagrees. "I don't think there is any way the resuscitative drugs would have affected (the teen's electrolytic balance)," he said, noting that when the teen came in, she had low potassium levels.

Very high-protein/low-carbohydrate diets result in a condition called ketosis. In ketosis, the body has used up its preferred fuel reserves, glycogen derived from carbohydrates, and instead burns fat. This generates substances called ketone bodies, which can be smelled in the breath.

Wahida Karmally, a spokesperson for the American Dietetic Association, told Reuters Health that these diets can cause muscle breakdown, weakness, nausea and dehydration. They limit the intake of entire categories of food that provide certain nutrients, such as potassium, she explained. "These effects can happen right away," she said.

"It is a worrying set of circumstances when kids die suddenly," Robinson said. "The whole point of writing the paper is to ask clinicians to keep their eyes open. If kids come in with sudden death and they're on this kind of diet, we really have to start paying more attention to it."

Source: Southern Medical Journal 2002;95:1047-1049.


Study: More Survive Heart Failure  

By Stephanie Nano

Associated Press Writer

The Associated Press

Thursday, October 31, 2002

Doctors have made progress over the last five decades in keeping heart failure patients alive and preventing the life-threatening condition, at least in women, a new study shows.

While new drugs have been shown to improve survival, the research reported in Thursday's New England Journal of Medicine (news - web sites) is the first population-based evidence that people are living longer with the disease.

About 4.8 million people have heart failure, which occurs when a weakened heart cannot pump blood efficiently through the body. It mostly afflicts the elderly and is thought to be on the rise because of the aging of the U.S. population. It contributes to about 287,200 deaths a year.

Analyzing 50 years of data from the Framingham Heart Study, the researchers found the number of new cases in women had dropped by about one-third. But there was no change for men.

They also concluded that survival improved for men and women, with the risk of dying after developing heart failure falling about one-third since the 1950s.

Despite the improvements, "we still do have to appreciate that this is a highly lethal condition," said Dr. Daniel Levy, director of the government-funded Framingham study, which has been tracking residents of the Boston suburb since 1948.

"We think it is most likely that improvements in treatment are reducing the number of people with new heart failure and prolonging survival," said Levy.

The study of 10,317 people compared death rates from heart failure for 1950-69 with the next three decades. A total of 1,075 developed heart failure and they were followed for 10 years. The researchers calculated that the risk of death fell by about one-third.

In the 1990s, 59 percent of the men had died within five years, a drop from 70 percent in the earlier period. For women, the five-year death rate dropped to 45 percent from 57 percent.

"It's not a huge change. But it's the first time that such a study has showed our treatments are impacting on the survival of patients," said Dr. Margaret M. Redfield of the Mayo Clinic, who was not involved in the study.

The researchers suspect the number of new cases for men remained unchanged because of gender differences in the causes of heart failure. Treatment has improved vastly for high blood pressure, a prominent cause for women. More people are surviving heart attacks, a main cause for men, and the damage to their heart makes them vulnerable to heart failure, Levy said.

A second study in the journal suggests that a widely used medication for heart failure, digoxin, a type of digitalis, could be dangerous for women.

Researchers at Yale University looked at data from an earlier study to see if digoxin affected men and women differently. That study determined that digoxin, which has been used for centuries and makes the heart contract more forcefully, did not reduce deaths overall but did result in less hospitalization.

Researcher Dr. Harlan Krumholz said they were surprised to find that women in the study who took digoxin died more frequently (33 percent) than women who took a dummy pill (29 percent). They calculated that digoxin increased the risk of death in women by 23 percent. There was no difference in the death rate among men.

Acknowledging their study was not conclusive, Krumholz said: "This analysis raises the possibility that digoxin may, in fact, be harming women."

More than 25 million prescriptions for digoxin are filled in the United States each year, many of them for heart failure, according to researchers.

Dr. Mihai Gheorghiade of Northwestern Memorial Hospital said doctors might want to consider lower doses for women but they shouldn't stop using what he considers a good, inexpensive drug.

Added Dr. Sidney Smith, chief science officer of the American Heart Association (news - web sites): "A study like this raises some questions, but I think we need more information before we would just say out of hand that some women might not benefit," he said.

On the Net:

New England Journal:

American Heart Association:


Patients May Be More Satisfied with Same-Race Docs 

By Charnicia E. Huggins

Reuters Health

Thursday, October 31, 2002

NEW YORK (Reuters Health) - Most patients seem to prefer doctors of their same race or ethnicity, and those that do have same-race physicians report greater satisfaction with their care, new study findings show.

"The take-home message is not that patients should only be seeing doctors of the same racial/ethnic group," Dr. Thomas A. LaVeist of Johns Hopkins University in Baltimore, Maryland told Reuters Health. Instead, he said, it should be that "when patients have a choice, patients are more satisfied and more likely to choose physicians of the same racial/ethnic group.

"The key is choice," he said.

The findings are based on an analysis of data from 2,720 black, white, Hispanic and Asian Americans who were involved in the 1994 Commonwealth Fund Minority Health Survey.

Most of the patients had white doctors, but those who were able to choose their physician were more likely to select doctors of their same race or ethnic group, LaVeist and his co-author, Amani Nuru-Jeter, report in the latest issue of the Journal of Health and Social Behavior.

This "may suggest that patients are more likely to trust and feel greater comfort with physicians of the same race group," the authors speculate.

Most white respondents, and about half of Asian Americans, said that their doctors were white and Asian American, respectively. Only 21% of the African Americans and 19% of the Hispanics reported having doctors of their same race/ethnic group.

Patients whose physicians were of their same racial/ethnic group, however, reported higher levels of satisfaction with their care than those who were treated by doctors of another race, the report indicates.

For example, black patients with African-American physicians reported being more satisfied with their care than black patients who had white or Asian doctors. Similarly, Hispanic patients reported higher levels of satisfaction when their physician was Hispanic, and this remained true regardless of whether English was their primary language.

It is not clear why doctor-patient race concordance was associated with greater patient satisfaction, but LaVeist speculates it may be because doctors and patients of the same race and ethnic group are able to communicate better--both verbally and nonverbally.

"I think there's an understanding you have with a person of the same culture," he said. There is a "sense of closeness, a sense of familiarity, and greater comfort with a person of the same racial/ethnic group."

Not that these qualities are lacking in other doctor-patient relationships, he said, comparing the situation to a marriage. Although some people may tend to marry within their own racial/ethnic groups, there are many happy marriages between individuals of different racial/ethnic groups, he said.

Thus, LaVeist is not advocating that the healthcare system be segregated as in previous centuries. "We were not served well with that," he said.

Instead, he recommends that along with training more African American, Hispanic, Asian and Native American physicians, "medical schools need to continue and expand efforts to train physicians to communicate well with patients from racial and ethnic groups other than their own."

Source: Journal of Health and Social Behavior 2002;43:296-306.


Homespun Fitness


Thursday, October 31, 2002

(HealthScoutNews) --According to cardiologists at the Medical College of Wisconsin, household chores will get your heart rate going and work off those extra calories.

Here are some everyday activities that will burn about 100 calories:





Wash dishes


Wash windows


Rake leaves


Shovel snow


Blow snow


Stack firewood


Mow lawn


The above guide is estimated for a 120- to 150-pound healthy person.


Psychological Stress Does Not Cause Cancer: Study

By Charnicia E. Huggins

Reuters Health

Thursday, October 31, 2002

NEW YORK (Reuters Health) - Mothers who experience the stress associated with a child's death have a slightly higher risk of developing cancer than those who do not experience such an event, new study findings show. But contrary to widely held beliefs, the stress did not seem to cause the cancer, researchers in Denmark report.

Previous studies have suggested that psychological stress causes cancer, but the scientific evidence to support this belief has so far been mixed. Supporters of the theory speculate that stress has a negative effect on the immune system, leading to a decrease in the number and activity of certain immune cells, which consequently allows cancer cells to spread.

In the present study, however, the mothers' higher risk of cancer appeared to be related to their smoking and other harmful stress-related activities, rather than the stress itself, the report indicates.

"We found no indication to support the idea that severe life stress causes cancer," lead study author Dr. Jiong Li of the Danish Epidemiology Science Center at the University of Aarhus in Denmark told Reuters Health. "The slightly increased risk may be a result of stress-induced risk behaviors."

Li and his colleagues investigated the stress-cancer link in a study of 21,062 parents in Denmark who experienced what they refer to as "the most severe stressor we know of--the loss of a child"--from 1980 to 1996. For comparison, the study also included nearly 294,000 parents who did not suffer a similar loss.

Overall, mothers who experienced the loss of a child were approximately 18% more likely to have developed cancer during the 7 to 18 years of follow-up than were their peers in the comparison group, the investigators report in the November 15th issue of the journal Cancer.

However, these cancers were also 65% more likely to be lung-related, the report indicates.

"Bereaved mothers might take up more adverse health behaviors," which may explain their slightly higher risk of developing cancer, Li said.

Bereaved fathers, however, were not found to have a higher risk of cancer than their non-bereaved counterparts, the report indicates.

Prior studies have found stress to be associated with increased smoking and heavy drinking and decreased physical activity, the authors note. Also, it is known that bereaved mothers experience more psychological stress than bereaved fathers.

Thus, the findings show that "long-term effects of bereavement exist, as well as short-term difficulties," Li said. To combat these effects, bereaved parents "need help from healthcare providers...or even community social workers," he advised.

"It is not enough to just alert people that adverse lifestyles resulting from psychological distress will lead to an increased risk of disease," he said, citing a need for "bereavement intervention programs" to help parents deal with their loss. "Unfortunately, we seldom see this in most occasions," he said.

Still, he added, there is "no reason to fear a higher cancer risk in stress-exposed people."

Source: Cancer 2002;95:2237-2242.


Study Explains Why Depression Can Strike Again

By Amanda Gardner
HealthScoutNews Reporter


Thursday, October 31, 2002

THURSDAY, Oct. 31 (HealthScoutNews) -- Physicians and patients have long known that people who have a major depressive episode have a greater risk for suffering another. These people, although ostensibly recovered, also remain unusually sensitive to emotional stress.

Now researchers reporting in the November issue of the American Journal of Psychiatry have identified what may be a "depression trait marker" in the brain which explains why patients who have recovered nevertheless remain vulnerable to another depressive episode.

And in a second study released today, another research team says it has identified the first gene that leaves women vulnerable to clinical depression.

"Depression is not a single event for many people and each episode, if you're lucky, can be treated and you can be well, but depressed patients know that they are at risk for more episodes," says Dr. Helen Mayberg, lead author of the "trait marker" study and a professor of psychiatry and neurology at the University of Toronto. "The question is what about your brain seems to be the area of vulnerability."

Previous research has already demonstrated that the brains of depressed people work in different ways than healthy people. This study takes the concept further.

It "goes to a new level because it talks about people who have recovered from depression or who have been treated. Their brains are functioning differently, and it's a question of why they're functioning differently," says Dr. Kenneth Skodnek, chairman of the department of psychiatry and psychology at Nassau University Medical Center in East Meadow, N.Y. "This is special because I believe this is the first time that there has been evidence even when someone recovers that the brain is still not functioning normally."

In this study, researchers asked 25 adults to remember an extremely sad experience in their life, then scanned their brains with positron emission tomography (PET) while they recalled the event.

The participants belonged to one of three categories: 10 women who had recovered from a major depression (nine were on medication and one was not); seven women who were at that time in the throes of a major depressive episode (only one was on medication); and eight healthy women who had no personal or family history of depression.

The scans, which measure blood flow, showed that the brains of the recovered patients and currently depressed women experienced different changes than the brains of the healthy participants.

"We saw that recovered patients looked for all intents and purposes like acutely depressed patients and that there were some very specific areas of the brain that changed uniquely in depressed patients that we don't see in healthy subjects and vice versa," Mayberg says. "Under that emotional stressor, the recovered depressed patients looked like the worst depressed patients. When we stressed healthy subjects' brains, we didn't see any decrease in brain activity."

Specifically, the subgenual cingulate and the medial frontal cortex areas of the brain were involved. The subgenual cingulate has already been identified as being involved in the experience of intense sadness even in healthy individuals. It is also a target of antidepressant medication.

"These people are different even when they're treated," Skodnek says. "It's almost like someone comes in with congestive heart failure, you treat them" and the heart appears to be doing OK. "But if you know what's going on with the heart, it's not OK."

Whether the differences in brain function are a cause or effect of a previous depressive episode remains unknown.

Nevertheless, this research and future studies it spawns will have important implications for identifying people at risk for depression and in identifying new targets for drug therapy.

Although this appears to be a trait marker for depression, Mayberg is careful not to overstate the case. "I wouldn't want anyone to think we've got the glucose tolerance test for depression," she says.

Meanwhile, researchers at the University of Pittsburgh say they've found evidence that a gene in chromosome 2q33-35 leaves women at a higher risk for depression. However, they found no such correlation in men, suggesting that vulnerability to the disease is at least in part influenced by one's gender.

What To Do

For more information on depression, visit the National Alliance for the Mentally Ill or the National Institute of Mental Health.


Laser Test May Help ID Rheumatoid Arthritis Early

By Hannah Cleaver

Reuters Health

Thursday, October 31, 2002

BERLIN (Reuters Health) - German researchers are developing a technique for diagnosing rheumatoid arthritis using laser light that they say takes just a few minutes to give a result and should pick up the condition earlier than current tests.

Initial tests have shown the exam was able to accurately identify more than 80% of cases, and a clinical study is set to begin before the end of this year, Professor Juergen Beuthan of the Berlin Free University's institute for medical physics and laser medicine told Reuters Health Thursday.

Beuthan said he was optimistic the test will give medics an early jump on the condition and give more patients the chance to hold the pain of full-blown rheumatoid arthritis at bay.

"There is no cure for this arthritis but with early diagnosis the patient and their doctor have the chance to act and delay the full onset of the condition," he said.

Rheumatoid arthritis occurs when the immune system, for unknown reasons, mistakenly attacks the joints, leading to inflammation, swelling and pain. Over time, this process erodes the bone and soft tissue within the joints.

"The diagnosis is made using a laser scanner, almost like the red pointers that people have. It sends an infrared light through a joint, usually a finger joint," Beuthan explained. "The degree by which the light is scattered as it passes through the tissue is then processed by a computer. If the light is scattered more than usual, it means there could be a problem."

The technique does not look at the condition of the bone in the joint, but instead gives information about joint fluid and the membrane surrounding the bone. If the light is more scattered than it would be when passed through a normal joint, it means the fluid has thickened, indicating the early onset of rheumatism.

"A doctor using this diagnosis technique must also look to clinical indications. We are not creating a machine which can do everything but it should be an extremely helpful tool in making early diagnosis," said Beuthan.

He said the procedure takes just a few minutes, from sticking a finger under the infrared light to getting the result from the computer.

"Any general practitioner could use this, they all have computers, all they need in addition would be the software and the infrared scanner," the researcher said.

He has been working on the scanner for a number of years, developing the technology with German technology giant Siemens, which intends to manufacture and sell the equipment if all goes according to plan.

Initial tests carried out in Goettingen University in southern Germany have involved around 180 joints, Beuthan said, and have yielded sensitivity of more than 80%. This means the test is able to detect 80% of cases.

"We are getting ready to conduct the clinical trial at the Berlin Charite Hospital," he said. "It will involve at least 70 patients and will be comparative against other techniques such as x-ray and MRI. It will start before the end of the year and take up to a year to complete."

Work is also being carried out using infrared light to produce three-dimensional images of joints in the US. Beuthan said he is working closely with colleague Andreas Hielscher at Columbia University in New York on the possibilities of the technique for producing more in-depth images.


Study: Free Smoke Alarms Don't Cut Fire Deaths

By Adam Marcus
HealthScoutNews Reporter


Thursday, October 31, 2002

THURSDAY, Oct. 31 (HealthScoutNews) -- Campaigns to provide free smoke alarms in housing projects don't reduce the number of fires or fire-related injuries, says a new study from London.

The researchers were trying to replicate the success of a similar program in Oklahoma City, which was credited with an 80 percent reduction in hospitalizations and deaths from fire injuries. This time, however, the giveaway didn't produce so great a benefit -- in fact it didn't appear to help at all.

Two years after handing out more than 20,000 smoke alarms, mounts and instructional brochures in several languages, people who received the detectors were no less likely to be seriously hurt or killed in fires. The fire department responded to just as many blazes in the housing complexes the program targeted.

The odds of having a detector installed were roughly the same for homes with free alarms as those that had to buy their own, 30 percent versus 32 percent; and the chances that the detector was working properly -- that is, had a good battery -- were nearly identical, 16 percent versus 17 percent.

Why the handout program didn't work isn't clear, say the researchers, who publish their findings in the latest issue of the British Medical Journal. Tenants may not have understood the installation instructions they were provided or may have lacked the right tools to put up the detector. Although the researchers distributed educational materials in foreign languages, even this didn't insure that the alarms would be properly placed and maintained.

"Simply giving alarms to poor, urban households is unlikely to reduce injuries related to fire," and thus may be a waste of resources, the scientists wrote.

In a second study also appearing this week in the journal, researchers found that nearly half of smoke alarms in a London neighborhood weren't working within 15 months of being installed. The main reasons: missing or disconnected batteries, often because of frustration over false alarms. About one in six people had removed the detectors.

Alarms using long-lasting lithium ion batteries were more than twice as likely as conventional models to be working when checked, as were those with an ionization sensor. However, households with a smoker were about 40 percent less likely than nonsmoking homes to have a functioning smoke detector.

Carol Runyan, director of the Injury Prevention Research Center at the University of North Carolina in Chapel Hill, says detector handouts aren't necessarily ineffective, but they're not a "one-size-fits-all" proposition. "There's a lot more to it than just getting smoke detectors into the hands of people in the household," Runyan says.

Dr. Barry Pless, an injury prevention specialist at Montreal's McGill University, calls the latest research "very important and sobering."

The detector handout "seemed like a no-brainer" when it began, says Pless, author of an editorial accompanying the journal articles. However, the reality proved that taking aim at fire is harder than it appears.

The failure of the British initiative leads to two conclusions, says Pless, editor of the international journal Injury Prevention. Either freebie smoke alarms need to run on household electricity, thereby short-circuiting the dead or disconnected battery problem, or housing projects should all be rigged with sprinkler systems to douse fires before they spread.

In the United States, 94 percent of homes have at least one smoke alarm. The 6 percent that don't account for half the fire-related deaths each year, according to the National Fire Prevention Association.

Margie Coloian, a spokeswoman for the Quincy, Mass. group, says smoke alarms are a major reason the number of fire-related deaths have been dropping since the late 1970s. Last year, 3,110 people died in residential fires, down more than 9 percent from 2000, Coloian says.

What To Do

A false alarm beats no alarm at all when a real fire hits in the middle of the night. Smoke detectors are incredibly inexpensive these days.

For more on fire prevention, try the National Fire Prevention Association. For a look at how smoke detectors function, try HowStuffWorks.


Gene Therapy Triggers Bone Growth in Rats

Reuters Health

Thursday, October 31, 2002

NEW YORK (Reuters Health) - Using stem cells genetically engineered to express a bone-generating protein, researchers have succeeded in growing new bone in the spines of rats.

The approach is not ready for human testing yet, but the study's authors suggest that this type of gene therapy, which involves manipulating cells outside of the body before treatment, holds promise as a treatment for bone disorders.

In the experiments, Dr. Gregory A. Helm of the University of Virginia in Charlottesville and colleagues worked with stem cells, the immature "master" cells capable of maturing into different types of body tissue. The researchers genetically engineered human bone marrow stem cells to make them express bone morphogenetic protein (BMP-9), which promotes the growth of new bone. The modified stem cells were then injected into the rats on one side of the spine, while the other side was injected with stem cells that contained an inactive gene.

The gene therapy seemed to trigger the growth of new bone, Helm and his colleagues report in the November issue of the journal Neurosurgery. Eight weeks after treatment, new bone had grown on the treated side of the spine, but not on the untreated side. The bone seemed normal, and there were no signs that the new bone caused any problems, such as pressing against the spinal cord.

According to the study's authors, the report is the first evidence that this type of gene therapy "is effective and has the potential to become a useful, minimally invasive technique to induce spinal (fusion)." Spinal fusion, which is used to treat degenerative bone disease, involves taking bone from one part of the body and transplanting it into the spine.

Before the gene therapy approach can be tested in people, though, the authors caution that "it is crucial that evidence be demonstrated that genetically modified, human-derived progenitor cells have the ability to promote" the growth of new spinal bone.

Funding for the research was provided by Medtronic Sofamor Danek, Inc., and the National Institutes of Health (news - web sites).

Source: Neurosurgery 2002;51:1239-1245.


