NOVEMBER 1, 2002
Woes Behind Much Insomnia: Survey
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
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.
and Heart Bypass Surgery
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
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
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
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.
<P< after month a depression had who
people in found was pain chest and between association
strongest The years. five of end the at cardiac have to
likely more were points four all scores higher with>
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
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.
University has a Web site for people who have undergone
Herpes Infection Could Skyrocket
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
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
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
Source: Sexually Transmitted Diseases 2002;29:608-620.
Medicare Payments to Rise
By Janelle Carter
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
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
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
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
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
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
The government also established guidelines to begin covering
drug-eluting stents once they gain approval from the Food
and Drug Administration (news
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: http://www.cms.gov
Function Discovered for Breast Cancer Gene
By Alison McCook
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
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
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
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
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
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
"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.
May Heal Depression
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
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.
Learn more about coping with cancer at the National
May Be More Image-Obsessed Than Germans
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
"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
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
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
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
"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.
May Cut Bladder Cancer Risk in Ex-Smokers
By Serena Gordon
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
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
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
More than 50,000 Americans are diagnosed with bladder cancer
every year, according to the National Cancer Institute
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
sites) without a pitcher or a third baseman,"
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.
Procedure May Complicate Pregnancy
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
"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
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
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.
Approves Nicotine Lozenge
WASHINGTON (AP) - Smokers trying to quit will soon be able
to try a nicotine-containing lozenge to help reduce their
The Food and Drug Administration (news
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.
Acid May Help Prevent Pregnancy Complication
By Alison McCook
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
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,"
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
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
Source: American Journal of Epidemiology 2002;156:806-812.
a Used Mattress Cause SIDS?
By Ed Edelson
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
"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
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
"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
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,
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],"
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
Gene Research Consent Forms Misleading: Study
By Vicki Brower
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
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
"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
"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."
Clots: What You Don't Know Can Kill You
By Amanda Gardner
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
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
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
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
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
"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
"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
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,
Online or call 1-800-CLOT-FREE. For more on deep vein
thrombosis, visit the University
of Massachusetts Medical School.
Parents Lack Info About Hepatitis A: Survey
By Charnicia E.
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
According to a recent study by researchers at the US Centers
for Disease Control and Prevention (news
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
Most such communities are in the Western US. See www.cdc.gov for more information on hepatitis A
and a breakdown of hepatitis A rates in various US regions.
(HealthScoutNews) --All surgery carries risks, so it's best
to know as much as you can before hopping onto an operating
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
- How will surgery benefit
- 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
- How long will it take
me to recover?
- How much will it cost?
Health System 'Dysfunctional': Panel
By Todd Zwillich
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
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
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
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
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.
(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
- 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
- Choose shoes shaped like
- 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.
Issues Caution Regarding Use of Bone Cement
WASHINGTON (Reuters Health) - The US Food and Drug Administration
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
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
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
A full copy of the FDA notice can be obtained on the agency's
Web site at www.fda.gov/cdrh/safety/bonecement.html.
Not Race, Key In Cancer Screening
By Jennifer Thomas
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
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
"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
Still, racial disparities in cancer screening do persist, Coughlin
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
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
cancer at the American Cancer Society (news
Fit Doesn't Cancel Out Risks of Excess Fat
By Jacqueline Stenson
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
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.
Hormone Leads to Less Bleeding
By Amanda Gardner
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
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
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
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,"
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
Top Health Hazards Ranked
By Emma Ross
AP Medical Writer
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
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
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
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
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
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
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
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,
Teen Dies After Following High-Protein Diet
By Dana Frisch
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
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
Source: Southern Medical Journal 2002;95:1047-1049.
More Survive Heart Failure
By Stephanie Nano
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
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
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
"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
Added Dr. Sidney Smith, chief science officer of the American
Heart Association (news
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,"
On the Net:
New England Journal: http://nejm.org
American Heart Association: http://www.americanheart.org
May Be More Satisfied with Same-Race Docs
By Charnicia E.
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
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.
(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
The above guide is estimated for a 120- to 150-pound healthy
Stress Does Not Cause Cancer: Study
By Charnicia E.
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
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
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
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,"
"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.
Explains Why Depression Can Strike Again
By Amanda Gardner
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
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 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
"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
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
Institute of Mental Health.
Test May Help ID Rheumatoid Arthritis Early
By Hannah Cleaver
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
"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.
Free Smoke Alarms Don't Cut Fire Deaths
By Adam Marcus
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
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
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,"
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.
Therapy Triggers Bone Growth in Rats
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
Source: Neurosurgery 2002;51:1239-1245.
'Valve' Tied to Recovery from Heart Attack
By Adam Marcus
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
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
Diet May Affect Grandkids' Disease Risk
By Merritt McKinney
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
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.
Can Prevent Emergencies, Too
By Ed Edelson
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
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
Linked to Mental Abilities in Elderly Women
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
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
"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"
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,"
Source: American Journal of Epidemiology 2002;156:842-850.
in Athletes May Have Cumulative Effect
By Alison McCook
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
Source: Neurosurgery 2002;51:1175-1181.
Combo Fights Bone Marrow Cancer-Study
By Lisa Richwine
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
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
sites) requires tight controls on Thalomid's use to
make sure pregnant women do not take it.
of Delivery Does Not Up C-Section Risk: Study
By Pat Hagan
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
"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
OCTOBER 30, 2002
Your Child Cope With a More Stressful World
By Jennifer Thomas
WEDNESDAY, Oct. 30 (HealthScoutNews) -- They don't have to
deal with grueling commutes, bad bosses or endless streams
But children, even young ones, are increasingly struggling
with the stresses of modern life, child development experts
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
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
"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
"It says to me that something is out of balance here,"
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 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
Network for Children Care or KidsHealth.org.
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.
Undergo Memory Brain Boost After Age One
By Alison McCook
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
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
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.
(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
sites) suggests you:
- Clean the lint filter
after every laundry load and the exhaust about once
- 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
Failure Declines in Women, but Not Men
By Keith Mulvihill
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
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
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
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.
Ads for Fighting Fat
(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.
Failure Drug Ups Death Risk in Women, Not Men
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
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
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
Source: The New England Journal of Medicine 2002;347:1403-1411.
Gene for Cystic Fibrosis Possible
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
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
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.
To learn more, go to the Cystic
Pain Not in the Imagination
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
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.
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.
U.S. Preschoolers Have Never Visited Dentist
By Charnicia E.
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
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.
Weapon in War Against Cholesterol
By Kathleen Doheny
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
Rather, it will often complement the existing treatments and
help when the statins -- such as Lipitor (news
sites) (atorvastatin) or Zocor (simvastatin) -- aren't
enough to lower cholesterol and the risk of heart disease,
"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
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
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
"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
Contraceptives Cut Risk of Ovarian Cysts
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
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.
Doctor Warns of Post-Nipple Pierce Infection
By Hannah Cleaver
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
"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
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
Living With Heart Failure
By Adam Marcus
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
"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 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
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 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.
Cancer Gene' Boosts Prostate Risk, Too
By Patricia Reaney
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
sites), a British scientist said Wednesday.
Dr. Ros Eeles, a medical geneticist at The Institute of Cancer
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
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
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.
TUESDAY, OCTOBER 29,
Proof That Chiropractic Care Helps Headache
By Charnicia E.
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
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
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
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.
Sex Often Part of Casual Teen Relationships
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
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
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
Linked to Higher Risk of Ovarian Cancer
By Merritt McKinney
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
"Rather, we think that elevated IGF-I levels are due to
other causes preceding ovarian cancer development,"
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.
(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
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.
All Garlic Supplements Created Equal
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.
ConsumerLab.com, 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, ConsumerLab.com licenses its flask-shaped "Seal
of Approved Quality" to companies whose products
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
"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 ConsumerLab.com, 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
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.
Study Suggests Estrogen May Worsen Alzheimer's
By Suzanne Rostler
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
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
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
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
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.
in Saliva Protects Babies from Mom's HIV
By Alison McCook
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
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
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,"
HIV-1 is a major type of the virus that can cause AIDS (news
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
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
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,"
Source: Journal of Infectious Diseases 2002;186:1173-1176.
Feet Mean Sore Feet
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.
Learn more about flat feet at the British
Orthopaedic Foot Surgery Society.
Ointment Relieves Chronic Skin Rash in Mice
By Merritt McKinney
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.