Molecular 'Valve' Tied to Recovery from Heart Attack

By Adam Marcus
HealthScoutNews Reporter


Thursday, October 31, 2002

THURSDAY, Oct. 31 (HealthScoutNews) -- Drugs that open a kind of cellular carburetor may help prevent rampant damage in the wake of heart attacks, new research has found.

Heart attacks occur when blood flow to the organ's muscle cells is blocked. Specifically, the loss of oxygen prevents cell engines called mitochondria from generating ATP, the chemical fuel that drives life. Deprived of energy, heart muscle dies. Depending on the spread of this damage, the pump can weaken or fail completely.

However, researchers in the United States and Canada have found a molecular valve inside mitochondria that appears to help match energy supply with energy demand in the heart (and other organs, too). The valve, called an ion channel, regulates the flow of potassium ions, and when these positively charged atoms are allowed to pass freely through the channel into the mitochondria, heart muscle is less vulnerable to an attack.

"The heart is pumping 24 hours a day, year after year. By age 75 it has pumped more than 2 billion times without stopping, and it needs a continuous supply of energy," says Brian O'Rourke, a cell physiologist at Johns Hopkins University School of Medicine in Baltimore and a co-author of the new study.

"When you have a heart attack the fuel gets shut off, and some cells die a slow or a quick death. Somehow this channel improves that. They don't die," O'Rourke says. He and his colleagues report the findings in tomorrow's issue of Science.

In one experiment, the team used charybdotoxin -- a poison derived from scorpions -- to freeze the activity of the channel, dubbed mitoKCa because it responds to signals from calcium. Regular floods of calcium into heart muscle cells makes them contract.

Then, their collaborators at the Otsuka Maryland Research Institute showed they could cut the damage from heart attacks in rabbits in half by pre-treating them with a drug that keeps the potassium channel open.

O'Rourke says potassium channel opening drugs could one day help prevent cell death from heart attacks or heart procedures such as bypass surgery or angioplasty. They may also be useful in fighting damage associated with stroke, Alzheimer's disease (news - web sites) and other brain disorders.

However, he adds, it's far too soon to know if such an approach works in people. "It's sort of an untapped area right now," he says.

Elizabeth Murphy, a cell signaling expert at the National Institute of Environmental Health Sciences who was familiar with O'Rourke's research, says it could one day have "great therapeutic potential" for heart patients. However, drug makers must first develop potassium ion channel activators that are specific to heart muscles, Murphy adds, since interfering with cells in other organ systems, such as blood vessels, might have unwanted effects.

What To Do

For more on how the heart functions, try the Cleveland Clinic. To learn about the warning signs of a heart attack, visit the American Heart Association.


Grandpa's Diet May Affect Grandkids' Disease Risk

By Merritt McKinney

Reuters Health

Thursday, October 31, 2002

NEW YORK (Reuters Health) - We are what we eat, or so the saying goes, but new research suggests that we may be what our parents and grandparents ate as well.

A new study from Sweden has found that nutrition during childhood--particularly among boys--may influence the risk of cardiovascular disease and diabetes in later generations.

Some researchers have theorized that poverty during childhood or adolescence, which often goes hand-in-hand with inadequate nutrition, may have a life-long effect. According to this idea, poverty early in life "programs" the body to be accustomed to inadequate nutrition, not the high-calorie diet typical in many developed countries today.

Dr. Lars Olov Bygren of Umea University in Sweden and colleagues set out to see whether the programming effect of nutrition could be passed down to later generations. They studied three generations born in 1890, 1905 and 1920 in a parish in northern Sweden. During the late 19th and early 20th centuries, this area was impoverished and harvests were often meager. Based on historical information, the researchers classified food availability in any given year as poor, moderate or good.

What a person's parents and grandparents ate appeared to have a significant impact on their risk of cardiovascular disease and diabetes, Bygren's team reports in the European Journal of Human Genetics.

People whose relatives had lived through a famine tended to have a lower risk of disease, according to the report. For people whose fathers did not have enough food during the "slow-growth" period of childhood that occurs before puberty, their risk of cardiovascular disease was lower than normal. To a lesser extent, the same was true for people whose paternal grandmother had lived through a famine.

Similarly, having a paternal grandfather who had lived through a famine was associated with a lower risk of diabetes. But if a paternal grandfather had plenty of food during his slow-growth period, his grandchildren were about four times more likely to die with diabetes.

The investigators did not examine the possible causes of the connection between childhood nutrition and disease risk in later generations, but Bygren said that the findings suggest that social influences may have an effect on genetic factors. This turns much of the thinking on the causes of disease "upside down," according to Bygren.

Source: European Journal of Human Genetics 2002;10:682-688.


ERs Can Prevent Emergencies, Too

By Ed Edelson
HealthScoutNews Reporter


Thursday, October 31, 2002

THURSDAY, Oct. 31 (HealthScoutNews) -- A hospital emergency room can be a great place to head off an emergency in addition to treating whatever problem brings someone there, a study finds.

The emergency in the making is a stroke caused by the irregular heartbeat called atrial fibrillation, and records of more than 78,000 visits show that the emergency room is a prime location to identify people with the problem and start them on preventive treatment, says a report in tomorrow's issue of Stroke.

"The basic lesson of the study is that in the United States we are tremendously under-treating atrial fibrillation with proven therapies to reduce stroke risk, and that these patients may be easily identified as they flow through the emergency room system," says Dr. Phillip A. Scott, an assistant professor of emergency medicine at the University of Michigan Health System and lead author of the report.

People with atrial fibrillation or other heart rhythm problems are more likely than others in the general population to require emergency treatment, the study finds. The overall incidence of atrial fibrillation among ER patients in the study who had electrocardiograms was 1.1 percent, about a fifth higher than the estimated general prevalence. Many of those people whose atrial fibrillation had been previously identified were not taking the drug most effective at reducing stroke risk.

That drug is warfarin, best known by the brand name Coumadin, an anticoagulant that can prevent a blood clot that can cause a stroke. Only 55 percent of the people who were eligible for warfarin were taking the drug, Scott says.

"Current computer models estimate that we could prevent 40,000 strokes each year if we were able to get all eligible patients on appropriate medication," he says. However, he quickly adds that reaching that goal would require a basic change of attitude about emergency room function.

"Right now, emergency physicians have not been expected or trained to evaluate patients for preventive medical therapy," Scott says. "What we have to do is identify how emergency physicians can single out these patients and then intervene to increase the use of anticoagulants such as warfarin."

It won't be easy, Scott says, since emergency rooms now are staggering under a burden of more than 100 million patient visits a year, a number increasing by 6 percent to 8 percent annually. But "there are methods to intervene that require little or no time," he says. People can help by doing something as simple as taking a pulse; an irregular beat can be an indicator of atrial fibrillation.

Emergency rooms are "overworked, understaffed and overwhelmed," says Dr. Larry B. Goldstein, a professor of medicine at Duke University Medical Center and a spokesman for the American Stroke Association, but they are nevertheless one of the few places where the undiscovered problems of many Americans can be identified.

"About 40 percent of Americans don't have a primary-care physician, so the only time they interact with the medical care system is in the emergency room," Goldstein says. He sees that interaction as an opportunity to intervene in a variety of problems -- "not only atrial fibrillation, but also high blood pressure, obesity, cigarette smoking and other general lifestyle factors that are amenable to modification before they go on to heart attack or stroke."

Can that happen? Maybe, Goldstein says, "if the proper programs are put into place and supported. There is the potential to give a consistent message of good health practices."

What To Do

You can learn more about atrial fibrillation, its dangers and treatment, from the American Heart Association. Get a primer on brain attacks from an affiliated site, the American Stroke Association.


Coffee Linked to Mental Abilities in Elderly Women

Reuters Health

Thursday, October 31, 2002

NEW YORK (Reuters Health) - Elderly women who drank relatively large amounts of coffee over their lifetimes appear to out-perform less frequent coffee drinkers in certain tests of mental abilities, according to new study findings.

Researchers from the University of California, San Diego in La Jolla found that women who reported being frequent lifetime coffee drinkers performed better than non-coffee drinkers in memory tests involving words and shapes, and in calculation and category tests, in which they named as many animals as they could in 1 minute.

Women at least 80 years old who were lifetime coffee drinkers outperformed their peers on 11 out of 12 tests, although the results did not reach statistical significance. This suggests that the relationship between coffee and mental acuity may become stronger as women age, the authors report.

These findings are supported by previous research that suggests that caffeine--of which coffee is the main source--produces certain effects in the body that improve memory and repair memory impairments.

People tend to experience a decline in their mental functioning from age 60 on, the researchers note, and the current findings suggest that, in women, coffee may counteract that process.

"It is biologically plausible that caffeine lessens age-related cognitive decline," Dr. Marilyn Johnson-Kozlow and her colleagues write in the recent issue of the American Journal of Epidemiology.

The investigators obtained their findings from tests of mental acuity in 890 women and 638 men. Participants were, on average, around 73 years old.

During the study, the participants completed questionnaires regarding how many cups of coffee they drink on an average day, and the number of years they had been coffee-drinkers. Regular coffee drinkers were considered to be those who drank at least one cup of coffee each month, and the highest category of consumers included people who currently downed approximately 5 cups each day.

Johnson-Kozlow's team found that women who drank relatively large amounts of coffee over their lifetimes outperformed their peers in tests where they had to recall a list of words and reproduce a geometric form after a delay of 30 minutes. High lifetime female coffee drinkers also did better on tests where they counted backward from 100 in multiples of seven, and spelled the word "world" backwards.

The link between coffee consumption and mental abilities persisted when the authors factored in the effects of certain potential confounders, such as age, education, and whether the women had received estrogen replacement therapy, which previous studies have suggested may boost memory.

However, coffee drinking was not linked to all of the tests designed to measure participants' mental acuity, the authors note, suggesting that caffeine may have a "differential effect," improving mental functioning in some areas, but not others.

In terms of why mental functioning wasn't linked to coffee drinking in men, the researchers suggest that the number of men included in the study may not have been large enough to detect an effect. Alternatively, they propose that some silent factor may be either clouding the relationship in men, or creating a false relationship in women.

However, men and women may also simply respond differently to caffeine, Johnson-Kuzlow and her colleagues add. "Gender differences may be due to pharmacodynamic differences in sensitivity to caffeine effects between men and women," they suggest.

Source: American Journal of Epidemiology 2002;156:842-850.


Concussions in Athletes May Have Cumulative Effect

By Alison McCook

Reuters Health

Thursday, October 31, 2002

NEW YORK (Reuters Health) - The more concussions a young athlete has, the worse they can get, new study findings suggest.

High school athletes who have experienced at least three prior concussions tend to experience more severe subsequent concussions than those with no history of this type of head trauma. Specifically, athletes with at least three prior concussions in their past were nine times more likely than those with no concussion history to experience at least three problems after a subsequent concussion, including loss of consciousness, amnesia and confusion.

Lead author Dr. Michael W. Collins of the University of Pittsburgh in Pennsylvania told Reuters Health that the apparent cumulative damage of repeated concussions may happen because the athletes are returning to the field before they had fully recovered from their previous head trauma.

Consequently, he recommended that health officials ensure the athlete has completely healed from a concussion before being allowed to play sports. "Any athlete who is symptomatic for an injury shouldn't be back playing sports until they're symptom-free completely," Collins noted.

Collins and his team developed their findings by comparing the severity of concussions in 60 athletes who were previously concussion-free and 28 who had already suffered at least three prior concussions. Students experienced concussions most commonly during soccer and football.

Reporting in the November issue of the journal Neurosurgery, the investigators found that almost 26% of athletes with a history of concussion lost consciousness after a subsequent concussion, an event seen in only 5% of those experiencing their first concussion. Athletes with at least three prior concussions were also four times as likely as those with no history of the trauma to develop amnesia or confusion after another concussion.

In an interview with Reuters Health, Collins explained that it is often difficult to determine when an athlete has recovered enough from a prior concussion to recommence sports. Standard tests of brain status--such as CT scan, MRI, and a neurological exam--have trouble identifying signs of a concussion, Collins said, so many health workers can only measure an athlete's condition by asking them how they are feeling.

The problem with that approach, Collins said, is that the symptoms of concussion are often hard to identify. Athletes who experience headache, sensitivity to light, difficulty concentrating or fatigue may either not identify them as symptoms of an ongoing injury, or downplay their severity in order to rejoin their teammates, Collins explained.

Unfortunately, the symptoms of concussion can be severe enough to affect athletes' performance in sports and in school, the researcher noted. "It's not like an ankle sprain or a knee sprain where you're limping," he said.

And the current study illustrates some of the potential effects of returning to play before fully recovering, Collins noted. "You can try to play through this injury, but it's not in the athlete's best interest," he said.

Source: Neurosurgery 2002;51:1175-1181.


Thalidomide Combo Fights Bone Marrow Cancer-Study

By Lisa Richwine


Thursday, October 31, 2002

WASHINGTON (Reuters) - Treatment with the notorious drug thalidomide and another medicine may offer an effective but less toxic alternative to the usual chemotherapy for patients newly diagnosed with multiple myeloma, researchers said on Wednesday.

Giving thalidomide and the steroid dexamethasone as initial treatment to patients with the incurable bone-marrow cancer spared them the nausea, vomiting and hair loss associated with standard chemotherapy.

In a 50-patient clinical trial at the Mayo Clinic, the drug combination reduced cancer by at least half in 64% of patients, an effectiveness rate similar to what scientists have seen with chemotherapy, said Dr. Vincent Rajkumar, a Mayo Clinic hematologist and oncologist.

The toxicity "appears lower, and the response rate is as good or better than that obtained using complex combinations of chemotherapy regimens," Rajkumar said.

Thalidomide was pulled off the market worldwide in 1962 after being linked to severe birth defects. Celgene Corp. now sells the drug under the brand name Thalomid for treating leprosy, but its most common use is for cancer.

Both thalidomide and dexamethasone are taken orally, which is less cumbersome than the intravenous infusion used to deliver chemotherapy, Rajkumar said.

The thalidomide regimen did present its own side effects, the most serious being blood clots in the legs of six patients. Other effects included constipation, sleepiness, numbness in the hands and feet and skin rash.

The goal of initial therapy for most multiple myeloma patients is to reduce the amount of cancer so that patients can undergo a bone marrow transplant, Rajkumar said.

He said it was too early to recommend the combination treatment for routine use. He has started a larger trial comparing thalidomide and dexamethasone to dexamethasone alone.

The study will evaluate "how much extra response do we actually get over (dexamethasone), how much toxicity are we buying in that process and is it worth it," Rajkumar said.

The research was published in the Journal of Clinical Oncology. Previous studies found thalidomide effective for multiple myeloma patients who had failed other therapies.

Multiple myeloma is among the most difficult cancers to treat. It strikes the plasma cell, which is a type of white blood cell found in many tissues of the body. Average survival for a patient diagnosed with multiple myeloma is about three to four years. More than 11,000 people in the United States are expected to die from the disease this year.

Scientists are unsure how thalidomide fights cancer, but one theory is that it works by blocking the growth of blood vessels that help tumors survive, Rajkumar said.

Celgene is waiting for the results of further research before applying for approval to market Thalomid as a first-choice treatment for multiple myeloma, said Sol Barer, Celgene's president and chief operating officer.

Barer said the company may file an application some time in early 2005, but added that the timing depended upon the pace of recruitment and other matters.

The FDA (news - web sites) requires tight controls on Thalomid's use to make sure pregnant women do not take it.


Fear of Delivery Does Not Up C-Section Risk: Study

By Pat Hagan

Reuters Health

Thursday, October 31, 2002

LONDON (Reuters Health) - Women who are anxious about childbirth are not more likely to need an emergency caesarean section, according to British research.

The findings contrast with an earlier Swedish study that suggested anxiety over the trauma of labor increased the chances of an emergency C-section.

Professor Pauline Slade from Sheffield University's Clinical Psychology Unit and Rebecca Johnson of the Child, Adolescent and Family Therapy Service in Chesterfield decided to test whether the Swedish findings would be repeated in British women. They thought the link might have played a part in the increase in caesarean births in the UK, from 10% of all births 15 years ago to around 22% today.

They included 424 pregnant women in the study. At the 32nd week of pregnancy, the researchers asked each woman to complete two questionnaires measuring fear and anxiety over childbirth. The questionnaires were then matched up with each pregnancy outcome to see if there was any correlation between fear and mode of delivery.

The results, published in the November issue of the British Journal of Obstetrics and Gynecology, did find a link between surgical deliveries and previous history of C-section delivery, age and medical risk, but there was no evidence of a connection with anxiety and fearfulness.

Johnson told Reuters Health the findings did reveal higher levels of anxiety among first-time mothers in the UK compared with Sweden.

"We had expected women who went on to have emergency caesareans to have higher levels of fear, but that was not the case. There was no correlation.

"But women were more frightened than those in the Swedish study. That does seem to suggest there is something culturally different about the way we approach childbirth. There's something going on in the way childbirth is viewed, either culturally or within medicine," she said.

Source: British Journal of Obstetrics and Gynaecology 2002;109:1213-1221.



Help Your Child Cope With a More Stressful World

By Jennifer Thomas
HealthScoutNews Reporter


Wednesday, October 30, 2002

WEDNESDAY, Oct. 30 (HealthScoutNews) -- They don't have to deal with grueling commutes, bad bosses or endless streams of bills.

But children, even young ones, are increasingly struggling with the stresses of modern life, child development experts say.

There are no statistics on rates of stress in children, and the sources of their worries are, of course, different than for adults.

Yet events ranging from the carnage of the Maryland/Virginia sniper or the 9/11 terrorist attacks to divorce or a death in the family are putting -- and keeping -- kids on edge.

So, too, can milestones that to adults would be a cause for celebration, such as moving to a new neighborhood or the birth of a child in the family.

"Young children can feel stress and it can start at any age," says Rebecca Newgent, an assistant professor at the University of Arkansas' department of educational leadership, counseling and foundations.

"However, children may not recognize what they're feeling as being stress, and they may not have the vocabulary to express it. They just know they feel bad," she adds.

So what's a parent to do?

The first thing is to realize that children do experience stress, which can be hard to imagine as you watch your child zip down the street on a scooter, Newgent says.

"You think of children as having a more carefree, easygoing life," she says. "They don't have to worry about paying bills and making sure food is on the table. But their stressors are just as real and just as serious for them at their level."

Signs of stress in children can include physical symptoms such as stomach aches, headaches, asthma flare-ups and even high blood pressure. Kids under stress can also become irritable or withdrawn. They may also misbehave at school or neglect their studies, Newgent says.

Other signs can include nightmares or not wanting to be alone.

If stress goes unchecked, children may start to show psychological symptoms such as forgetfulness, a lack of concentration, chronic anxiety and even depression.

To help children cope with stress, experts suggest parents take some simple steps.

Start by making time for conversation. If you've ever tried, say, asking a 6-year-old boy how school was going, you know no matter how many questions you ask the most complex answer you're likely to get is: "It was OK."

That doesn't matter, says Joy Faini-Saab, an associate professor of educational theory and practice at West Virginia University. "What's most important is taking the time to try and letting the child know you're there in case they need you.

"It's really important to allow them to talk about things," Faini-Saab adds. "The conversations may not be very long and that's OK, as long as they have the opportunity to talk when they need to."

Throughout childhood, sometimes all a child needs is to have a parent there. "Sometimes, simple proximity is all that's needed," Faini-Saab says.

If a child is having trouble fitting in at school, it can help to get him involved with an after-school activity, where he can make other friends or feel good about learning something new, Newgent says.

"If the stress lasts too long, children can start to feel helpless and hopeless," she says. "It's very important to lead them to something that can bring a sense of accomplishment, to help them feel like they have some sense of control."

Parents also can teach their children how to cope by encouraging them to do something healthy to relieve stress. Going outside to play or getting involved with a physical activity, whether it's sports at school or some community or church-based program, are great ideas.

"Encourage them to find a mental or physical release that gives them a break from their stress," Newgent says.

Faini-Saab says the epidemic of childhood obesity means many kids aren't getting the stress-busting physical activity they need.

"It says to me that something is out of balance here," she says.

Then, there's the other extreme -- kids who are involved with so many activities that they never have time to simply play. Faini-Saab recommends that families limit children to no more than one or two after-school activities a week, depending on how demanding each activity is.

"Kids need time to think, dream and imagine," Faini-Saab says. "Studies clearly indicate that incubation time is very important for the creative thinking process and for their development."

Finally, parents need to watch how they deal with stress in their own lives. If they deal with stress in a healthy manner, their children will learn from them.

Parents should also make sure they don't confide too much in their children. Kids need reassurance that they're safe and their parents are going to handle any problems in the family.

"The level of tension is felt by the children, and if that continues for a long time, it's bound to cause them stress," Faini-Saab says.

What To Do

For information on helping children cope with stress, check the National Network for Children Care or Are you unwittingly contributing to stress in your child's life by pushing her too hard? Check this Ohio State University Web site and find out.


Babies Undergo Memory Brain Boost After Age One

By Alison McCook

Reuters Health

Wednesday, October 30, 2002

NEW YORK (Reuters Health) - Researchers at Harvard University have timed babies' ability to retain long-term memories to the period during which certain regions of the brain develop and mature.

Conor Liston and Dr. Jerome Kagan in Cambridge, Massachusetts found that long-term memory--defined as the ability to recall an event four months later--only begins to develop after babies reach one year of age.

The authors obtained their findings by testing the long-term memory of babies exposed to a series of actions when they were 9, 17 and 24 months of age. Four months later, the now-21 month and 28 month olds recalled the actions well, while the younger babies did not.

Kagan explained to Reuters Health that the human brain starts a dramatic period of maturation between the ages of 8 and 12 months. The current findings suggest that this period of maturation is linked to long-term memory. Thirteen-month-olds, whose brains were relatively immature during their exposure to the events, were less able to recall them than older infants, whose brains had already gone through a period of rapid neurological growth at the time of exposure.

Liston and Kagan report their findings in the October 31 issue of Nature.

During the study, the authors showed babies a series of activities along with a verbal cue, then asked them to repeat them. Activities included wiping a table with a paper towel and throwing the towel away or making a rattle by placing something inside a bottle and shaking the bottle.

Four months later, the authors re-tested the babies to see how well they remembered the previous activities. As they had anticipated, the two older groups of babies performed the previously demonstrated activities better than they did unfamiliar activities, which suggests they were able to recall what they had learned. In contrast, the 13 month-olds performed the supposedly familiar tasks just as well as they did a task that they had never seen before.

Kagan explained that previous research has shown that between 8 and 12 months of age, babies experience "dramatic growth" in the regions of the brain known as the frontal lobe and the hippocampus, a part of the brain that is important for making memories. During that period, he said, individual nerve cells physically grow, elongating the finger-like structures that form connections between individual cells.

Previous research has discovered the same link between the timing of brain maturation and short-term memory, Kagan noted, adding credence to the idea that a baby's ability to form memories is linked to the degree of development in his brain.

Source: Nature 2002;419:896.


Clothes Dryer Caution 


Wednesday, October 30, 2002

(HealthScoutNews) -- A dryer clogged with lint can overheat and cause a fire. The buildup can occur in the filter or inside the exhaust duct and obstruct the flow of air.

To prevent a fire, the U.S. Consumer Product Safety Commission (news - web sites) suggests you:

  • Clean the lint filter after every laundry load and the exhaust about once a month.
  • Check the exhaust more often if you have a plastic, flexible duct. They're more of a lint-trap than the metal varieties.
  • While the dryer is operating, check to see that the outside exhaust is working.
  • Damp clothing at the end of a cycle might be a sign that the lint screen or exhaust is blocked.


Heart Failure Declines in Women, but Not Men

By Keith Mulvihill

Reuters Health

Wednesday, October 30, 2002

NEW YORK (Reuters Health) - New cases of heart failure have declined steadily for women over the last 50 years, but the rates remain nearly unchanged in men, new study findings show.

The main reason for the difference between the sexes is that men and women tend to develop heart failure for different reasons, the study's lead author, Dr. Daniel Levy of the National Heart, Lung, and Blood Institute in Bethesda, Maryland, told Reuters Health.

An estimated 5 million Americans have congestive heart failure, a chronic condition in which the heart loses its ability to pump blood efficiently. The disease causes fatigue and shortness of breath as fluid accumulates in the lungs and tissues. Leading causes are damage to heart muscle from coronary artery disease or high blood pressure.

In the current study, Levy and colleagues evaluated statistics for 10,311 men and women between 1950 and 1999 and identified 1,075 cases of heart failure. The findings are published in the October 31st issue of The New England Journal of Medicine (news - web sites).

The number of new cases of heart failure dropped by 30% to 40% among women between 1950 and 1999, but changed very little in men over the same time period, Levy explained in an interview with Reuters Health.

While both high blood pressure and heart attack increase a person's risk for later developing heart failure, Levy notes that high blood pressure-related heart failure in women is more common. And in general, major "advances have occurred in the awareness, treatment and control of high blood pressure, which has reduced the number of woman who go on and develop heart failure," Levy said.

Men who develop heart failure, on the other hand, often have suffered a heart attack, explained Levy. And since more men are surviving more severe heart attacks, and are therefore more likely too later develop heart failure, the rate of heart failure among men has not seen a similar decline.

The study also showed that mortality risk after a diagnosis of heart failure declined by about one third from the 1950s to the 1990s.

"Despite the favorable trends in survival, heart failure remains highly fatal; among subjects who were given a diagnosis of heart failure in the 1990s, more than 50% were dead at five years," the researchers note.

"We know that treatment of high blood pressure reduces mortality in those with heart failure by 50%, however only about 27% of people with hypertension have their condition medically controlled," Levy said.

If physicians could improve blood pressure control in the community they could have a greater impact on deaths from heart failure, he added.

Source: The New England Journal of Medicine 2002;347:1397-1444.


False Ads for Fighting Fat


Wednesday, October 30, 2002

(HealthScoutNews) -- According to the U.S. Federal Trade Commission, about 40 percent of weight loss advertisements are misleading and 55 percent of them contain at least one unproven statement.

The commission studied 300 print ads and concluded that many of them made dubious claims -- especially regarding rapid weight loss or the ability to lose weight without diet or exercise. The FTC also cautioned consumers not to get sucked in by "before-and-after" pictures, because they are rarely realistic.


Heart Failure Drug Ups Death Risk in Women, Not Men

Reuters Health
Wednesday, October 30, 2002

NEW YORK (Reuters Health) - Women with heart failure who take digoxin, a form of the drug digitalis commonly used to treat the heart condition, appear to have a higher risk of death than women who don't take the drug, according to a study released Wednesday.

This does not appear to be true for men with heart failure.

Women were found to have a 4.2% higher risk of dying during the study if they took digoxin, while the mortality risk for men was the same whether or not they took the drug, according to the study published in the October 31st issue of The New England Journal of Medicine (news - web sites). About 33% of women taking digoxin died compared with 28.9% of women taking an inactive placebo.

After accounting for other factors that differed between men and women, Dr. Saif S. Rathore of the Yale University School of Medicine and colleagues found that digoxin increased a women's risk of death by about 23%.

"Although digoxin appeared to have no clinically meaningful effect on mortality among men, we found that there was a suggestion of increased harm associated with digoxin use in women," said Rathore in a prepared statement. "This pattern persisted after we accounted for factors that differed between men and women taking digoxin and those who had been taking placebo," he added.

Additional research should be done to confirm the findings, the authors say. For now, women with heart failure who are taking digoxin should talk with their doctor about whether they should continue the drug, they add.

According to the report, women who took digoxin were less likely to be hospitalized than women taking a placebo, although "women may not consider the potential increased risk of death associated with digoxin therapy worth the small reduction in the risk of hospitalization," according to the report.

The findings are based on a re-analysis of data previously collected as part of the Digitalis Investigation Group trial. Earlier findings showed that overall, patients who took digoxin spent less time in the hospital. The new analysis was not conducted in collaboration with those researchers.

The study involved 302 clinics in the United States and Canada. It included 6,800 heart failure patients who came to the clinics between 1991 and 1993. The patients' average age was 64, and they were followed for about 3 years.

All patients had heart failure, a seriously reduced ability to pump blood, often due to an underlying problem, such as heart disease. The patients, who had a normal heart rhythm and a wide range of heart-pumping capacities, were randomly assigned to receive either digoxin or an inactive placebo. Nearly all were also taking blood pressure drugs, including a diuretic (to reduce blood volume and the heart's workload) and angiotensin-converting enzyme (ACE) inhibitors, which help blood vessels relax.

Digitalis is a drug extracted from the leaves of plants belonging to the foxglove family. Digoxin, a derivative of digitalis, is used widely for treating the heart's reduced pumping efficiency, which is the hallmark of heart failure. The drug works by increasing the force of heart muscle contractions.

With the aging of the population, heart failure has been on the rise in the United States, especially among older Americans. It currently affects about 4.8 million people, and causes more than 40,000 deaths annually. Of the 400,000 new cases diagnosed each year, about half die within five years.

Source: The New England Journal of Medicine 2002;347:1403-1411.


Unidentified Gene for Cystic Fibrosis Possible


Wednesday, October 30, 2002

WEDNESDAY, Oct. 30 (HealthScoutNews) -- Some people with cystic fibrosis (CF) lack any of the more than 1,000 reported disease-causing mutations in the only known CF gene, says a study by Johns Hopkins Medical Institutions researchers.

That means there may be another unidentified gene that causes CF in those people or they have another unknown disease with symptoms similar to CF, the researchers say. CF is a life-shortening disease that causes frequent, severe lung infections.

The study was presented at the recent annual meeting of the American Society for Human Genetics and appeared in a recent issue of The New England Journal of Medicine (news - web sites).

More than a decade ago, scientists found CF was caused by the loss of the function of a protein called CFTR. Less severe cases of CF are referred to as non-classic CF. People with non-classic CF do have some working CFTR, but not at normal levels.

This study involved detailed genetic analysis of 74 people diagnosed with non-classic CF. The results showed that 29 of the people had mutations in both copies of the CFTR gene, 15 had only a single mutation and 30 had no detectable mutations in the CFTR gene.

The findings should prompt discussion about what is and isn't non-classic CF, says Dr. Garry Cutting, director of the DNA Diagnostic Lab at the McKusick-Nathans Institute of Genetic Medicine at Hopkins.

Extensive clinical evaluation of people without identifiable changes in the CFTR gene may lead to improved diagnosis and treatment of CF and CF-like conditions, Cutting says.

More information

To learn more, go to the Cystic Fibrosis Foundation.


Pelvic Pain Not in the Imagination


Wednesday, October 30, 2002

WEDNESDAY, Oct. 30 (HealthScoutNews) -- Many women who suffer chronic pelvic pain have been told by doctors, family and friends that their pain is normal.

That's what a survey presented at the recent annual meeting of the American Society for Reproductive Medicine found.

The survey included 968 women, aged 15 to 59, who suffer chronic pelvic pain caused by endometriosis and/or post surgical scar tissue. The survey was conducted by the Endometriosis Association.

It found that nearly 60 percent of the women were told their pain was normal (56 percent of those by their obstetrician/gynecologist and 29 percent by family/friends) and 40 percent were told they exaggerate their pain (52 percent by their doctor and 43 percent by family/friends).

The survey results are cause for concern, given the impact pelvic pain can have on a woman's life, says Mary Lou Ballweg, president and executive director of the Endometriosis Association. She says many women are forced to alter their lives because of the debilitating effects of pelvic pain.

It often takes years for a woman with pelvic pain to be properly diagnosed, Ballweg says.

The survey found that 43 percent of the women described their pain as constant, and more than half described their pain as severe to unbearable. More than 80 percent of the women said they've been unable to work at times because of their pelvic pain, and 45 percent said they've been debilitated for two to three days or longer each month.

Chronic pelvic pain accounts for 12 percent of hysterectomies and 40 percent of laparoscopic surgeries.

More information

The Endometriosis Association offers diagnostic kits, information about choosing the right doctor and other educational literature for women suffering chronic pelvis pain. To get more information, go to the Endometriosis Association or call 1-800-992-3636.


Many U.S. Preschoolers Have Never Visited Dentist

By Charnicia E. Huggins

Reuters Health

Wednesday, October 30, 2002

NEW YORK (Reuters Health) - Many children--particularly those from low-income families--are missing out on regular dental visits, ending up with more severe problems when they do get to the dentist, according to new study findings.

According to study authors Drs. Clemencia M. Vargas of the University of Maryland Dental School in Baltimore, Maryland and Cynthia R. Ronzio, "under the current dental care system in the United States, dental care is discretionary for the well-off but more of a luxury for the poor."

Their study involved more than 9,000 children and teens aged 2 to 18 who were involved in the third National Health and Nutrition Examination Survey (NHANES III). While 37% of the 2- to 5-year-olds involved in the survey visited the dentist regularly, more than half had never seen a dentist. Just over three-quarters of the 6- to 18-year olds had visited the dentist during the previous year, while 8% had never been to the dentist.

Overall, about 9% of the younger children and 21% of the older kids and teens needed dental care, either by their own or their parent's admission or according to a dental examination, the study findings indicate. Those children who needed dental care were the least likely to have had regular checkups, and more likely to see the dentist "as needed," the investigators report in the November issue of the American Journal of Public Health.

Such sporadic use of dental care makes prevention, early diagnosis and care very difficult, the researchers note.

White children were more likely to have visited the dentist during the previous year than black and Mexican American children. And similar to previous studies, children and teens from families with a higher socioeconomic status were more likely to have visited the dentist during the previous year, as were children from households with higher educational levels.

Among some children, barriers to receiving adequate dental care may include a scarcity of dentists who will treat young children, as well as misinformation among parents, many of whom think that their child does not have to visit the dentist because their teeth are not yet permanent. In fact, children should begin visiting the dentist at 12 months of age, experts say.

What's more, the link between poverty and poor dental health is like a spiral, according to the researchers. Parents may not take their child to the dentist unless the youngster has pain or other symptoms, but once this occurs, the problem may be more extensive and pricey to fix.

"A lack of dental care creates more severe oral health needs, which in turn, result in increased difficulties in getting care," Vargas and Ronzio told Reuters Health in an e-mail interview. "This is because as dental problems are left untreated, they become more complicated and expensive to treat."

In light of the findings, "nationally, we need to recognize the public significance of children with unmet dental needs," they advise. "We need more support for dental care, and we need greater availability of dentists who treat children."

Vargas performed the research while a fellow at the National Center for Health Statistics.

Source: American Journal of Public Health 2002;92:1816-1821.


New Weapon in War Against Cholesterol

By Kathleen Doheny
HealthScoutNews Reporter


Wednesday, October 30, 2002

WEDNESDAY, Oct. 30 (HealthScoutNews) -- ZETIA, the newest drug to help fight high cholesterol, isn't expected to eliminate the need for the statin drugs that are now the mainstay of treatment.

Rather, it will often complement the existing treatments and help when the statins -- such as Lipitor (news - web sites) (atorvastatin) or Zocor (simvastatin) -- aren't enough to lower cholesterol and the risk of heart disease, experts say.

"It's not in any way meant to displace the statins," says Dr. Rick Veltri, vice president of clinical research for the Schering-Plough Research Institute in Kenilworth, N.J. Schering-Plough and Merck & Co. formed a joint venture to market the new drug.

Just approved last week by the U.S. Food and Drug Administration (news - web sites), ZETIA can be used as a stand-alone therapy or in combination with the statins. A 10-milligram tablet is meant to be taken once a day.

"ZETIA (ezetimibe) has a different mode of action [than the statins]," Veltri says.

To better understand how each drug works, it helps to know that cholesterol in the blood is controlled principally by the liver, which produces cholesterol and bile acids, and by the intestines, which absorb cholesterol from food and from the bile.

Statins work by blocking an enzyme involved in the production of LDL cholesterol, the bad cholesterol, especially in the liver. "ZETIA blocks cholesterol activity in the intestine," Veltri says. Its action is "distinct and complementary" from that of statins.

More than 100 million Americans have total blood cholesterol values above 200 milligrams per deciliter, considered the cutoff for a healthy level by the American Heart Association (news - web sites). LDL levels should be less than 100 milligrams per deciliter, ideally, experts say, although levels of 100 to 129 are considered "near optimal" by the heart association.

About 13 million Americans are treated with statins for their LDL levels, and 60 percent still have unhealthy LDL levels, even while on the medication, according to Schering-Plough.

ZETIA can reduce LDL cholesterol quickly and dramatically, Schering-Plough has found. In its so-called "add-on study," 769 subjects with high-cholesterol who were taking statins were assigned to take ZETIA as well, or to take placebo. The ZETIA group obtained a 25 percent reduction in LDL levels, while the placebo group only got a 4 percent reduction.

The ZETIA groups' LDL went from an average of 139 milligrams per deciliter to 102, but the placebo group's LDL dropped only from 139 to 133.

Although ZETIA is brand new, "It may get quickly into the mainstream," says Dr. Robert Bonow, chief of cardiology at Northwestern University School of Medicine and president of the American Heart Association.

Besides being used as an add-on therapy for patients already on statins who haven't lowered their LDL cholesterol enough, ZETIA might be used alone, eventually, Bonow speculates. However, he agrees with Veltri that the new drug won't replace statins.

"Statins are here to stay," he says.

A 30-day supply of ZETIA is about $58, and the drug is expected to be available in pharmacies by mid-November.

In addition to prescribing medication to those with high cholesterol, doctors advise their patients to reduce dietary cholesterol and fat, exercise regularly and lose weight if necessary.

What To Do

For more information on what to do about high cholesterol, see the National Institutes of Health. For information on cholesterol statistics, check the American Heart Association.


Oral Contraceptives Cut Risk of Ovarian Cysts

Reuters Health

Wednesday, October 30, 2002

NEW YORK (Reuters Health) - Women using oral contraceptives are considerably less likely to develop ovarian cysts than those not taking the pill, Danish researchers report.

Ovarian cysts are small, fluid-filled growths on the ovaries. The specific type of cyst examined in the new study is a fairly common kind known as a functional ovarian cyst. These cysts form when an egg follicle in the ovary grows but does not rupture and release the egg during ovulation. Functional cysts are non-cancerous and usually disappear within a few months, though sometimes surgery is necessary to remove a large, growing cyst or one that is causing severe pain.

Birth control pills suppress ovulation and therefore may prevent ovarian cysts by blocking the formation of egg follicles in the ovaries, according to study author Jes Westergaard of the department of obstetrics and gynecology at Odense University Hospital in Odense, Denmark, and colleagues.

In the study of 428 women aged 14 to 45, the researchers found that 29 had functional ovarian cysts. When they compared women using oral contraceptives to those using non-hormonal intrauterine devices (IUDs) or no method of contraception, those on the pill were 78% less likely to develop functional ovarian cysts than the other women.

The results indicate that oral contraceptives "have a protective effect" against the development of functional ovarian cysts, the researchers write.

All of the women using birth control pills were taking lower-dose versions commonly prescribed today.

Most of the cysts resolved on their own within a few months, the researchers noted in the study, published in the a recent issue of the journal Contraception.

The risk of developing ovarian cysts was not linked to a woman's age, height, weight or the number of children she had birthed, results showed.

Source: Contraception 2002;66:153-157.


German Doctor Warns of Post-Nipple Pierce Infection

By Hannah Cleaver

Reuters Health

Wednesday, October 30, 2002

BERLIN (Reuters Health) - Infected nipple piercings can in the worst cases result in disfiguring abscesses, but not enough attention is paid to the problem by doctors or people who have piercings, a German doctor said on Wednesday.

Dr. Volker Jacobs from the women's health clinic at the Technical University of Munich said poor hygiene standards in piercing studios and lack of information for those who have piercings sometimes had dire consequences.

"It is thought that there are between two and three million piercings of all kinds in Germany alone each year and that around 20% of those become infected," he told Reuters Health.

"The piercing leaves a hole which doesn't heal for quite a long time. Many people put in the decorative piercing in just two weeks after the piercing was conducted. This is stupid, the piercing hole hasn't healed properly after such a period of time."

"It takes ten days for one millimeter of healing and when you think of a nipple piercing, that is around ten millimeters, which means about 100 days for the healing process to be completed."

But there has barely been any systematic examination of the problem, said Jacobs.

Jacobs is due to publish three case studies in Zentralblatt für Gynakologie within the next couple of weeks. Another paper by the physician is due to appear in the Deutsche Aerzteblatt medical journal within the next fortnight.

He said: "I am publishing three case studies in my first paper and I have seen seven other cases in total published. But that is all, and nine of those 10 have only been published in the last two years. People haven't been paying enough attention to this problem."

In one case, a woman in her late 20s had to undergo surgery because an abscess in her breast resulting from the nipple piercing infection had grown to the size of a fist before she sought professional medical help.

"We had to take out a part of her breast measuring five by six by seven centimeters. Her breast was reduced by that size--it is not as if you take out the abscess and have the full breast left," he said. "She had of course, to have general anaesthetic and was in hospital for a few days."

People with infections often left it too long before going to a doctor, he said.

"And people touch the piercing when it is new, and don't wash their hands, play with it--and this leads to infections. A big problem is also that the piercing culture is something of a subculture and as such not very open to new people offering advice."


More Living With Heart Failure

By Adam Marcus
HealthScoutNews Reporter


Wednesday, October 30, 2002

WEDNESDAY, Oct. 30 (HealthScoutNews) -- Americans are apparently now living longer with heart failure, mostly because of improvements in treatment for the incurable disease.

Researchers tracked the trends in heart failure over the past 50 years and found the ailment is now as much as 40 percent less common in women than it was in 1950. However, it remained unchanged in men over the period, possibly reflecting advancements in treating heart attacks, the chief source of heart failure in men.