May Lower Rheumatoid Arthritis Risk
By Charnicia E.
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
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
Take New Approach to Fight Cancer
By Patricia Reaney
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,"
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.
Insight for Men Who've Had Prostatectomy
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
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.
Here's where to go to find out more about prostate
U.S. Moms Receive Many Interventions in Labor
By Alison McCook
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
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
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,"
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
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
"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.
Store Machines OK for Testing Blood Pressure
By Pam Harrison
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
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
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.
Drug Therapy Helps Rheumatoid Arthritis Sufferers
By Ross Grant
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,
"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,"
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.
Get Bulk of Nutrition Info from TV
By Suzanne Rostler
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
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
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).
People Do Just as Well After Heart Transplant
By Pam Harrison
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
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
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
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.
or Low C-Section Rates Predict Infant Outcomes
By Alison McCook
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
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
More Education, the More Likely You'll Quit Smoking After
By Adam Marcus
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
"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
Tub May Be OK for Some on Blood Pressure Meds
By Pam Harrison
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
"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
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
(HealthScoutNews) -- According to the U.S. Food and Drug Administration
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.
Team Will Hunt for Disease Hotspots on Genes
By Alicia Ault
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
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
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,
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
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.
Can Hurt Healthy Men's Kidneys, Study Shows
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
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
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.
MONDAY, OCTOBER 28,
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
Here's where to go to find out more about back
Halts Mexican Cantaloupe Imports
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
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
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:
May Not Affect Memory over Long Term
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
"Findings from this...study 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.
Breed of Head Lice Survives
By Adam Gorlick
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
"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
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
"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
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."
On the Net:
Calories May Keep Heart Young: Study
By Suzanne Rostler
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
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
The findings, which appear in this week's online early edition
of the Proceedings of the National Academy of Sciences
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
'Cooks' Proteins in the Body
By Merritt McKinney
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
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
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
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.
Juice May Cut Risk of Kidney Stones
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
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
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.
Pain Medication Use Linked to Hypertension
By Alison McCook
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
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,"
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
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
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
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.
Misjudge Local Drug Resistance Problems
By Charnicia E.
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
They investigated doctors' perceptions about antibiotic resistance
in a survey of 424 internal medicine physicians at four
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
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,"
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."
of Internal Medicine 2002;162:2210-2216.
Juice May Inhibit Respiratory Bacteria
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
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
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
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.
Teens Gamble, Some Already Have Problem: Study
By Paula Moyer
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
"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."
Alternative Med Use Also Popular Among Kids
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
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
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.
Nile '02 Outbreak Biggest of Its Kind in West
Monday, October 28, 2002
CHICAGO (Reuters Health) - This summer's West Nile virus (news
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
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
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
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
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.
Criticizes Vaccine Safety Assessment
By Richard Woodman
Monday, October 28, 2002
LONDON (Reuters Health) - New systems are urgently needed to
ensure childhood vaccines are safe, a researcher urged
Dr. Thomas Jefferson, who has been funded to investigate vaccine
safety by the European Commission (news
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
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
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.
Students Show More Risky Behaviors
By Alison McCook
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
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
"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.
Deaths Climb in Miami-Dade County
By Paula Moyer
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
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
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
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."
SUNDAY,OCTOBER 27, 2002
the Lord and Pass the Broccoli
By Amanda Gardner
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
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
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
of Minority Health at the Department of Health and
Human Services (news
sites), the Minority
Health Network or the CDC's Minority
Issues Hand-Washing Guidelines
By Daniel Q. Haney
AP Medical Editor
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
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
"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
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
On the Net:
CDC guidelines: http://www.cdc.gov/handhygiene/
Injuries Prompt Lens Crackdown
By Charley Gillespie
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
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
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
"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
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
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
On the Net:
It's Not Just for Kids Anymore
By Holly VanScoy
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
- Susceptibility to distractions
that don't seem to affect their classmates.
- Reliance on stimulants,
such as coffee, as a means of focusing on important
- 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
"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
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
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
Finds New Food Poisoning Items
By Daniel Q. Haney
AP Medical Editor
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
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
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
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
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
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,
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.
On the Net:
Meeting site: http://www.idsociety.org/ME/AM2002/ToC.htm