At the same time, the chances of surviving the disease are now about a third better than they were five decades ago, according to the study, which appears in tomorrow's issue of The New England Journal of Medicine (news - web sites).

"We are now seeing evidence that survival following onset is improving," says Dr. Daniel Levy, director of the Framingham Heart Study and a researcher with the National Heart, Lung, and Blood Institute. The lack of a decline in cases among men isn't a failure, Levy adds. "Improvements in management of myocardial infarction have resulted in the survival of more people with the condition."

Even so, other experts say heart failure remains epidemic in this country, affecting some 4.8 million people and killing nearly 290,000 a year. There is no cure for the disease short of a transplant, although even this procedure doesn't restore a normal lifespan to organ recipients.

Two classes of drugs, angiotensin-converting enzyme (ACE) inhibitors and beta blockers, can ease the strain on failing hearts. These have made a major impact in short-term survival rates. However, the long-range outlook for patients remains bleak, and more than half die within five years of being diagnosed with the condition.

"Medical therapies are now improving survival. But there's no indication that the epidemic is going to stop," says Dr. Margaret Redfield, a heart failure expert at the Mayo Clinic and author of an editorial accompanying the journal article.

Surges in obesity and diabetes, two major risk factors for heart failure, could hurt the gains made in decades past, she says. And as more people receive beta blockers and ACE inhibitors, which are widely under-prescribed, the number of people living with heart failure will increase. High blood pressure is another important risk factor for the disease.

The Framingham study is an ongoing look at thousands of Massachusetts residents and their children who entered the project in 1948. It recently added a third generation of volunteers, who now total about 14,000.

Levy and his colleagues compared heart failure rates and mortality in 10,317 men and women. Between 1950 and 1999, 1,075 members of the group, or about 10 percent, developed heart failure, 51 percent of whom were female.

The incidence of the disease was steady among men in the study, but fell by between 31 percent and 40 percent among women. At the same time, the one-month, one-year and five-year mortality rates fell between 1950 and 1999, to 11 percent, 28 percent and 59 percent among men, and 10 percent, 24 percent and 48 percent among women.

Dr. Clyde Yancy, an internist at the University of Texas Southwestern Medical Center and a spokesman for the American Heart Association (news - web sites), says the latest results are encouraging.

"What is really exciting is that the data still don't reflect current practice, and my suspicion is that in everyday practice it's even better" now than in 1999, Yancy says.

Yancy warns, however, that "we can't assume that we've won anything. It's very clear to everybody involved that there is no cure" for heart failure.

What To Do

For more on heart failure, try the American Heart Association or the Heart Failure Society of America.


'Breast Cancer Gene' Boosts Prostate Risk, Too

By Patricia Reaney


Wednesday, October 30, 2002

COVENTRY (Reuters) - A genetic variation that makes women more susceptible to breast and ovarian cancer also raises a man's risk of developing prostate cancer (news - web sites), a British scientist said Wednesday.

Dr. Ros Eeles, a medical geneticist at The Institute of Cancer Research (news - web sites) in southern England, told a medical conference that men with an inherited defect in the BRCA 2 gene have a five-to-seven fold increased risk of prostate cancer than those without the fault.

She announced plans to launch a Europe-wide study of 500 men who have four or more close relatives who developed breast cancer (news - web sites) before age 60. They may have inherited the mutation and may be more likely to develop prostate cancer.

"We are trying to see if you can identify a high-risk group (of men) that you can target for screening," Eeles told the first annual meeting of the medical charity Cancer Research UK.

Forty percent of early-onset, aggressive prostate cancers are linked to inherited factors. Some are due to alterations in the BRCA 2 gene, according to Eeles.

The trial, which is due to begin in December or January, will be among the first to use genetic screening to target men in this way.

"The crucial thing about screening for prostate cancer is to identify those men with a high risk of an aggressive form of the disease," Eeles added.

Prostate cancer is a leading cause of cancer deaths in men. In the United States alone this year about 200,000 men will develop the disease and 40,000 will die from it.

The prostate specific antigen (PSA) test helps doctors detect early signs of the disease but scientists have questioned its accuracy. The test is also not very good at indicating whether a cancer is quick- or slow-growing.

"At the moment it is the best test we've got," said Eeles.

The disease is more common in older men. Very few men under 50 suffer from it. Half of all cases are in men 75 and older. It is normally treated with surgery or radiation.

The BRCA 2 gene mends damage to DNA. Mutations in the BRCA 1 and BRCA 2 genes increase breast cancer risk.

Eeles and her colleagues will screen men with the BRCA 2 mutation with the PSA test for five years and offer biopsies to those with raised levels of the antigen.

They will compare the number of men who develop the illness with results from a randomized PSA test trial being conducted in the Netherlands.

"As scientists' understanding of cancer genetics improves, pressure on screening programs will increase dramatically and it will not be possible to screen every man--we need a more targeted approach," Eeles added.



Little Proof That Chiropractic Care Helps Headache

By Charnicia E. Huggins

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - While many advocates of chiropractic spinal manipulation say the technique is an effective treatment for headache, there is little scientific evidence to support that claim, according to the results of a new study.

Previous research has shown that many headache sufferers use complementary and alternative medicines, especially relaxation therapies and chiropractic care. And many chiropractors say they have successfully treated patients with headache, according to the National Board of Chiropractic Examiners.

Yet, the present findings show that "the evidence is not strong enough to say manipulation is good for headaches in general," study author Dr. John A. Astin of the California Pacific Medical Center Research Institute in San Francisco told Reuters Health.

"It may come," he said, but right now, the "number of studies is too few and flawed."

Astin and his co-author Dr. E. Ernst investigated the effectiveness of spinal manipulation for headache in a review of eight previously published studies. Astin performed the research while at the University of Exeter in the UK.

The researchers could not draw any definite conclusions about the effectiveness of spinal manipulation due to the small number of studies involved and the different study methods used, they report in the journal Cephalalgia.

Altogether, most of the studies found spinal manipulation to be beneficial, but in four of the eight studies those benefits were comparable to those seen among patients in the various comparison groups, the investigators report.

Thus, it is hard to know whether the patients' improvement was a result of the chiropractic manipulation or of the patients' expectations that they would get better, Astin said.

One of the more recent studies found that the chiropractic therapy reduced the patients' frequency and duration of migraine headaches, and that these positive effects remained evident at follow-up 2 months later. However, Astin and Ernst found the study to have a number of "methodological and statistical problems...that call into question the validity of these findings."

In light of the overall findings, there is "not enough evidence" to tell patients that spinal manipulation is an effective headache treatment, Astin said. It is "up to patients to see if they want to experiment with it."

The researcher added that so far, the strongest evidence in favor of chiropractic care suggests it may be beneficial for low back pain. "Other than that, evidence is very minimal," he said.

The study was funded by a grant from the National Center for Complementary and Alternative Medicine.

Source: Cephalalgia 2002;22:617-623.


Survey: Sex Often Part of Casual Teen Relationships

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - A new survey of 15- to 17-year-olds has found that, at least in terms of teens' perceptions, oral sex and intercourse are nearly as common in casual relationships as they are in more serious, committed relationships.

While 26% of surveyed teens said that oral sex was part of a dating relationship, 23% said that oral sex was typical of a casual relationship, or "hooking up." Twenty-seven percent said dating relationships "almost always" or "most of the time" included sexual intercourse, while 24% said intercourse was usually part of a casual relationship.

About one third of the 505 teens interviewed by telephone reported that they had done "something sexual" in a casual relationship, including 14% who said they had had sexual intercourse. One third said they had sexual intercourse in a committed relationship.

But commitment does not necessarily imply exclusivity. Nearly one quarter of teens said that cheating on a boyfriend or girlfriend was common. Teens also said that they are less likely to use condoms if they are in a serious relationship.

Discussions about condoms and sexually transmitted diseases (STDs) were easier to broach in more serious relationships, according to the survey by SexSmarts, a partnership between the Kaiser Family Foundation and Seventeen magazine. Kissing was also described as part of a more committed relationship.

More than 70% said that girls are more entitled to request that a boyfriend use a condom, compared to someone they are "hooking up" with. But girls in longer-term relationships were more likely to report using birth control pills and less likely to say they used condoms. Talk about sexual history and STD testing was also more common in longer-term relationships.

And when it comes to sexual decision-making, knowing and even trusting another person is not the only factor influencing what a teen might do, according to the survey. More than two-thirds said that alcohol and drugs affect their decisions and slightly more said they are influenced by what the other person wants to do. What a parent might think was important to 68% of teens.

The interviews were conducted by International Communications Research for the Kaiser Family Foundation.

The findings are presented along with special articles in the October issue of Seventeen. More information can be found at


Hormone Linked to Higher Risk of Ovarian Cancer

By Merritt McKinney

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - High levels of a protein called insulin-like growth factor (IGF)-I may increase women's risk of developing ovarian cancer before age 55, the results of a new study suggest.

Measuring IGF-I levels is unlikely to be useful as a screening test for ovarian cancer, according to the study's lead author, Dr. Rudolf Kaaks, of the International Agency for Research on Cancer in Lyon, France. However, he told Reuters Health that the discovery of elevated levels of the growth factor in women with ovarian cancer raises the possibility that diet, which can increase IGF-I, may be involved in ovarian cancer.

Ovarian cancer is highly treatable in its early stages, but the cancer is rarely caught early, in part because its symptoms, such as bloating and abdominal discomfort, can signal any number of problems. Also, there is not a good screening test for ovarian cancer, so more than two thirds of cases are not detected until after cancer has spread outside the ovaries. Once ovarian cancer spreads, the 5-year-survival rate is only 29%.

Because detecting ovarian cancer before it spreads can be life-saving, the scientific search is on for ways to detect the disease. Some preliminary studies have found that IGF-I levels are higher than normal in ovarian tumors, and there is some evidence that IGFBP-3, a protein that transports IGF-I, is reduced in ovarian cancer.

In the new study, Kaaks and his colleagues tested the connection between IGF-I, IGFBP-3 and ovarian cancer in women enrolled in several long-term health studies. The study included 132 women with ovarian cancer and 263 healthy women who were matched by age.

Based on blood samples taken at least one year before women were diagnosed with cancer, the researchers did not detect any overall link between levels of IGF-I or IGFBP-3 and ovarian cancer. However, for women who received a cancer diagnosis before age 55, levels of IGF-I but not IGFBP-3 seemed to affect cancer risk. Among the younger women, those with the highest levels of IGF-I were almost five times more likely to be diagnosed with ovarian cancer than women with the lowest levels.

The study did not examine how IGF-I may increase the risk of ovarian cancer, but the investigators suggest several possibilities in their report in the International Journal of Cancer. The growth factor could promote tumor growth by increasing the proliferation of cells, as well as by inhibiting the mechanism that instructs defective cells to kill themselves. Another possibility, according to the report, is that IGF-I may somehow interact with hormones or ovulation in premenopausal women.

"I doubt whether elevated IGF-I would ever be useful as a marker for ovarian cancer screening," Kaaks told Reuters Health. It is "unlikely," he said, that high levels of IGF-I would be caused by a preclinical ovarian tumor.

"Rather, we think that elevated IGF-I levels are due to other causes preceding ovarian cancer development," he said.

He explained that many factors, including nutrition, affect blood levels of IGF-I. "It is possible," Kaaks said, "that the elevated IGF-I in women at increased risk of ovarian cancer was a result of nutritional factors."

According to Kaaks, "Circulating IGF-I might thus provide a physiologic link between a Western lifestyle, characterized among other things by a diet rich in energy and animal protein, and ovarian cancer risk." He noted that the risk of ovarian cancer is much higher in industrially developed countries than in developing nations.

Source: International Journal of Cancer 2002;101:549-554.


Scratching the Surface


Tuesday, October 29, 2002

(HealthScoutNews) -- Eczema flare-ups that turn your skin red, dry and scratchy are almost unavoidable, but you can decrease their frequency with a specific skin care routine.

The American Academy of Family Physicians (news - web sites) offers these tips:

  • Limit your contact with household cleaners, aftershave lotions, detergents and other things that may inflame your skin.
  • When you wash the dishes or do other chores that require you to have your hands in water, wear plastic gloves. Also wear gloves outdoors in the winter. Cold, dry air can aggravate your eczema.
  • Wear cotton clothes. Wool and synthetic fibers can irritate your skin.
  • Use a small amount of mild soap in the bath. The water should be cool or warm and you should soak in the tub for 15 to 20 minutes. Your skin's outer layer will absorb the water and become less dry. Moisturize while your skin is still damp.


Not All Garlic Supplements Created Equal

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - Whether you're hoping to keep vampires away this Halloween or using garlic supplements to scare off other health threats, the product you buy may not contain enough of the smelly bulb's active ingredient to do the job, according to a new report., a commercial testing company based in White Plains, New York, reported Tuesday that half of the garlic supplements the company tested did not contain "therapeutic" levels of allicin, garlic's supposed active ingredient.

For a fee, licenses its flask-shaped "Seal of Approved Quality" to companies whose products pass testing.

The company notes that garlic is the most popular selling herbal product and is purchased by millions of people to fight elevated cholesterol and high blood pressure.

The company evaluated label dosage claims and tested 13 non-aged garlic products and one aged garlic product.

"The amount of allicin produced by the non-aged garlic products ranged from as little as 400 micrograms to 6,500 micrograms per daily recommended serving," the company said in a press release. "This huge variation could certainly affect the relative potency of the products."

The one non-aged garlic product met its label claims for garlic-related compounds.

"It is impossible for a consumer to know for sure how strong a garlic product is without testing it," said Dr. Tod Cooperman, president of, in a prepared statement. "Few products clearly state their allicin yield and, when they do, they are not always accurate."

The findings add to a growing body of evidence that has found many dietary supplements lacking in terms of quality control.

Under the Dietary Supplement Health and Education Act of 1994, supplement manufacturers are required to have on file substantiation of any claims they make about how a product affects the structure or function of the body. They must also notify the Food and Drug Administration (news - web sites) (FDA) of claims that they are making within 30 days of marketing a given dietary supplement.

However, the FDA does not regulate ingredients in supplements or dosage levels.


Rat Study Suggests Estrogen May Worsen Alzheimer's

By Suzanne Rostler

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - The results of a new study in rats suggest that estrogen replacement therapy may hinder--not help--memory in older women with Alzheimer's disease (news - web sites).

Many animal and laboratory studies had suggested that estrogen might protect the brain from memory loss, but it is not clear if this is true for estrogen replacement therapy (ERT).

In the new study, rats had their ovaries removed--putting them into a low-estrogen state similar to menopause--and given a drug to stimulate brain inflammation, which occurs in patients with Alzheimer's disease. The researchers found that these rats actually fared worse on memory tests when they received steady doses of estrogen.

The findings add to a growing body of research demonstrating the potentially negative effects of ERT, long thought to protect women against certain age-related changes. While estrogen may protect certain women from memory loss, it may not be beneficial for those with brain inflammation, which occurs in patients with Alzheimer's disease.

"Our results suggest that chronic ERT in postmenopausal women may exacerbate the memory impairment induced by the presence of chronic neuro-inflammation associated with Alzheimer's disease," Dr. Gary L. Wenk and colleagues from the University of Arizona in Tucson, conclude.

In an interview with Reuters Health, Wenk stressed that future studies will need to investigate whether synthetic estrogen has the same effect when it is given in fluctuating levels, similar to what occurs before menopause. Such a therapy may provide a more effective way to slow the progression of Alzheimer's disease and other age-related memory changes.

"We want to try to reproduce hormonal fluctuations between estrogen and progesterone as much as possible in rats to try to mimic the conditions that existed previously in rats and in women," he said.

In the study, the researchers trained the rats to negotiate a water maze, and tested them on how well they remembered the course following treatment. The investigators implanted a capsule that delivered a constant and steady dose of estrogen, similar to the way ERT is delivered in women, into some of the rats. Memory was compared among six groups of rats.

Brain inflammation by itself did not affect the memories of rats with ovaries, suggesting that naturally-occurring estrogen may protect memory. The findings are consistent with those of other studies showing the mind-protecting effects of estrogen in women, the authors note.

However, the relationship between estrogen and inflammation was more complicated when the hormone was given synthetically, according to the report in the October issue of Behavioral Neuroscience.

The removal of the ovaries did not affect performance in the water maze. However, rats that also received ERT or experienced brain inflammation in addition to losing their ovaries were found to have impaired memory. The combination of inflammation and ERT caused far worse memory problems, as judged by their ability to negotiate the water maze.

Source: Behavioral Neuroscience 2002;116:902-911.


Substance in Saliva Protects Babies from Mom's HIV

By Alison McCook

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - Babies with relatively high levels of a particular compound in their saliva appear to be less likely than others to acquire HIV (news - web sites) from their infected mothers at one month of age, according to new study findings.

Dr. Carey Farquhar of the University of Washington in Seattle and colleagues found that babies with higher levels of a substance called secretory leukocyte protease inhibitor (SLPI) at one month of age were half as likely as those with lower levels of SLPI to have acquired HIV from their mothers.

Farquhar told Reuters Health that it may eventually be possible to administer drugs that mimic the action of SLPI to help prevent babies from acquiring their mothers' HIV infection.

"SLPI is a protein that could be developed into a drug," Farquhar noted.

HIV-1 is a major type of the virus that can cause AIDS (news - web sites). It is more readily transmitted through sex, infected blood and from mother to child, and may progress to AIDS more quickly than another common type, HIV-2.

Previous research has shown that SLPI in saliva has antiviral, antibacterial and anti-inflammatory properties. In fact, one study suggested that this healing compound may be one reason why dogs and other animals lick their wounds.

Researchers have also shown that SLPI, along with other compounds in saliva, can combat HIV-1, but only SLPI has demonstrated itself capable of going head to head with the virus when tested in the lab at concentrations normally found in saliva.

In the current study, reported in the October 15th issue of the Journal of Infectious Diseases, the investigators tested 602 samples of saliva from 188 infants born to mothers who were infected with HIV-1. The saliva was collected from the infants at birth and when they were 1, 3 and 6 months old.

Although Farquhar and colleagues did not discover an overall link between the risk of mother-to-child infections, they noted that babies with higher levels of SLPI at the age of 1 month were half as likely as other babies to have picked up HIV-1 from their mother's breast milk.

Most often, the concentration of SLPI in infants' saliva dropped from birth to 6 months, the report indicates.

Although HIV does not often infect people after an oral exposure--which researchers have suggested may also be due to SLPI--around 40% of all cases of mother-to-child transmission occur through breast milk, Farquhar told Reuters Health in an interview.

Breast milk contains HIV, the author noted. During delivery, a baby also becomes orally exposed to the mother's blood and genital secretions in the birth canal, while in the womb the baby drinks amniotic fluid, which also contains HIV, Farquhar noted.

The researcher added that it may not be useful to test babies' SLPI levels at birth to determine their susceptibility to infection. "We found that month 1 SLPI levels were associated with breast milk transmission and in countries where HIV-infected women breast-feed their babies, it would probably be better to test maternal HIV viral load to determine how much virus the mother has in her body," Farquhar said.

Source: Journal of Infectious Diseases 2002;186:1173-1176.


Flat Feet Mean Sore Feet


Tuesday, October 29, 2002

TUESDAY, Oct. 29 (HealthScoutNews) -- Don't get caught flat-footed with flat feet.

The American Academy of Orthopaedic Surgeons (AAOS) says flat feet -- a condition where a foot doesn't have a normal arch -- can cause disabling foot pain as well as knee pain, shin splints, achilles tendonitis and plantar fasciitis.

About 25 percent of Americans have flat feet, and most of them don't have a problem. However, anyone suffering foot or leg pain should pay attention to whether one foot is flatter than the other.

There are a number of ways to determine if you have flat feet. One is a footprint test that you can do when you step out of the swimming pool. Check your wet footprint. If everything is normal, the front of your footprint should be joined to the heel by a strip about half the width of the front of the foot.

But if you have flat feet, that strip will be the same width as the front of your foot. Your footprint will look like a stretched-out pancake. If there's only a thin strip, that means you have a high arch.

You can also do a shoe evaluation. Place your shoes on a flat table and examine them at eye level from behind. You're checking to see if there's even sole wear. A flat foot causes more wear on the inside of the sole, especially in the heel area. That type of wear will make the shoe easy to rock from side to side.

Check the upper part of the shoes as well. A flat foot caused the upper part of the shoe to lean inward toward the sole.

If you suffer foot pain and have flat feet, the AAOS suggests you see an orthopedic surgeon for an evaluation.

More information

Learn more about flat feet at the British Orthopaedic Foot Surgery Society.


'Decoy' Ointment Relieves Chronic Skin Rash in Mice

By Merritt McKinney

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - An ointment containing a "decoy" for a protein involved in inflammation seems to be a promising treatment for the chronic skin condition atopic dermatitis, according to the results of a new mouse study.

Atopic dermatitis is a chronic inflammatory disease that causes red and itchy spots on the skin. The condition is most common in childhood, affecting 10% to 15% of children and adolescents in Western countries.

Ointments that contain corticosteroids can relieve atopic dermatitis, but these steroids can cause side effects. Other treatments are being studied, but like steroids, they can have effects throughout the body, not just in the skin.

In skin cells taken from people with atopic dermatitis, there is often an overproduction of immune molecules called cytokines and chemokines, which can contribute to inflammation. A protein called NF-kB promotes the production of one type of cytokine, so a team led by Dr. Ryuichi Morishita, of Osaka University in Japan, set out to target NF-kB.

Morishita and colleagues used substances called oligodeoxynucleotides (ODN) as "decoys" for NF-kB. The idea behind the approach was that by impersonating NF-kB, the ODN might interfere with the inflammatory process, which would lead to an improvement in atopic dermatitis.

The approach seemed to be effective and safe in mice, according to a report in the journal Gene Therapy. In mice with a condition similar to atopic dermatitis, symptoms improved after treatment with an ointment that contained the decoy.

In comments to Reuters Health, Morishita added that in a preliminary study carried out in people earlier this year, symptoms on the face "dramatically improved without any apparent side effects." Morishita's team is now planning another human trial in conjunction with AnGes MG, a spin-off venture of Osaka University.

Morishita noted that, unlike other treatments for atopic dermatitis, the decoy in the ointment is rapidly degraded once it enters the bloodstream, meaning that the effects of the treatment are limited to the skin, which should avoid side effects that occur throughout the body. The hope with the ointment, according to the Japanese researcher, is that it will offer another choice for people with atopic dermatitis who either cannot tolerate steroids or would prefer not to take them.

Source: Gene Therapy 2002;9:1221-1229.


Breast-Feeding May Lower Rheumatoid Arthritis Risk

By Charnicia E. Huggins

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - Women who spend a total of 2 or more years of their lives breast-feeding may be less likely to develop rheumatoid arthritis than those who breast-feed for 3 months or less, new study findings show.

"We know that breast-feeding is good for the babies," lead study author Dr. Elizabeth W. Karlson of Brigham and Women's Hospital in Boston, Massachusetts, told Reuters Health. "This is a study that suggests that breast-feeding is beneficial for the mother."

Rheumatoid arthritis occurs when the immune system, for unknown reasons, mistakenly attacks the joints, leading to inflammation, swelling and pain. Over time, this process erodes the bone and soft tissue within the joints. The condition is more common in women than in men, and previous research suggests that certain hormonal factors may be associated with an increased risk of the disease.

Karlson and her team investigated that association in a study of about 80,000 women from 11 states who were involved in the on-going Nurses' Health Study from 1976-2000. They evaluated the influence of several reproductive and hormonal risk factors including the women's age at first menstruation, their number of children, their age at their first birth and their length of time spent breast-feeding.

Overall, 623 women developed rheumatoid arthritis during the study period. Those who did not have children were more likely to develop the condition than mothers, the investigators report.

And among mothers, those who spent a cumulative 2 or more years breast-feeding were 50% less likely to develop rheumatoid arthritis than those who breast-fed for 3 months or less, study findings indicate.

Those who breast-fed for 13 to 23 months also tended to have a lower risk of developing the condition, but the risk was lowest among those who breast-fed for at least 24 months, which suggests that the "longer you breast-feed, the larger the reduction" in risk, Karlson said.

Furthermore, the link between the length of time spent breast-feeding and the reduced risk of rheumatoid arthritis remained even when the investigators took into consideration the women's smoking, which is known to be associated with an increased risk of the condition, Karlson said.

The exact reason for the association is unknown, but Karlson speculated that it may be due to one of the hormonal factors that are elevated during breast-feeding. More study is needed, she said.

No association was found between any other reproductive or hormonal factors and rheumatoid arthritis risk.

The study findings were presented on Tuesday at the annual meeting of the American College of Rheumatology in New Orleans, Louisiana.


Scientists Take New Approach to Fight Cancer

By Patricia Reaney


Tuesday, October 29, 2002

COVENTRY (Reuters) - British scientists are trying to develop a drug that mimics the action of a natural protein in the body, which could pave the way for a new approach to fighting cancer.

Unlike chemotherapy drugs, which kill cancerous and healthy cells and produce serious side effects, the new drug would selectively destroy only the diseased cells.

Professor Julian Blow, of the University of Aberdeen, told a medical conference Tuesday the aim was to mimic the effect of a protein called geminin, which is involved in cell division.

Geminin controls the process of copying DNA, which occurs whenever a cell divides. High levels of it can kill cancer cells but healthy cells have a type of safety mechanism that seems to protect them from it.

"This mechanism has not been targeted before (against cancer). It is a completely new way of going about it," Blow said.

When he and his colleagues tested large quantities of geminin on bone and lung cancer cells in laboratory studies they found it caused the cells to kill themselves in a type of cell suicide.

But when healthy cells were exposed to it they stopped dividing but were not harmed.

They believe high levels of the protein would have the same damaging impact on different types of cancer.

"We found that normal cells had a mechanism to make them completely resistant to over-expression (too much) of this protein," Blow said, adding that cancer cells could not deal with it.

He and his team are now searching for compounds that have a similar effect to geminin, which is too large a molecule to be delivered as an anti-cancer drug.

"We predict that if we can make a proper drug-like molecule that mimicked the effects of geminin this would potentially show much, much higher selectivity toward killing cancer cells than conventional drugs," he added.

Blow presented his findings to the first annual meeting of the medical charity Cancer Research UK, the biggest independent cancer research organization in the world.

About 300 of Britain's top cancer experts are attending the three-day meeting which will set the agenda for cancer research in the country.


Online Insight for Men Who've Had Prostatectomy


Tuesday, October 29, 2002

TUESDAY, Oct. 29 (HealthScoutNews) -- There's a new online calculator that helps forecast the future health of men who have had radical prostatectomy to treat localized prostate cancer (news - web sites).

The calculator predicts the likelihood of a man's level of prostate-specific antigen (PSA) remaining low seven years after removal of the prostate gland. About 30 percent to 40 percent of men who have a prostatectomy experience an increase in their PSA level. That may indicate a recurrence of prostate cancer within five to 10 years after the surgery.

To get results, visitors can go to prostate calculator and enter information such as pre-operative PSA level, their preoperative or postoperative cancer stage, and biopsy or pathologic Gleason score. Once the information is entered, it just takes a mouse click to get the prognosis.

The site doesn't collect any personal information and patient privacy is respected. Along with the prognosis, the site offers access to cancer-related information. It doesn't promote specific doctors or treatments.

The calculator was produced by the Artificial Neural Networks in Prostate Cancer Project, based in Denver, Colo. It's based on a multi-year study that examined factors that influenced PSA recurrence in 2,065 men who had radical prostatectomy between 1988 and 2000.

The calculator's accuracy rate is estimated to be more than 70 percent. It's not meant to replace doctors but does provide an improved method of predicting prostate cancer recurrence, says the author of the study that provided the basis for the calculator.

Each year, about 40,000 American men have a radical prostatectomy to treat localized prostate cancer.

More information

Here's where to go to find out more about prostate cancer.


Most U.S. Moms Receive Many Interventions in Labor

By Alison McCook

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - Although most women in the United States appear satisfied with their experience when giving birth to a child, the majority also received seven different medical interventions during labor, according to new survey findings.

Maureen Corry of the Maternity Center Association in New York City, who commissioned the survey, said that the number of interventions employed seems surprisingly high, since most of the women surveyed were healthy. These interventions carry certain risks, she added, and may also interfere with the normal birth process.

Corry also noted that 71% of women surveyed said that they did not walk around the hospital or birth center once they arrived and started having contractions. Of those who didn't walk around, the majority said they couldn't do so because they were attached to devices such as an intravenous drip.

Walking around during labor is healthy, Corry told Reuters Health. "In a sense, the normal childbearing experience is being interfered with because of these interventions," she said.

Along with an intravenous drip, the interventions given to most expecting mothers included a bladder catheter, electronic fetal monitoring, an epidural and an artificial rupture of the membranes that envelop the baby in order to induce labor.

The survey, called "Listening to Mothers," was conducted by Harris Interactive. It consisted of responses from more than 1,600 women who had given birth within the last 2 years. The Maternity Center Association released the results of the survey on October 24.

The survey also found that women who relied on pain medications during childbirth opted most often for epidurals. Fewer opted for drug-free methods of pain relief, such as massage, application of hot and cold objects, or getting into a shower, tub or pool.

Although most women who chose an epidural said that it was "very" helpful in alleviating their discomfort, many women who opted for drug-free methods reported that they were helpful, as well.

Based on these findings, Corry told Reuters Health that she wondered whether many mothers knew about drug-free techniques to alleviate pain, and suggested that some who didn't opt for these techniques may very well have benefited from them. "The nice thing about the drug-free (techniques) is that they're risk-free," she said.

Most women said they felt positive emotions immediately after giving birth, but many also experienced negative feelings, such as feelings of depression during the week before the survey (19%), lack of sexual desire (59%) and physical exhaustion (76%). These findings suggest that many women may require more emotional and physical support after giving birth, Corry noted.

Although 70% of the women who completed the survey said they were treated with kindness and understanding during labor, Corry noted that the joy of giving birth to a healthy child may have overshadowed what the women experienced during labor.

"I think women, if they go home with a healthy baby, that's what they wanted," she said.

Corry said that she hopes these findings inspire people involved in the birthing process to listen more to what women want, and address their needs to improve how they experience becoming new mothers. "I think we need to engage women more in this whole discussion of pregnancy, labor and birth," she said.


Drug Store Machines OK for Testing Blood Pressure

By Pam Harrison

Reuters Health

Tuesday, October 29, 2002

EDMONTON (Reuters Health) - Electronic blood pressure-monitoring machines found in drugstores, supermarkets and other locations are reasonably accurate, provided people take three readings about a minute apart, a researcher reported here at the medical meeting Canadian Cardiovascular Congress 2002.

Patients typically insert their arm into the device for a quick update on their blood pressure, said Merle Wilson, a nurse in the Cardiovascular Risk Factor Reduction Unit at the University of Saskatchewan, Saskatoon.

Wilson tested the devices in 16 pharmacies across the province, using four volunteers. Two of the four volunteers were being treated for high blood pressure while the other two had normal blood pressure.

The researcher measured blood pressure in one arm with a traditional blood pressure cuff, and in the other arm with the electronic machines.

The investigator found that the machines in drug stores tended to overestimate blood pressure by about 8 millimeters of mercury for systolic blood pressure (the top number in a blood pressure reading), and by about 4 millimeters of mercury for diastolic blood pressure (the lower number in a blood pressure reading).

The good news is that the devices did not underestimate blood pressure.

None of the drug store blood pressure monitoring machines "underestimated systolic blood pressure and only one underestimated diastolic blood pressure by more than 5 millimeters of mercury," she said. "We conclude that if a patient's blood pressure is at goal in the drug store, it is unlikely to be above goal in the physician's office."

For people with high blood pressure without diabetes or kidney disease, blood pressure is considered to be "at goal" when it is less than 140/90 millimeters of mercury.

Wilson also told Reuters Health that the accuracy of drug store blood pressure machines can be improved if people take three readings between 30 to 60 seconds apart, the last reading being the most accurate.

People should also try to sit quietly for a few moments before taking their blood pressure and refrain from drinking coffee or smoking for at least 30 minutes before using the machine, she said.


Combo Drug Therapy Helps Rheumatoid Arthritis Sufferers

By Ross Grant
HealthScoutNews Reporter


Tuesday, October 29, 2002

TUESDAY, Oct. 29 (HealthScoutNews) -- Treating rheumatoid arthritis with multiple drugs from the start appears to significantly reduce the number of sick days taken by people with the disease and the potential for long-term disability, a new study says.

Rheumatoid arthritis (RA) affects about 2.1 million people in the United States, compared to the 21 million affected by osteoarthritis. It is an inflammatory disease that causes pain, swelling, stiffness and loss of function in the joints. But unlike most forms of arthritis, RA usually begins when people are in their 20s or 30s. In many cases, the resulting fatigue from the illness forces people to change or quit their jobs.

"It's important to keep these people working, so they can live their lives normally," says Dr. John Klippel, medical director for the Arthritis Foundation.

Researchers from Finland presented the findings at the annual scientific meeting of the American College of Rheumatology, which concludes today in New Orleans.

The researchers tracked 162 patients for five years at the Lappeenranta Central Hospital in Finland. For the first two years, half of the patients received a combination of drugs while the other half received a single drug. Then, for the last three years, all of the patients could choose to be treated with a combination of drugs, including methotrexate and sulfasalazine.

Those who got just a single drug early on had an average of almost three times as many sick days during the five years as those with the more aggressive treatments -- 32 days a year compared to 12. While all of the patients could work at the start of the study, 29 percent of the first group had retired by the end, compared to 20 percent of the second group, says lead researcher Dr. Kari Puolakka.

More aggressive therapy not only improves the quality of life for RA patients, Puolakka says, it also "saves substantially the costs to society." Disability benefits for the single-drug group cost the Finnish government almost 900 Euros (about $900) a year, compared to just over 300 Euros (about $300) a year for the group that received a mix of medications, she says.

In America, the study confirms a recent shift in treatment methods from a single drug to a combination of drugs, Klippel says.

"Over last three to five years, doctors have started using more and more of this type of therapy. This study provides some important evidence for us that it works," he says, adding that about 60 percent to 80 percent of U.S. rheumatologists now use this combination therapy.

A study like the Finnish one would be very difficult to perform in the United States, Klippel adds. Besides tracking a large group of patients for five years, the researchers had to collect accurate information about their missed work days. Because Finland has nationalized medicine, the study is much more reliable, he says.

The most important finding of the study, Klippel says, is that the type of combination therapy used is already showing a major impact on a patient's quality of life five years later. This bodes well for a patient's next 10, 15 or 20 years, he says.

"For most people, the symptoms are improved but not completely removed. But they have much more control over their lives," Klippel says.

Rheumatoid arthritis has several characteristics that make it different from other kinds of arthritis. For example, rheumatoid arthritis generally occurs in a "symmetrical pattern." This means that if one knee or hand is involved, the other one is also.

The disease often affects the wrist joints and the finger joints closest to the hand, although it can also affect other parts of the body besides the joints. In addition, suffers may have fatigue, occasional fever and a general malaise, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

What To Do

To learn more about rheumatoid arthritis, visit the National Institutes of Health or the National Library of Medicine.


Americans Get Bulk of Nutrition Info from TV

By Suzanne Rostler

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - Television is the top source of nutrition information for nearly three quarters of Americans, out-performing newspapers and the Internet in a national survey.

And 58% of the 700 adults surveyed by the American Dietetic Association (ADA) cited magazines as a major information source, up from 47% in 2000. The Internet was cited by 13% overall, up from 6% in 2000, and was most popular among adults aged 25 to 34 and college graduates.

Overall, all information sources were cited more often in the latest survey, compared with 2 years ago, indicating greater interest in news in general, including nutrition news, Dr. Jeff Hampl, a registered dietitian and professor at Arizona State University in Phoenix and an ADA spokesman, told Reuters Health.

More information appears to be translating into action. A greater percentage of Americans said they were taking steps to improve their nutrition and health, according to the survey, which grouped respondents into one of three categories based on their stated commitment to a healthy lifestyle.

About 38% of respondents fell into the "I'm Already Doing It" category in 2002, up from 28% in 2000. People in this group reported making improvements in their eating habits over the past 2 years.

At the same time, 30% of respondents fell into the "I Know I Should, But..." category, down from 40% in 2000. There was no change in the percentage of individuals in the "Don't Bother Me" category, which describes people who are not concerned with nutrition.

However, Hampl said the increasing number of Americans battling excess weight suggests that while people may be interested in taking action, they are not always doing so. According to two recent studies, rates of overweight and obesity among adults and children soared between 1988 and 2000.

Among adults, the rate of extreme or morbid obesity nearly tripled over the past decade, while more and more children are being diagnosed with previously adult obesity-linked conditions such as high cholesterol and type 2 diabetes.

Part of the problem is confusion over the idea that all foods are okay in moderation. "Moderation," Hampl said, is a subjective term.

"When I say moderation I mean once every 6 months, but some people assume they can have it as often as they want, as long as they have a little bit," he said. "Any food can be enjoyed; it's just a matter of how often, how much, and how does your overall diet justify including that food."

In other survey findings, many people remain confused about what constitutes a serving size. Most people overestimated the serving size of cooked pasta or rice (a half-cup); cooked meat, chicken or fish (2-3 ounces); and cooked vegetables (a half-cup).


Older People Do Just as Well After Heart Transplant

By Pam Harrison

Reuters Health

Tuesday, October 29, 2002

EDMONTON (Reuters Health) - Heart transplant recipients 60 years of age and older at the time of the operation fare as well in the long run as younger patients, according to the longest study ever done of older people given a donor heart.

Older patients are also less likely than younger patients to experience any episodes of rejection, both soon after receiving the transplant and over the long term, the study shows. Findings from the study were presented here at the Canadian Cardiovascular Congress.

Dr. Philippe Demers of Stanford University School of Medicine in California and colleagues compared outcomes for transplant recipients between the ages of 18 and 60 at the time of the transplant and recipients who were 60 to 70 years old when they received the transplant. There were 403 patients in the younger group and 81 patients in the older group.

Thirty days after patients had received their donor heart, 6% of both younger and older patients had died. Both groups of patients spent 20 days in hospital, on average, Demers said.

While younger patients experienced an average of 2.6 episodes of rejection during the first few months after receiving their transplant, older patients had only 2 rejection episodes over the same time period.

One year later, 39% of older patients still had not shown any signs of rejection, compared with 27% of younger patients. Survival for older patients was also the same, up to 10 years after transplant, as for the younger patients. At one year, 83% of younger patients were still alive, compared with 88% of the older group. Five years later, 73% of the younger group were still alive as were 75% of the older group, while 50% of the younger group and 51% of the older group were still alive at 10 years.

As might be expected with increasing age, older patients were more likely to develop various types of cancer over time than the younger patients. On the other hand, older patients were no more likely to develop lymphomas or infections than younger patients.

"We believe the critical element in transplant patients over the age of 60 is careful pre-transplant assessment in order to detect any cancer" that might be present prior to the operation, Demers told delegates.

At Stanford, the upper age limit for heart transplant recipients is between 70 to 75.


High or Low C-Section Rates Predict Infant Outcomes

By Alison McCook

Reuters Health

Tuesday, October 29, 2002

NEW YORK (Reuters Health) - Infants born at hospitals that perform more or less than the expected number of cesarean sections appear to be more likely than others to have complications, new study findings suggest.

The investigators found that babies born at hospitals that perform fewer cesarean sections than expected were almost twice as likely as those born in hospitals who give the procedure as often as expected to experience a lack of oxygen, a complication that can lead to long-term problems.

Babies born at hospitals that performed more than the expected amount of cesarean sections appeared to have a more than threefold higher risk of this complication, according to Dr. Jennifer L. Bailit and her colleagues at the University of North Carolina at Chapel Hill.

In an interview with Reuters Health, Bailit clarified that she did not believe the risk of complications in infants stems specifically from how well or how poorly the cesarean section is performed at different hospitals. Rather, she suggested that the rate at which hospitals perform the procedure may reflect an overall "quality problem."

For example, she noted that doctors who work at hospitals in which less than the expected number of babies are delivered via a cesarean may be less able to recognize which mothers need the operation. "It could be that they're not recognizing babies with problems," she said.

The rate at which hospitals performed cesareans was associated with adverse outcomes in the infant in the form of asphyxia, a condition in which babies do not receive enough oxygen, which can lead to long-term neurological damage.

Specifically, Bailit's team found that 0.17% of babies born at hospitals that performed as many cesareans as expected experienced asphyxia, a complication noted in 0.33% of those at hospitals that performed fewer than the expected number of cesareans. A total of 0.58% of babies born at hospitals with higher than expected rate of cesareans experienced asphyxia, according to the report in a recent issue of the American Journal of Obstetrics and Gynecology (news - web sites).

The findings are based on a review of birth certificate data from hospitals in Washington State gathered between 1995 and 1996. The study includes the results of 138,682 deliveries of babies who were neither highly premature nor of very low birth weight, and who showed no major anomalies.

Bailit explained that she and her colleagues determined how many cesareans a hospital should have performed by calculating the chance of cesarean for each woman who delivered at each hospital, taking into account risk factors such as the woman's age and the duration of gestation. The study authors then added up the total expected rate for each hospital by adding up the rates estimated for all of its patients, and compared it with the facility's actual rate of the procedure.

The next step may be to figure out the differences between hospitals that perform as many cesareans as they should, and those that perform either more or less, Bailit added. "We need to find out more about what drives quality in obstetrics...and what can we change to make it better for everybody," she said.

Source: American Journal of Obstetrics and Gynecology 2002;187:721-727.


The More Education, the More Likely You'll Quit Smoking After Pregnancy

By Adam Marcus
HealthScoutNews Reporter


Tuesday, October 29, 2002

TUESDAY, Oct. 29 (HealthScoutNews) -- Poorly educated women are least likely to stay smoke-free after pregnancy, endangering not only their own health but that of their babies, a new study has found.

While 30 percent of women with a college degree who smoked before getting pregnant were no longer doing so three years after delivery, the rates of smoking among those who never finished high school didn't change in that period. These women also had the highest rates of smoking to begin with -- nearly 40 percent, compared with less than 12 percent among college grads, the study says.

When they did quit, less-educated women were much more likely to relapse in the first 1.5 years after giving birth, with only about 16 percent staying off tobacco. Nearly half of the college graduates who quit managed to remain off cigarettes during the first 17 months or so after delivery. Women who lived with a smoker were four times more likely to resume the habit.

The study also found that nearly 70 percent of college graduates who were smoking in the year before delivering said they quit for at least a week. That was nearly twice the rate among those who never finished high school -- 40 percent -- or who went no further than 12th grade -- 56 percent.

Poorer women were less likely to quit and more likely to relapse than were wealthier mothers, and education and income are closely linked. But even after accounting for income, the effects of education on tobacco use were strong, the researchers say.

"Less advantaged women fall further and further behind in terms of health," says Dr. Robert Kahn, a pediatrician at Cincinnati Children's Hospital and lead author of the study, which appears in the November issue of the American Journal of Public Health.

"These women face a cluster of hurdles in keeping up with more educated and more advantaged women," Kahn says. "Factors likely poverty, depression and the very powerful cues of other household smokers also contribute substantially in the persistence of their smoking."

While women who choose to resume smoking may be making the wrong choice, Kahn also blames the health-care system for failing poor mothers at a pivotal time.

"In the third trimester [of pregnancy] women are as healthy as they'll ever be in their reproductive years," he says. Their rates of smoking and drinking are low, they're typically eating well, and their odds of catching a sexually transmitted disease are small.

But after delivery, Kahn says, "there's such a focus on the infant that we let some critical health gains evaporate." Medicaid, the federal government's insurance plan for the poor, is often more generous to pregnant women than to those who've already given birth, he says.

Another "critical area" for future research, Kahn says, is to figure out how to encourage the family members of pregnant smokers to quit.

T. J. Mathews, a tobacco expert at the National Center for Health Statistics, commends Kahn and his colleagues for their research. However, he notes the data they used, which came from studies in 1988 and 1991, are dated and don't reflect current smoking rates.

In 2000, Mathews says, 12.2 percent of pregnant women in the United States smoked, according to information on birth certificates. That's probably an underestimate of the true percentage, and is somewhat less than the number of women who smoked in the months before learning they were pregnant, he says.

What To Do

For more on smoking during pregnancy, try the U.S. Centers for Disease Control and Prevention. And for more on women and smoking, visit the American Legacy Foundation.


Hot Tub May Be OK for Some on Blood Pressure Meds

By Pam Harrison

Reuters Health

Tuesday, October 29, 2002

EDMONTON (Reuters Health) - People on blood pressure-lowering drugs do experience a drop in blood pressure when sitting in a hot tub, but a short soak does not seem to be harmful for such patients, according to findings presented here at the Canadian Cardiovascular Congress 2002.

"There has been some concern that blood pressure might fall too much in patients on antihypertensive (blood pressure-lowering) agents by getting into a hot tub," said Dr. Tae Won Shin, a resident physician in the College of Medicine at the University of Saskatchewan, Saskatoon. Most hot tubs post warning signs suggesting that people with high blood pressure consult their doctor before using the tub.

In the new study, Shin and colleagues monitored blood pressure and heart rate in 23 volunteers with normal blood pressure and another 21 volunteers who were being treated for high blood pressure with a variety of medications. Blood pressure was monitored before, during and after the participants spent 10 minutes in a hot tub heated to 40 degrees Celsius (104 degrees Fahrenheit).

After 10 minutes in the hot tub, systolic blood pressure--the top number in a blood pressure reading--dropped by 26 millimeters of mercury in those who had high blood pressure and by 23 millimeters of mercury in those with normal blood pressure. This effect was expected, Shin told Reuters Health, as it is well known that blood pressure drops when people are immersed in hot water.

But, he added, there was no difference in how the blood pressure changed between people with high blood pressure and those with normal blood pressure. Ten minutes after people had gotten out of the tub, blood pressure in both groups approached pre-tub levels, he added, and there was again no difference in how blood pressure returned to normal between the two groups. None of the participants had any symptoms such as dizziness, headache, nausea, heart palpitations or chest pain.

"Doctors can reassure most patients on the safety of a soak in a hot tub," said Dr. Thomas Wilson in a prepared statement. "Despite warnings to the contrary." Wilson is a spokesperson for the Heart and Stroke Foundation of Canada and co-author of the study.

According to the American Heart Association (news - web sites) (AHA), hot tubs should pose little risk to people with high blood pressure who are not experiencing symptoms of the condition.

"The relaxing of the blood vessels associated with the heat is about the same as from a brisk walk. Any active symptoms such as chest pain or shortness of breath that would cause a person to avoid moderate exercise would also be a reason to avoid a hot tub or sauna," according to the AHA.

The group notes that alcohol should not be used in conjunction with hot tubs.

"Also, moving back and forth between cold water baths and saunas or hot tubs can raise blood pressure. If you have high blood pressure, don't do this," the AHA recommends.


Microwave Alert


Tuesday, October 29, 2002

(HealthScoutNews) -- According to the U.S. Food and Drug Administration (news - web sites), if you microwave water in a clean cup without adding coffee, sugar or some other substance, it may heat past boiling point.

If this happens, a slight movement such as picking up the cup, or pouring in a spoon of coffee, can cause the water to erupt and explode, scalding your hands or face.


Global Team Will Hunt for Disease Hotspots on Genes

By Alicia Ault

Reuters Health

Tuesday, October 29, 2002

WASHINGTON (Reuters Health) - Scientists from the United States, Canada, the United Kingdom, China and Japan said Tuesday that they have begun studies to map the major areas of common disease-causing genes in the human genome (news - web sites), and to determine if these genetic variations are found in most people around the world, regardless of ethnic heritage.

The International HapMap Project is expected to cost at least $100 million and take 3 years to complete. It is the next step in the effort to completely decode the human genome.

The HapMap "is the personalization of the genome," said Dr. Francis S. Collins, director of the National Human Genome Research Institute. It "will provide a powerful tool to help us take the next quantum leap toward understanding the fundamental contribution that genes make to common illnesses like cancer, diabetes and mental illness," he said.

In the project, scientists will take blood samples from 200 to 400 people in Nigeria, Japan, China and the United States. The groups were chosen because they are largely representative of populations found on each continent, Collins said. The goal is not to trace heritage, ethnicity or social characteristics, but to see if disease-causing genetic variations are common across a wide range of populations.

The samples will be broken into "chunks" of genomic material and analyzed. Scientists already know that variations in genetic sequences--called single nucleotide polymorphisms, or SNPs--often appear as blocks in a person's genome and are inherited together.

These "haplotype" blocks tend to cluster together in what Collins called "neighborhoods."

The scientists believe they can identify many of these neighborhoods. By mapping them, they will provide a guide for other researchers who are looking for specific genes that might be responsible for disease.

The HapMap researchers will use fairly new technology that will help them quickly identify the haplotypes. In the US, the Baylor College of Medicine Human Genome Sequencing Center will help, using technology developed by San Diego-based Parallele Bioscience that allows very rapid screening of genetic material. Another San Diego-area company, Illumina, will also provide quick-screen tools, to the Wellcome Trust Sanger Institute in the UK.

Without this technology, it would likely take a decade or more to figure out which genetic areas might be hotbeds for disease, said Collins.

"Essentially, the HapMap is a very powerful shortcut that represents enormous long-term savings in studies of complex disease," said Dr. David Bentley of the Sanger Institute.

The 3-year HapMap goal isn't a hard and fast deadline, but "a goal to aim for," Bentley told Reuters Health. The researchers may have to add more population groups as they go along, or may run into technical difficulty, he said.

As information becomes available, it will be put up immediately on the Internet, Bentley said.

"All of this data is for the whole world and will be placed immediately in the public domain," added Collins. Researchers at universities and private companies will be able to use the information to develop new therapies.

The National Institutes of Health (news - web sites) will provide almost one third of the money and be charged with decoding about 30% of the genetic material. Other funds are from the Japanese Ministry of Education, Culture, Sports, Science and Technology; The Wellcome Trust; Genome Canada; the Chinese Ministry of Science and Technology; the Chinese Academy of Sciences; the Natural Science Foundation of China; and the SNP Consortium.


Smoking Can Hurt Healthy Men's Kidneys, Study Shows

Reuters Health
Tuesday, October 29, 2002

NEW YORK (Reuters Health) - Men who smoke have more than triple the risk of developing impaired kidney function compared with their nonsmoking peers, Australian researchers have found.

In women, on the other hand, smoking was not associated with kidney problems, Dr. Esther M. Briganti of Monash University in Clayton and colleagues report.

While experts have long recognized the additional damage smoking can do to the kidneys of people with diabetes or high blood pressure, there has been little research on how smoking affects healthy people's kidneys, the researchers note in the October issue of the American Journal of Kidney Diseases.

To investigate, Briganti's team evaluated the smoking habits and kidney health of 11,247 otherwise healthy men and women aged 25 and older.

Men who smoked were more likely to have high levels of protein in their urine, an indicator of impaired kidney function, the report indicates. The association was particularly strong in those with "high-normal" levels of blood pressure or blood sugar metabolism.

In general, the more years a person spent smoking, the more likely they were to have impaired kidney function, Briganti and colleagues report.

"Men were more than three times as likely to have (kidney) impairment if they smoked than men who did not smoke. However, smoking was not associated with (kidney) impairment in women," the authors write.

"Our data indicate that the general public without typical risk factors for kidney disease of (high blood pressure) and diabetes...should be warned that smoking is associated with kidney damage, in addition to its other known health consequences," they conclude.

Source: American Journal of Kidney Diseases 2002;40:704-712.



Back Pain Could Be From the Brain


Monday, October 28, 2002

MONDAY, Oct. 28 (HealthScoutNews) -- That pain in your back may really be in your head.

Abnormal pain-processing pathways in the brain may be the culprit in people who have lower back pain that doctors can't trace to a specific physical cause, says a study presented this weekend at the American College of Rheumatology's annual meeting in New Orleans.

The University of Michigan researchers say there's no explanation for this effect, but it's similar to altered pain perception they found in people with fibromyalgia in a previous study.

Using a super-fast form of magnetic resonance imaging (MRI), the researchers looked at the brains of 15 people with lower back pain. Their body scans showed no apparent physical cause, such as a ruptured disk, for their back pain.

They were compared to 15 people with fibromyalgia and 15 control subjects without back pain or fibromyalgia.

All the study participants were give the MRI scans for 10 minutes while varying degrees of controlled pressure was applied to the base of their left thumbnail.

The researchers found it took only mild pressure to make the people with lower back pain and fibromyalgia report they felt pain. When subjected to the same amount of pressure, the people in the control group reported little pain.

In the people with lower back pain and fibromyalgia, that mild pressure produced measurable responses in brain areas the process pain sensation. Those brain responses didn't occur in the control group until they were subjected to substantial pressure on their thumbs.

The study notes striking differences in areas of pain-related brain activity in all three groups. People with lower back pain showed no increased activity in two brain areas that were active in both the people with fibromyalgia and those in the control group.

At the same time, the people with fibromyalgia had increased activity in two other brain areas that weren't active in those with lower back pain or in the control group.

The findings may help lead to a better understanding of lower back pain and pain perception in general, the researchers say.

More information

Here's where to go to find out more about back pain.


FDA Halts Mexican Cantaloupe Imports

The Associated Press

Monday, October 28, 2002

WASHINGTON (AP) - The government stopped imports of Mexican cantaloupes Monday until it can certify they are produced in more sanitary conditions, a step taken because of repeated food-poisoning outbreaks linked to the imported melons.

The Food and Drug Administration (news - web sites) said it was stopping imports before the fall season begins for Mexican cantaloupe, so that produce already on store shelves should not be affected.

In the last three years, imported Mexican cantaloupes have been linked to four outbreaks of salmonella infection that killed two people and hospitalized at least 18 others.

Salmonella is a type of bacterium that can cause life-threatening infections in young children, the elderly and others with weakened immune systems. Healthy people who are infected often experience fever, diarrhea, nausea, vomiting and abdominal pain.

The FDA blames poor sanitation in the growing, packing and shipping of the cantaloupes, and for over a year has not allowed imports of certain brands. But because FDA workers have found salmonella-tainted cantaloupes in most of Mexico's growing regions, Monday's action expands the import stop to all brands until the FDA and Mexican government finish developing a food-safety program to improve sanitation.

Meanwhile, the FDA urged consumers to take steps to avoid all types of contaminated produce by buying only fresh produce that is not bruised or damaged, keeping it refrigerated, and washing all fruits and vegetables before eating.

On the Net:



Alcohol May Not Affect Memory over Long Term

Reuters Health
Monday, October 28, 2002

NEW YORK (Reuters Health) - Enjoying a cocktail now and then is not associated with declining mental function over time and may even make women sharper, according to a new report.

"Findings from suggest that long-term social and habitual consumption of alcohol is not associated with an increased risk of cognitive decline in men and may even protect against cognitive decline in women," Constantine G. Lyketsos and colleagues from Johns Hopkins University in Baltimore, Maryland, write.

Nearly 1,500 adults 18 and older were divided into five groups based on their self-reported alcohol consumption at three points during the nearly 12-year study. All completed a test to measure memory and other cognitive skills.

Group 1 was comprised of non-alcohol users. Adults in the second group were dubbed social or infrequent drinkers, and consumed no more than four drinks a day but did not drink daily and drank on fewer than 20 days a month.

The frequent or habitual drinkers in the third group had no more than four drinks a day but reported drinking on at least 20 days a month. Group four was comprised of heavy but infrequent users who had more than four drinks daily on fewer than 20 days, and adults in group 5 drank the same amount on at least 20 days a month.

All groups of adults experienced some decline over the years regardless of how much alcohol they consumed at any time, probably reflecting the inevitable effects of aging. But teetotalers, especially women, experienced greater declines in cognitive ability. Test scores were nearly 1 point lower overall among female nondrinkers compared with women who often drank heavily, for instance.

There was no difference among men, according to the report in a recent issue of the American Journal of Epidemiology.

It is not clear from the study why drinking would protect women's memories. The researchers suggest potential flaws in the study design, including the "survival bias" in which the least healthy individuals, including those with cognitive problems, die before the end of the study.

Source: American Journal of Epidemiology 2002;156:747-752.


Stronger Breed of Head Lice Survives

By Adam Gorlick

Associated Press Writer

The Associated Press

Monday, October 28, 2002

John Clark is trying to solve a problem that's left hundreds of parents — not to mention their children — scratching their heads in search of answers.

Over-the-counter shampoos are losing their effectiveness against head lice, parasites that can plague 12 million schoolchildren each year. Clark and researchers at the University of California have been trying to find out why some head lice don't die when doused and scrubbed with pesticide-based shampoos.

"The lice are becoming resistant and the resistant lice are taking over," Clark said.

The reason, he said, lies in the shampoos' active ingredient that attacks the insects' central nervous systems and causes the critters to suffocate. The poison acts in the same way as DDT, a pesticide that was widely used to kill lice before it was banned in the United States in 1973.

After three decades of exposure to DDT, lice began developing a genetic immunity to it. The pesticide-laced shampoos, which were made available without a prescription in the 1980s, helped the resistant strain of lice evolve, public health experts said.

"We get calls from child care providers and schools who say lice are increasingly more difficult to get rid of," said Steven Shuman, the state Department of Public Health (news - web sites)'s deputy director for maternal, child and family health. "When people get lice, they want to get rid of them as fast as possible. And that leads to a misuse of the products designed to kill them."

In samples of head lice sent to him from school nurses across the country, Clark said he has no problem finding bugs with the genetic makeup that makes them stronger than the pesticide.

"We started hearing about resistance in 1994," Clark said. "I would say that between five and 10 years at the most, they won't be effective at all."

But studying dead head lice tells only so much. In order to get a sense of how the parasites behave and exactly how they react to pesticides, researchers had to design an environment where the louse — which has only been able to survive on a human scalp — can live.

"Nobody wants these things living on them, so we had to create an artificial scalp to study them while they're alive," Clark said.

Clark and the other researchers, funded by a $500,000 grant from the National Institute of Health, have been trying to replicate conditions of a human scalp where a louse can feed on blood and lay eggs.

In a setup that looks nothing like a human head, the lice are placed inside tubes with a tuft of human hair. A thin plastic membrane stretches over the bottom of the tube, fooling the lice into believing it is a scalp. The tube is then lowered into a container of blood, which a louse can feed on through the membrane.

"They lay their eggs there, they raise their kids there and they eat there," Clark said. "They're happy."

Miwa Takano-Lee, a researcher at the University of California at Riverside who helped design the artificial scalp, said the device will help scientists study why lice spread so rapidly among people.

"Everybody assumes they're transported from head-to-head contact," Takano-Lee said. "But they do not jump. We're trying to figure out what motivates them to disburse. They have everything they need when they're on a person's scalp, so it doesn't make sense why they would want to leave."

But the research goes beyond the interest of science.

When many students — including some in Massachusetts — are diagnosed with head lice, some are not allowed to attend class.

In a rush to relieve their children's' itchy scalps and anxious to save the hours it could take to comb lice out of their hair, parents often turn to insecticide-based shampoos.

"I speak to so many frustrated parents," said Debrah Altschuler, president of the National Pediculosis Association, a Needham-based nonprofit group that advocates against the misuse of pesticidal lice treatments. "They've spent all this money on products that didn't do anything, and their kids still have lice."

Altschuler, who said using chemical lice treatments can cause cancer and other health hazards if used incorrectly, said picking lice and their eggs off a scalp is the best way to get rid of them.

"We are not entirely anti-pesticide or anti-chemical," she said. "But we need to reserve those treatments in a way that they'll be safe and effective."

A convenient solution to lice control might be found in the development of new products that mix different active ingredients, Clark said. By mixing compounds that kill lice differently, it would take the insects longer to develop a resistance than if they were subjected to just a single poison.

"If we're going to get a handle on control, it's going to have to be done through very controlled prescription use of pesticides," Clark said. "When these things are sold over-the-counter, they're not used properly. And that leads to the problems we're seeing now."

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Cutting Calories May Keep Heart Young: Study

By Suzanne Rostler

Reuters Health

Monday, October 28, 2002

NEW YORK (Reuters Health) - Cutting calories may do more than help people shed excess weight, research suggests. According to a new report, a low-calorie diet may also slow age-related changes in the heart's genes that can lead to chronic disease.

In the study, "middle-aged" 14-month-old mice were fed either a normal diet or one restricted in calories. When the mice reached 30 months of age, or the equivalent of 90 years of a human life span, the researchers analyzed their heart tissue.

The hearts of mice on the low-calorie diets showed nearly 20% fewer age-related genetic changes and also appeared to have less DNA damage than those of mice on regular diets. Restricting calories also inhibited potentially disease-causing changes in the immune system, and suppressed apoptosis, or programmed cell death.

While apoptosis is beneficial in tissues that undergo rapid DNA replication, such as skin, it can be damaging in other tissues, Dr. Tomas A. Prolla, the study's lead author, explained in an interview with Reuters Health.

"In the heart, which largely doesn't have dividing cells, the process of apoptosis acts to kill cells that can't be replaced. So in the long term, it is not beneficial," said Prolla, a researcher with the University of Wisconsin in Madison.

The findings, which appear in this week's online early edition of the Proceedings of the National Academy of Sciences (news - web sites), add to a growing body of research demonstrating the benefit of cutting back on calories. Previous studies have shown that calorie restriction can slow the aging of the muscles, brain and heart.

Prolla said a 30% reduction in normal caloric intake could probably do the trick. A person who normally consumes about 2,000 calories, for instance, could eat 600 fewer calories a day.

"As a whole, the data show that it is highly likely that calorie restriction can retard the aging process," Prolla said. "Even in middle age, calorie restriction can reduce rates of aging in the heart."

He cautioned that individuals who want to try cutting back on their food intake make sure they are getting enough vitamins and minerals to prevent deficiencies, and recommended including plenty of whole grains, fruits and vegetables.

Source: Proceedings of the National Academy of Sciences 2002;10.1073.


Nicotine 'Cooks' Proteins in the Body

By Merritt McKinney

Reuters Health

Monday, October 28, 2002

NEW YORK (Reuters Health) - As if smokers need another reason to kick the habit, California scientists have discovered that a byproduct of nicotine, the substance that makes cigarettes so addictive, causes a type of chemical reaction in the body similar to that which occurs when sugar is scorched or food goes bad. This reaction is thought to play a role in diabetes, cancer and other diseases.

Although the health effects of the nicotine byproduct, known as nornicotine, are uncertain, researchers also found that the substance interferes with the actions of a commonly used steroid medication.

The interaction between sugars and proteins can produce substances called advanced glycation endproducts, or AGEs. The accumulation of AGEs appears to contribute to the aging process and certain diseases.

Now Drs. Kim D. Janda and Tobin J. Dickerson at The Scripps Research Institute in La Jolla have found that nornicotine, which is found in tobacco and is produced as nicotine is metabolized, leads to small, but significant, accumulation of one type of AGE. They also found that blood collected from smokers had higher levels of the nornicotine-related AGE than blood from nonsmokers.

"Our results provide a direct chemical link between tobacco use and the development of AGEs, a class of compounds previously implicated in various disease states," Janda and Dickerson conclude in a report in the online early edition of the journal Proceedings of the National Academy of Sciences (news - web sites).

The findings suggest an "unrecognized pathway" through which tobacco use can be harmful to health, according to the report.

In comments to Reuters Health, study author Janda said that the "very startling point is that this chemical reaction that nornicotine can cause also can take place with certain drugs." The researchers found that nornicotine interacted with the steroid prednisone to form byproducts that may interfere with the activity of the steroid as well as cause harmful effects.

The interaction with prednisone raises the question of whether nornicotine also interacts with other drugs, according to the California researcher.

Janda said that "the public needs to be made more aware" that tobacco and other nicotine-containing products create a substance "that was previously unrecognized as a potential danger to proteins in the body and administered prescription drugs."

Janda pointed out that even nicotine patches and gums that people use to quit smoking can trigger the reaction. Of course, if these products are successful, then a person will no longer have to consume any sort of nicotine--in cigarettes or in gums or patches.

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.222561699.


Blackcurrant Juice May Cut Risk of Kidney Stones

Reuters Health

Monday, October 28, 2002

NEW YORK (Reuters Health) - A glassful of blackcurrant juice may make the risk of a certain type of kidney stone go down, a small study suggests.

Researchers in Germany measured levels of compounds associated with kidney stones in the urine of 12 healthy men aged 18 to 38 and determined their urinary pH levels after they consumed plum, cranberry or blackcurrant juice on separate days.

In the study, pH levels of urine increased after the study volunteers consumed blackcurrant juice, report researchers in the October issue of the European Journal of Clinical Nutrition. Low urinary pH, which indicates that the urine is more acidic, is associated with uric acid kidney stones. Uric acid kidney stones make up about 10% of kidney stones, which can also be comprised of calcium, oxalate or other minerals. About 85% of stones are comprised mainly of calcium.

Cranberry juice, on the other hand, decreased the urinary pH, suggesting that it may help to treat certain other types of kidney stones or urinary tract infections (UTIs), which affect more than half of women in the US, according to at least one survey. UTI symptoms can be mild, such as a frequent urge to urinate and pain on urination, or more severe, such as high fever, pain and blood in the urine.

The plum juice had no effect on pH level of the urine, or the excretion of compounds that play a role in kidney stones.

The study included only healthy adults or those with no history of kidney stones or kidney disease. Future studies should investigate the effect of juice on the urine of patients with stones, note the researchers, led by Dr. T. Kessler from the University of Bonn in Germany.

Source: European Journal of Clinical Nutrition 2002;56:1020-1023.


Frequent Pain Medication Use Linked to Hypertension

By Alison McCook

Reuters Health

Monday, October 28, 2002

NEW YORK (Reuters Health) - Women who frequently take certain over-the-counter pain-relief medications appear to have a higher-than-average risk of developing high blood pressure, new study findings suggest.

Dr. Gary C. Curhan of Harvard Medical School (news - web sites) in Boston, Massachusetts, and his colleagues found that women between the ages of 31 and 50 who take nonsteroidal anti-inflammatory drugs (NSAIDs)--such as ibuprofin (Motrin) and naproxen (Aleve)--at least 22 days per month appear to be 86% more likely than others to develop high blood pressure.

The investigators also discovered that similarly frequent users of acetaminophen (Tylenol) may be twice as likely as others to develop hypertension, or high blood pressure.

Although the risk of high blood pressure may increase with these medications, also known as analgesics, that does not mean women should not take them, Curhan cautioned. Analgesics can significantly improve quality of life for some patients, and not all frequent users will develop high blood pressure, he noted.

"If people have chronic pain, and they need analgesics, I would tell them to take them," Curhan stated.

"Not everybody that takes these gets hypertension," he added.

Curhan and his colleagues discovered the link by following 80,020 women who were all initially hypertension-free. At the outset of the study, the participants indicated how often they took analgesics, and which types. The authors then re-contacted the women 2 years later and noted how many had since developed high blood pressure.

The researchers discovered that more than half of the women in the study took aspirin, and around three-quarters said they used NSAIDs or acetaminophen. When the investigators compared their analgesic use to the risk of developing hypertension, they found that frequent NSAID or acetaminophen users--but not aspirin users--were more likely than others to develop hypertension.

The relationship between analgesic use and hypertension persisted even when Curhan's team removed the influence of factors that might lead to both long-term pain problems and high blood pressure, such as obesity and rheumatoid arthritis.

Curhan and his team report their findings in the October 28th issue of Archives of Internal Medicine (news - web sites).

In an interview with Reuters Health, Curhan said that this is the first study to show that analgesic use may be linked to high blood pressure, so further studies are needed to confirm these findings. That said, however, he pointed out that it makes good biological sense that NSAIDs and acetaminophen could increase a frequent user's blood pressure over time.

Previous research has shown that these pain medications can block the production of substances called prostaglandins, which are known to dilate blood vessels. With less prostaglandins, the vessels may narrow, Curhan said, eventually leading to hypertension.

But the present study only found a link between analgesics and hypertension, the researcher noted, and did not show that one causes the other. And although the authors tried to account for the influence of other factors that could lead to both analgesic use and hypertension, another, as yet unidentified third factor could be responsible for the findings, Curhan admitted.

In the meantime, Curhan suggested that frequent analgesic users have their blood pressure checked every year, so that doctors can treat their hypertension--if it appears--sooner rather than later.

"If we can do something early, that may have potential long-term benefits," he noted.

Source: Archives of Internal Medicine 2002;162:2204-2208.


Docs Misjudge Local Drug Resistance Problems

By Charnicia E. Huggins

Reuters Health

Monday, October 28, 2002

NEW YORK (Reuters Health) - Most doctors think antibiotic drug resistance is a serious national problem, but many consider it to be less important in their local hospitals, new study findings show.

Furthermore, many of the physicians studied also "tended to dismiss the importance of handwashing, and were reticent to endorse effective but restrictive interventions," study author Dr. Arthur T. Evans of Cook County Hospital in Chicago, Illinois told Reuters Health.

"Disparities in physician knowledge, beliefs and attitudes may compromise efforts to improve antibiotic prescribing and infection control practices," Evans and his colleagues write in the October 28th issue of Archives of Internal Medicine (news - web sites).

They investigated doctors' perceptions about antibiotic resistance in a survey of 424 internal medicine physicians at four Illinois hospitals.

Overall, nearly 90% of the doctors surveyed perceived antibiotic resistance as a "very important national problem," but only 55% of them considered the problem to be of great importance at their own hospitals, the authors report.

This discrepancy suggests "that many respondents see the risks as more theoretical than concrete, possibly weakening the impetus for behavior change," the researchers write.

Most doctors also underestimated the extent of drug resistance at their hospitals. Infectious disease specialists were an exception, however; they were not only more likely to recognize the importance of antibiotic resistance at their hospitals, but they also gave more accurate estimates of its prevalence.

This may have partly been due to the fact that about one third of the infectious disease specialists had patients who experienced an antibiotic-resistant infection. General internal medicine physicians were half as likely to have seen patients with resistant infections.

When asked the causes of antibiotic resistance, almost all (97%) of the physicians cited widespread and inappropriate use of antibiotics. However, only 6 in 10 physicians agreed that restricting doctors' use of broad-spectrum antibiotics--drugs that are used to combat a variety of organisms--would be an effective remedy.

The report also indicates that less than half (45%) of the physicians considered poor handwashing to be a very important cause of antibiotic resistance. This "tepid endorsement of poor hand hygiene...may reflect a similar lack of awareness of the effectiveness of this simple, yet underused, practice," the researchers speculate.

Altogether, "these contradictory perspectives must be addressed in order to combat antibiotic resistance effectively," Evans said.

Yet, "doctors alone are not going to solve this problem," he added. "Therefore, a more systematic approach that places some limits on antibiotic prescribing may be necessary to protect patients' long-term interests--i.e., slow or reverse the generation of resistant bugs."

Source:  Archives of Internal Medicine 2002;162:2210-2216.


Cranberry Juice May Inhibit Respiratory Bacteria

Reuters Health

Monday, October 28, 2002

CHICAGO (Reuters Health) - Preliminary study results suggest that cranberry juice may inhibit a type of bacteria that is a common cause of ear and respiratory infections in children, according to researchers at the annual meeting of the Infectious Diseases Society of America.

It seems--at least in the laboratory--cranberry juice can inhibit certain strains of Haemophilus influenzae, a type of bacteria found in the nose and throat of 75% of healthy children and adults. The bacteria can also cause infections, and may be responsible for up to 40% of bacterially-derived middle ear infections.

"We found that both cranberry juice and active chemicals in cranberry juice called proanthocyanidins do bind to and block these respiratory bacteria--Haemophilus influenzae--in the test tube," said lead author, Dr. Kirk McCrea of the University of Michigan in Ann Arbor.

McCrea cautions parents not to jump to the conclusion that giving their children cranberry juice will prevent or treat illness. Positive results in the laboratory often don't pan out in the more complex interactions that take place in the human body.

"Because this was a laboratory study, human research is needed to confirm that drinking cranberry juice reduces the risk of respiratory infections in children. We know that eating fruits and vegetables is healthful," McCrea said. "This is really on the fringe of looking at one of those health benefits and giving us more of an edge over infections. We've got a long way to go, but this study is a start."

And there can also be too much of a good thing. The American Academy of Pediatrics has made official their concerns over the excessive consumption of fruit juices by young children. The AAP recently stated that drinking too much fruit juice can contribute to obesity, the development of cavities (dental caries), diarrhea, and other gastrointestinal problems, such as excessive gas, bloating and abdominal pain.

However, earlier studies have shown that these same cranberry juice compounds may reduce the risk of urinary tract infections by binding to a strain of E. coli bacteria (news - web sites) in the bladder.

In the new study, the researchers found that the juice could prevent certain strains of the bacteria from sticking to red blood cells or mouth cells, a step that can allow the bacteria to linger in the body. It seemed that the juice inhibited the bacteria's pili, the hair-like structures that allow them to adhere to surfaces. The juice had no effect on strains of Haemophilus influenzae that lacked pili.

Most children are now immunized against Haemophilus influenzae type b (Hib), a more dangerous type of the bacteria that can cause meningitis, pneumonia or other serious infections.


Many Teens Gamble, Some Already Have Problem: Study

By Paula Moyer

Reuters Health

Monday, October 28, 2002

SAN FRANCISCO (Reuters Health) - Most teenagers buy lottery tickets and gamble in other ways, despite its illegal status for people younger than 18 years old, a Florida researcher reported here at the 49th annual meeting of the American Academy of Child and Adolescent Psychiatry.

"We need to be aware that adolescents gamble, just as adults do," Dr. Martin Lazoritz told Reuters Health. "They play cards with their friends; they buy lottery tickets. We also need to be aware that underage gambling is associated with several at-risk behaviors, such as cigarette smoking, and with alcohol and drug use," said Lazoritz, an associate chair of psychiatry at the University of Florida in Gainesville.

Lazoritz and colleagues sought to examine the prevalence of gambling-related behaviors and problems among adolescents aged 13 to 17. They selected 1,051 Florida adolescents at random and interviewed them over the telephone after obtaining their parents' consent.

According to interviews that took place in December 2001, almost 70% of the respondents reported gambling during their lifetime. What's more, 43% had done so in the past year, even though gambling is illegal in Florida for people under age 18. Despite the requirement that lottery ticket purchasers be at least 18 years old, 18.5% of the participants said that they had "ever bought" a State of Florida lottery ticket. Additionally, 12.5% have purchased such tickets in the past year. The participants who had gambled began doing so at an average age of 12.5 years.

"Based on established psychiatric criteria, 3.8% of the respondents were problem or pathological gamblers," Lazoritz said. "Problem or pathological gamblers are more likely to be preoccupied with gambling, to use gambling to escape, and to 'chase their losses' by continuing to gamble in order to recover prior gambling-related losses. Other warning signs are a sense of losing control while gambling, risking important relationships, and needing to borrow money from others to pay gambling-related debts."

He and his colleagues also found that problem gamblers were more likely to drink, to smoke cigarettes, to use marijuana, to make illicit use of prescription medications, and to use crack or powder cocaine, as well as other stimulants.

"Several aspects of our culture put teenagers at risk, and gambling is one of them," Lazoritz said. "Parents are often unaware of teenagers' participation in gambling. We need to be more aware of the possibility of problem gambling in teenagers, because of its hazards, and because it is associated with other risky behaviors."


Study: Alternative Med Use Also Popular Among Kids

Reuters Health

Monday, October 28, 2002

NEW YORK (Reuters Health) - While it is known that many adults treat their own illnesses with herbal medicine, prayer and other complementary and alternative therapies, new study findings show that many of them also use these remedies for their children.

The findings are based on random nationwide telephone surveys of 1,501 mothers, fathers and other primary caregivers of children and adolescents. Dr. Michael B. Aldous of the University of Arizona in Tucson and colleagues conducted the survey and analyzed the results.

Nearly one quarter (22%) of the parents used some type of alternative medicine for their child, and almost one in 10 allowed their child to visit a complementary and alternative medicine provider, such as a chiropractor, osteopathic physician or homeopath, study findings indicate.

Further, more than 80% of the parents were somewhat or very satisfied with their child's most recent use of complementary and alternative medicines and 86% of parents considered the therapies to be somewhat or very helpful. Finally, 90% said they would be willing to use complementary and alternative medicines for their children in the future.

Only two-thirds of the parents, however, informed their child's physician about complementary and alternative medicine use.

Numerous studies have indicated that some alternative medicines may interact with prescription drugs, making it important for a person's doctor to know what types of alternative medicine he or she may be taking. In fact, many researchers agree that more studies are needed to determine the health risks of various nontraditional therapies, to make sure that those risks do not outweigh their benefits.

Overall, the most common alternative medicines--used by 8% of the children and adolescents in the study--were vitamins other than multivitamins. Other popular therapies were herbal remedies, spiritual healing or prayer and various chiropractic therapies.

Use of these complementary and alternative medicines was twice as common among children with chronic illness than among their healthy peers. These therapies were most often used to treat respiratory illnesses other than asthma, strains and sprains, allergies, digestive problems and ear infections.

Twelve percent of the children also used alternative medicines as a method of disease prevention.

The findings were presented last week at the American Academy of Pediatrics' annual meeting in Boston.


West Nile '02 Outbreak Biggest of Its Kind in West

Reuters Health

Monday, October 28, 2002

CHICAGO (Reuters Health) - This summer's West Nile virus (news - web sites) outbreak in the US and Canada is the largest epidemic of mosquito-borne viral meningoencephalitis ever documented in the Western Hemisphere, according to the US Centers for Disease Control and Prevention (news - web sites) (CDC).

Meningoencephalitis combines two conditions: meningitis, or inflammation of membranes that encase and protect the brain and spinal cord; and encephalitis, which involves inflammation of brain tissue.

In the US, the 2002 epidemic surpasses the 1975 epidemic of St. Louis encephalitis (SLE), in which 1,967 cases were reported to the CDC. About 170 people died in the outbreak, according to the CDC's Dr. Roy Campbell. But this summer brought even higher numbers.

"As of last Friday, the states had reported about 3,400 West Nile-related cases to us," Campbell told the annual meeting of the Infectious Diseases Society of America. "Of those, about 2,000 were the more severe meningoencephalitis forms, and another 1,400 were a combination of milder West Nile fever or a form not yet clinically categorized."

Campbell said West Nile has killed about 190 Americans so far this year. "That number will go up because of a lag in reporting, and some patients will die later of complications from the disease."

Both West Nile and SLE belong to the arbovirus family, which includes more than 250 different tick- and mosquito-borne viruses.

As in 1975, the nation's heartland bore the brunt of the infections. The hardest-hit states this time were Mississippi, Ohio, Indiana, Illinois, North Dakota, Kentucky and Louisiana. But in 1975, Louisiana didn't report a single case of SLE.

Campbell pointed out that the CDC has incomplete data on why these genetically similar viruses strike certain geographic areas and leave others alone.

"The appearance of epidemics of West Nile or SLE depends on an extremely complex and poorly understood constellation of natural factors," the medical epidemiologist said, explaining that pieces of the puzzle clearly include such factors as bird and mosquito abundance and species composition, as well as climate and weather conditions.

It's known that the adult northern house mosquito, which is most responsible for transmitting these viruses, can survive winters by going into warm, humid, protected areas. The creature can also survive in the egg stage, ready to hatch in the spring, Campbell noted.

After the 1999 New York City outbreak, Campbell and other CDC investigators found live West Nile virus in bird tissue, demonstrating that the bug can go "underground" as a non-lethal host in birds, and perhaps ride along during migration.

Campbell cannot predict what will happen next year. "But typically after you have a major epidemic you get a few less severe years and the thing goes away for a while and may pop up a few years later. So we may be on the down slope for now."

There is no specific treatment for human meningoencephalitis, but Campbell says advances in medical care have helped cut the death rate from the 20% recorded in the 1933 SLE epidemic to about 10% today.

He says the best defense against these outbreaks is good surveillance, including surveillance of bird deaths and mosquito testing to detect viral activity early in the spring. Early warning gives communities more time to put control measures in place and educate the public about reducing risk, he explained.

"The CDC is helping all state health departments financially to do arbovirus surveillance. And there's now an effort afoot in Congress to pump a huge amount of federal dollars to states through the CDC," Campbell stated.


Researcher Criticizes Vaccine Safety Assessment

By Richard Woodman

Reuters Health

Monday, October 28, 2002

LONDON (Reuters Health) - New systems are urgently needed to ensure childhood vaccines are safe, a researcher urged on Monday.

Dr. Thomas Jefferson, who has been funded to investigate vaccine safety by the European Commission (news - web sites), said the clinical trials done before vaccines are launched lack statistical power to analyze the cause of rare severe events encountered when vaccines are used in large populations.

"At present the EU member states mainly use a mix of passive reporting and ad hoc studies for vaccine safety surveillance," he said in a statement. "The sensitivity of passive surveillance for the detection of adverse events is low and there are marked inter-country variations in the efficiency of safety surveillance.

"Ad hoc studies are usually retrospective, limited in size and prone to bias. The possible causal mechanisms of rare adverse events following immunization are difficult to interpret."

Jefferson, who coordinates vaccine work for the Cochrane Collaboration from Italy, told Reuters Health that vaccine safety evaluation was becoming even more difficult now that children were receiving several vaccines in the same jab.

"If you get six, seven or eight antigens and you get a temperature, which vaccine caused it?" he asked.

The Cochrane Collaboration, based in Oxford, England, has often criticized the lack of large randomized clinical trials in medicine generally, but according to Jefferson good research is even more important in the case of vaccines.

"It is not like giving drugs to treat patients with a disease. The aim is 100% coverage of children. You are experimenting on the weakest members of our society and they are healthy," Jefferson said.

He disclosed that pilot immunization registers are about to be launched in Sweden and Finland that will record when each person is vaccinated, the particular vaccine batch and any subsequent health outcomes.

Hopefully, these schemes could be extended across the European Union (news - web sites), though legislation would be required because of data protection and harmonization.

Other measures that would improve vaccine safety evaluation included internationally agreed definitions of adverse events and systematic reviews of the evidence, he said.


Gun-Toting Students Show More Risky Behaviors

By Alison McCook

Reuters Health

Monday, October 28, 2002

NEW YORK (Reuters Health) - Approximately 4% of US college students own guns, and those that do are more likely than others to engage in certain high-risk behaviors, such as binge drinking, new study findings show.

Dr. Matthew Miller of Harvard University in Boston and his colleagues found that gun-owning college students tend to drink higher amounts of alcohol at a time, and when doing so, are more likely than others to have unprotected sex and run-ins with police.

Other high-risk behaviors more commonly noted in gun-owners included driving while drunk and using crack and cocaine. Students were also more likely to own guns if they were attending college in a part of the country where gun ownership was more common in the general population.

Miller told Reuters Health that the study did not assess why gun-owners are more likely to show high-risk behaviors in college than those without guns, but he speculated that this tendency "may reflect a disposition to both own guns and engage in risky behavior."

Alternatively, the researcher suggested that some gun-owners may become "emboldened" by their weapons, and may consequently act in ways they would not if they didn't own guns. However, he noted that the behaviors seen in the study--binge drinking and unprotected sex, for example--are not commonly seen as behaviors of an emboldened person.

Miller and his team obtained their findings from questionnaires completed by more than 10,000 undergraduate students from 119 colleges throughout the US.

The authors discovered that 4.3% of college students--and 8% of male students--said they brought guns to college. Half of gun-owners said they purchased a firearm for protection.

The authors discovered that gun-owners in college were most often white men who lived off campus with a significant other.

Gun-owning college students also tended to have more exposure to guns and gun violence than those who did not own firearms, the authors report in the recent issue of the Journal of American College Health. For example, students who owned guns for protection were more likely to be threatened with a gun at college.

Students who hailed from states in which many people own guns--such as states in the East South Atlantic region, where 38% of households have guns--were more than three times as likely as those from New England, where gun ownership is rare, to bring a gun to college. They were also more than twice as likely to have been threatened by a firearm at college.

"I suspect that many administrators are surprised that, on average, across the US 4% of students have guns," Miller told Reuters Health in an interview.

The researcher said that he hopes these results inspire administrators to investigate further what compels students to bring guns to college, and how this tendency might have an impact on violence committed on college campuses.

Source: Journal of American College Health 2002.


Ecstasy-Related Deaths Climb in Miami-Dade County

By Paula Moyer

Reuters Health

Monday, October 28, 2002

SAN FRANCISCO (Reuters Health) - As use of the popular street drug known as Ecstasy has increased, so have deaths linked to its use, according to a Florida researcher.

"In Miami-Dade County we saw an increased number of Ecstasy-related deaths from 1997 to 2001," Dr. Maria J. Vega told Reuters Health. "We need to discourage young people from using this drug. Many people think of this drug as benign, but there are many dangers associated with its use."

Vega, an assistant professor of psychiatry at the University of Miami, presented her findings here at the 49th annual meeting of the American Academy of Child and Adolescent Psychiatry.

Ecstasy is also known as MDMA. Its key effects are euphoria, increased energy and greater emotional sensitivity. Some of the heaviest users are young people who use the drug at so-called raves, or all-night dances.

MDMA blocks the reabsorption of serotonin in the brain and simultaneously causes the release of serotonin and dopamine.

Vega and her co-author, Dr. Jon A. Shaw, collaborated with the Miami-Dade County medical examiner to quantify all Ecstasy-related deaths, and to analyze the cause and manner of death.

From 1997 to 2001, 49 Ecstasy-related deaths occurred in the county. Throughout that time period, the number of Ecstasy-related deaths rose every year, from 2 in 1997 to 19 in 2001.

Forty of the deceased were males, and nine were females. They were 13 to 51 years old at the time of their deaths, with an average age of 28. Among them 45% were white, 26% were Hispanic and 29% were African American.

The major cause of death was "acute polydrug toxicity," a toxic condition caused by ingesting multiple drugs. Other causes of death included multiple traumatic injuries and drowning. In some instances Ecstasy was thought to have worsened an existing medical condition.

Three deaths were linked to a combination of hyperthermia, or overheating, and kidney failure. "Ecstasy use at raves is associated with marathon dancing and inadequate fluid intake. As a result, the core body temperature can rise and cause organ damage."

Among the 49 deaths, 33 were accidental. Eight were homicides, three were suicides and five died from natural causes.

"Often when we talk to our teenagers about drug use, we limit the discussion to marijuana, cigarettes and alcohol," Vega told Reuters Health. "We need to talk about Ecstasy. If you don't ask, they won't tell you. It's marketed to teenagers, often through the distributors' Web sites."



Praise the Lord and Pass the Broccoli

By Amanda Gardner
HealthScoutNews Reporter


Sunday, October 27, 2002

SUNDAY, Oct. 27 (HealthScoutNews) -- It's preached in the pulpit and takes place among the pews, but the focus is not so much on saving your soul as it is on lowering your body fat, blood pressure, cholesterol and blood sugar.

Health disparities among racial and ethnic groups in the United States are soaring, with cancer, diabetes, stroke and heart disease rates all higher among blacks and Hispanics than among whites. While health officials grapple with how best to close the gaps, local communities have taken matters into their own hands.

One way is through church-based health programs that include everything from gospel aerobics to smoking cessation classes.

Jeanette Jordan, a Charleston, S.C.-based dietician and a spokeswoman for the American Diabetes Association, is working with the African-Methodist Episcopal Church in South Carolina to bring health programs to its 170,000 members. The program has produced The Good Health Cookbook and organized walking clubs, exercise classes and a "Health Minute" in churches. Jordan also published a "faith-based weight-management guide" called Be Good To Yourself, which includes sample menus and tips on how to modify your favorite recipes to reduce calories and fat.

Jordan says that about half the participants have decreased the amount of fat they were eating, although fruit and vegetable intake has remained flat, with only 13 percent of churchgoers eating five servings a day.

The Centers for Healthy Hearts & Souls in Pittsburgh also works through black churches to provide adult fitness and nutrition programs. "We've had 1,200 women who have participated in our fitness program, and I believe that somewhere around 75 percent have decreased their waist-hip ratio," says Mattie Woods, the centers' executive director. Right now, eight churches are involved in the program. Another 45 are on the waiting list.

Woods says the organization's success comes largely from the fact that community members themselves design and implement the programs, rather than an outsider who swoops in to impose his or her views.

"The actual community decides on what programs they feel are necessary for the community," Woods says. "There is an untapped resource of experts already in the community. It's from the inside. They say what works. They decide." One local fitness expert who had taught jazzercise for more than 10 years choreographed an exercise program to go with gospel music.

"The advantage is that more than half of the African-American population is spiritually rooted -- to church, to the community," says Jack Manson, an exercise physiologist and personal trainer at the Elmwood Fitness Center, part of the Ochsner Clinic Foundation in New Orleans. "The preachers ultimately have a great influence over their flock."

If the pastor places an emphasis on fitness, so will the congregation. "With something like gospel aerobics, you've got pastors supporting and encouraging this physical component of your life, which ultimately results in better health and a cleaner mind and spirit," says Manson, whose own church has an exercise program.

There is a downside to programs like gospel aerobics, Manson points out. For one thing, you're getting all different levels in one group, meaning that some women will be - literally - dancing circles around the others. You also may not have an organized way to keep track of people's progress, something that's essential to motivation and success.

Jordan says other obstacles may be unique to the black community. "The average African-American woman doesn't want to wear a size five or six, and three is out of the question," she says. "Even when they're at their correct weight, they want to gain weight to have bigger hips or larger breasts. Men wanted something they could hold on to."

In Africa, Jordan says, women stuffed their clothing with pillows because if you had voluptuous hips it meant you were more fertile. "Women think, 'If I look good, then that means I'm healthy,'" Jordan says. "That's another challenge, convincing them that looking good and being healthy are not the same thing."

What To Do

For more information and resources on minority health, visit the Office of Minority Health at the Department of Health and Human Services (news - web sites), the Minority Health Network or the CDC's Minority Health Program.



U.S. Issues Hand-Washing Guidelines

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Saturday, October 26, 2002

CHICAGO (AP) - The government issued guidelines Friday urging doctors and nurses to abandon the ritual of washing their hands with soap and water between patients and instead rub on fast-drying alcohol gels to kill more germs.

The goal: reduce the hospital spread of viruses and bacteria that infect an estimated 2 million people in the United States each year and kill about 90,000.

Many hospitals, anticipating the new guidelines from the Centers for Disease Control and Prevention (news - web sites), have already made the change, and studies show this can cut their infection rates in half.

Soap and water have been the standard for generations. But washing up properly between each patient can take a full minute and is often skipped to save time, especially in busy intensive care units where the risk of spreading germs is greatest.

While the alcohol-based gels and solutions kill more microbes, the main advantage is they are easier to use. With vials clipped to their uniforms, nurses can quickly swish their hands while on the move without stopping at a sink. The CDC estimates this saves an hour in an eight-hour intensive care shift.

"We've learned that using alcohol-based products improves adherence to hand hygiene," said Dr. Julie Gerberding, the CDC's director. "We will end up with more people doing the right thing and cleaning their hands."

She released the guidelines in Chicago at a meeting of the Infectious Disease Society of America.

The solutions are intended only to kill germs, not remove visible dirt. So hospital workers are still expected to wash up if they get messy hands. Also, surgeons have the choice of using the gels or sticking with antimicrobial soap.

Many brands of the solutions are available in grocery stores. They vary in how they look, feel and smell. But all contain 60 percent to 90 percent ethanol or isopropanol, and they are considered equally effective at killing germs.

The new guidelines apply only to hospitals and clinics, where there are many particularly nasty microbes, along with sick people who are susceptible to catching them.

At home, where such dangerous bugs are far less common, experts say ordinary soap and water are probably all people routinely need. But the alcohol gels can make sense in situations where water is not be easily available, such as at picnics, in portable toilets or on airplanes.

Hospital workers are instructed to clean up between each patient, before they put on gloves, after they take them off, when inserting catheters or when doing anything else that involves contact with body fluids.

Besides giving individual containers of gel to their staff, hospitals put dispensers at patients' bedsides, in clinics and wherever sick people are seen.

The alcohol dries in seconds without a towel and is so easy to use that "it is almost indefensible now not to clean your hands. People can't say they are too busy anymore," said Dr. David Gilbert of Providence Portland Medical Center in Portland, Ore., president of the Infectious Disease Society.

Using the gels involves squirting a dime-size dollop on one palm, then rubbing the hands together, covering all the surfaces, until the hands are dry.

Typically, people carry between 10,000 and 10 million bacteria on each hand. The medical profession has long known this is one way disease is transmitted. Dr. Ignaz Semmelweis pioneered the field in Austria in 1846, when he speculated that doctors spread "cadaverous particles" when they delivered babies after doing autopsies. He insisted that students clean their hands with chlorine.

Introduction of the alcohol gels "is the biggest revolution in hand hygiene since Semmelweis," said Elaine Larson, associate dean for research at Columbia School of Nursing. "We used to say `hand washing.' Now it's hand hygiene."

Editor’s Note: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.

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Eye Injuries Prompt Lens Crackdown

By Charley Gillespie

Associated Press Writer

The Associated Press

Saturday, October 26, 2002

COLUMBUS, Ohio (AP) - High school sophomore Robyn Rouse's eyes hurt soon after she put in the pair of green contact lenses she had bought at a grocery store to match her tennis shoes.

She removed the non-prescription lenses that night and awoke the next morning in pain, her eye swollen with an infection that would require a year of treatment and a cornea transplant to save her vision.

"It's a cheap way to really change the way you look," said Rouse, 15, of Cleveland, who paid $25 for the over-the-counter lenses. "I see girls with them on all the time. They are easy to get."

So easy, in fact, that officials fear their unregulated sale in stores, flea markets and over the Internet is threatening the eyesight of scores of youths, and the government has begun to crack down.

The U.S. Food and Drug Administration (news - web sites) warned consumers on Oct. 21 not to wear the lenses unless they are prescribed and fitted by an eye-care professional. It said it would seize unapproved lenses.

In issuing its warning, the FDA cited dozens of reports of corneal ulcers — abrasions that can lead to vision-threatening infections — and other eye injuries.

Over the past two years, Ohio, Illinois, Texas, South Carolina and Florida have ordered stores to stop over-the-counter sales of the lenses, which come in patterns that include zebra, cat eyes, alien and NFL logos.

But their popularity continues — especially during the Halloween season.

"Kids will want these lenses to go with their costumes ... and kids will find a way to get them," said Tony Sanders, spokesman for Illinois Department of Professional Regulation.

Illinois authorities have made nine arrests over unregulated sales. Ohio Attorney General Betty Montgomery recently obtained orders against four retailers ordering them to stop selling the contacts.

"What we are hoping is through the increased public awareness other retailers will voluntarily take them off the shelf," said Montgomery spokeswoman Stephanie Beougher.

Kate Cox, administrator of the South Carolina Opticianry Board, said calls had been coming in daily from parents, school nurses and consumers about problems with the contacts including allergic reactions, bacterial infections, corneal abrasions and ulcers.

Duluth, Ga.-based CIBA Vision, which produces Wild Eyes contacts, recently sent 53 letters to businesses demanding they stop selling its lenses.

"We only sell to licensed eye doctors and optometrists and businesses licensed to sell them," said spokeswoman Amanda Cancel.

Dr. Thomas Steineman, director of the Eye Clinic at Cleveland's Metro Health Medical Center, who treated Robyn Rouse, said he has treated other girls over the past year who had worn the lenses.

"Each buys a different color and they swap them back and forth. They treat them like a pair of shoes," he said.

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ADHD: It's Not Just for Kids Anymore

By Holly VanScoy
HealthScoutNews Reporter


Saturday, October 26, 2002

SATURDAY, Oct. 26 (HealthScoutNews) -- As college students settle into the routine of lectures, tests and papers this fall, a surprising number will learn something shocking: They have attention-deficit/hyperactivity disorder.

Once considered primarily a childhood condition, ADHD, as it is commonly called, is now known to be a lifelong condition for as many as half of those troubled with its hallmark symptoms of inattention, distractibility, impulsivity and emotional instability starting before age 7.

Despite its persistence in as much as 1 percent of the population, the disorder often remains undiagnosed for a decade or more, finally becoming debilitating when academic, social or work pressures mount after high school graduation.

That's why ADHD seems to break out like an epidemic on college campuses every fall.

"The structure of high school is such that students with ADHD can slip through unnoticed," says Robert J. Resnick, a professor of psychology at Randolph-Macon College in Ashland, Va. He's also the author of "The Hidden Disorder: The Clinician's Guide to Attention-Deficit/Hyperactivity Disorder in Adults."

"But college is a different story," Resnick adds. "The stepped-up demands of higher education, coupled with the absence of many familiar external structures and controls, bring these students problems with organization and distractibility to the forefront. They just can't fake academic performance any longer. When referred to the college's support services for help, they find out -- many of them for the first time -- that they have had ADHD for many years."

Female college students are just as likely as male students to be affected, despite the disproportionate number of boys diagnosed with ADHD in the early grades, says Resnick, a former president of the American Psychological Association.

"The condition is no respecter of gender," Resnick explains. "However, the symptoms in young males and females are often different. Boys with ADHD tend to be more active and aggressive, which results in earlier referral for assessment by parents and teachers. In elementary school, the ratio of boys diagnosed with ADHD to girls diagnosed is three- or four-to-one. On the college campus, the ratio is one-to-one."

Beth Howlett, clinical coordinator of the Counseling Center at Widner University in Chester, Pa., is familiar with the phenomenon. She estimates that only about one-third of the ADHD students she works with were diagnosed before they began college.

"Elementary and secondary teachers today are doing a better job spotting the symptoms of this disorder early," Howlett says. "But there are still many students, particularly girls, who slip between the cracks before they start college.?

According to Howlett, students with ADHD tend to have a familiar litany of complaints. These include:

·         Inability to concentrate in class or on homework assignments.

  • Inability to grasp the meaning of what they've read without repeated re-readings.
  • Difficulty following a professor's train of thought, paying attention through long lectures or labs, or taking notes in an organized way.
  • Susceptibility to distractions that don't seem to affect their classmates.
  • Reliance on stimulants, such as coffee, as a means of focusing on important tasks.
  • Abusing substances, such as alcohol, illegal drugs or prescription medications, as a means of managing stress.

"What I call the 'burden of reading' -- the sheer volume of mastery of the written word required in virtually every university course -- is one of the first things that shows up as a problem for the college student with untreated ADHD," Howlett says.

Although the official criteria for diagnosing ADHD later in life is identical to those confirming the disorder in young children, it is increasingly recognized that the condition is often more subtly expressed in adulthood.

As a recent article in American Family Physician notes, the "hyperactivity common in ADHD children is less likely to be overt in adults, and the on-the-go drivenness of the ADHD child is frequently described by ADHD adults as restlessness, difficulty relaxing or feeling ?chronically on edge.?"

"ADHD results in clinically significant impairment," Resnick says. "These are not students that experience difficulty paying attention from time to time in class, or occasionally can't remember something important. These are students who are chronically impulsive, distracted and disorganized. They don't forget where they left their car keys. They forget where they left their cars."

According to both Resnick and Howlett, the good news is that ADHD in adults is treatable, using the same behavioral and psychological approaches and medications that help younger patients with ADHD. Medications include methylphenidate (Ritalin (news - web sites)), dextroamphetamine (Dexedrine), pemoline (Cylert), and methamphetamine (Desoxyn).

Under the Americans with Disabilities Act, ADHD college students qualify for a range of accommodations on campus, too, such as therapy, along with assistance organizing their life, study skills, test-taking and securing adequate lecture or laboratory notes from their classes.

Howlett also says ADHD college students appropriately identified and served often fare better academically and socially than their non-ADHD peers.

"When they are diagnosed early and plugged in to the right resources, students with ADHD do well," she says. "But if the ADHD is left untreated, such students often grow increasingly disorganized, impulsive, frustrated and, ultimately, unsuccessful in this very competitive environment."

What To Do

Useful information for college students with ADHD can be found at the Student Alliance on ADHD. For practical tips on the management of ADHD in adults, click here.


Group Finds New Food Poisoning Items

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Saturday, October 26, 2002

CHICAGO (AP) - Bad tomatoes? Nasty butter? Disgusting chili? With a certain grim satisfaction, experts gathered this weekend for an infectious disease conference added some unusual suspects to the long list of foods that can make people sick.

Nationwide, the food supply is getting safer. Outbreaks of food poisoning have been declining since the mid-1990s, and often those that do occur are traced to such predictable sources as undercooked meat or raw chicken.

But presentations at this year's meeting in Chicago of the Infectious Diseases Society of America are a reminder that even the most innocuous sounding grocery items can be dangerous when something goes wrong, usually in the way they are processed or handled.

"It's ever-changing," said Dr. Jenny Lay of the Centers for Disease Control and Prevention (news - web sites). "The outbreaks today are very different from the ones 10 or 20 years ago."

The CDC and other agencies still investigate outbreaks involving a few dozen people in a single small town — the classic church supper incidents. But often outbreaks these days are harder to recognize. They involve small numbers of people spread over the entire country, all victims of broadly distributed foods contaminated at some point in production.

Bean sprouts, mangoes, almost anything people eat can do the job if they somehow become tainted with a variety of toxic organisms, such as salmonella or E. coli. At conferences such as this one, investigators often concentrate on cases in which the bug, the food or both are out of the ordinary.

That turned out to be the case last year in Nassau County, N.Y., when nearly 900 people got sick after eating at five restaurants with the same proprietor. The germ was an unusual one, Shigella flexneri. And the food? Bruised tomatoes.

The restaurants had acquired the "special grade" tomatoes from one source. They were shipped unrefrigerated and never washed. Investigators suspect they somehow get contaminated at the distributor.

Knowing the intimate details of such chains of events can definitely affect disease investigators' views about eating out, or even in.

"After a while, you start thinking about all the things that happen to food before it goes into your mouth," said the CDC's Dr. Pavari Kalluri. "It can deter your enjoyment."

Kalluri investigated an outbreak of botulism in Sanger, Texas, last year that was the country's largest in seven years.

Fifteen of the 16 victims had attended a church supper, and three became so sick they had to be put on breathing machines. It turned out they had eaten a dish made from frozen chili that was bought at a food salvage store. The investigators believe that somewhere along the line, the chili had been allowed to thaw.

In a Robeson County, N.C., school last November, 186 students came down with diarrhea after a homemade butter demonstration. The germ turned out to be E. coli 0157:H7. This is an especially nasty bug that causes an estimated 73,000 cases of diarrhea annually and more often spreads in undercooked hamburger. The investigators said the butter, which the students sampled, was made from unpasteurized milk.

Perhaps the oddest outbreak of the 0157 bug occurred last year at the Lorain County Fair in Ohio. Many of the victims had gone to a barn dance in a building used earlier to show animals. Apparently their stomping stirred up bacteria in leftover manure.

"You'll find a lot of things here that will kill you," said Dr. Peter Daley of the University of Calgary in Alberta, Canada.

His example was ciguatera, poisoning caused by eating warm-water reef fish that have accumulated naturally occurring toxins through their diet. About 20 members of a family got sick after eating grouper, surgeon and snapper brought home frozen from Fiji.

Daley said doctors need to keep this disease in mind, especially if patients complain of intestinal upsets and unusual numbness and tingling, although he conceded, "It's very rare. I don't expect to see another case in my career."

Editor’s Note:  Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.

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