The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
November 30, 2002

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of November 2-8

  1. Antidepressants: Too Much of a Good Thing?

    SATURDAY, NOVEMBER 2, 2002

  2. Gulf War Research Funds to Increase
  3. Web Sites Promote Anorexia and Bulimia as a 'Lifestyle'

 

FRIDAY, NOVEMBER 8, 2002 

Gender Plays Part in Transplant Success 

HealthScoutNews

Friday, November 8, 2002

FRIDAY, Nov. 8 (HealthScoutNews) -- If you are facing a transplant, you might want to ask about the gender of the donor organ.

A German study found that people given organs from female donors are more likely to reject the organ and have higher death rates compared to people who get organs from male donors. The report appears in a recent issue of the Journal of the American Society of Nephrology.

The study also suggests that female transplant patients have a higher organ rejection rate than men.

Researchers at the University of Heidelberg analyzed a database of 124,000 kidney transplants, 25,000 heart transplants and 16,000 liver transplants done around the world.

They found that men have a 22 percent higher risk of losing of transplanted kidney if it came from a woman. For women, the risk of losing a transplanted kidney was 15 percent greater if it came from a female donor.

Men and women who received female-donated kidneys also had a greater risk of dying.

Men who were given female hearts were 13 percent more likely to lose the heart compared to men who received male hearts. The researchers also found that women heart transplant patients were more likely to reject the heart than men.

The study says that gender may also be a factor in the success of liver transplants, but the results were unclear. When they analyzed data from around the world, the researchers found no gender difference. But they did find a gender difference in North America, where men who received livers from female donors had a greatly reduced chance of success.

The researchers say it's not known how gender affects organ transplants. One theory is that there are differences in male and female immune systems.

Whatever the cause, the researchers say their findings indicate that donor and recipient gender should be considered when doctors make decisions about immunosuppressant drugs. These drugs reduce the immune system's ability to react and are given to transplant patients to lessen the chance that their body will reject the transplanted organ.

The researchers say men and women transplant patients should be given gender-tailored immunosuppression therapy.

More information

The U.S. National Library of Medicine has more about transplant rejection.

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CDC Says C-Sections Are on the Rise

By Daniel Yee

Associated Press Writer

The Associated Press

Friday, November 8, 2002

ATLANTA (AP) - A government effort to reduce the rate of Caesarean births appears headed for failure, federal officials reported Thursday.

A California study found that the percentage of mothers who had had a child by Caesarean section and opted to repeat the procedure for subsequent children increased during the second half of the 1990s, the Centers for Disease Control and Prevention (news - web sites) said.

That is a reversal of the trend from the 1980s and early '90s.

Nearly a quarter of all deliveries in the country are by C-section. The United States is trying to reduce that to about 15 percent. Since 2000, the government has been promoting vaginal births, contending they carry a lower risk of medical complications for mothers.

But the California study casts doubt on whether the government can reach its goal. The CDC found that the percentage of women who chose a vaginal birth after having their previous child by C-section dropped from 23 percent to 15 percent between 1996 and 2000.

The CDC said the study supports other research indicating the same thing is happening nationwide.

California, which accounts for one-eighth of all births in the United States, will probably not meet the government health goals on Caesarean sections, the CDC said.

"California has the largest population of births in the country, so whatever happens here will be seen nationally," said the CDC's Dr. Sharon Durousseau.

The government has set a goal for 2010 of 37 percent of women having vaginal births after having Caesareans. The U.S. rate now is 22 percent.

The government cited medical and legal pressures for the increase in C-sections among these women.

Similarly, doctors said Caesarean sections are on the rise because it is convenient for health providers and patients to schedule births; because of the risk of lawsuits if something goes wrong with the baby; and because the stresses of labor can cause bladder problems in the mother.

Many obstetricians have long believed that once a woman gave birth by C-section, all subsequent deliveries would have to be done that way, too, because of the risk that the scarred uterus could rupture during labor if the mother attempted a vaginal birth. But in the 1990s, government experts concluded that many of these women could safely deliver vaginally.

Dr. Curtis Lowery, director of the maternal-fetal medicine division of the obstetrics and gynecology department of the University of Arkansas for Medical Sciences, said almost none of hospitals in Arkansas are performing vaginal births after Caesareans.

C-sections are "not an effective spending of health care resources," Lowery said. "What will happen as the result of multiple abdominal surgeries on patients?"

Federal officials said better education campaigns for women and health-care providers on the risks and benefits of vaginal births are needed.

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Getting the Dosage Right

HealthScoutNews

Friday, November 8, 2002

FRIDAY, Nov. 8 (HealthScoutNews) -- Medication errors decrease by 51 percent when a clinical pharmacist is included on daily patient rounds in hospitals. That startling finding comes from a study in the latest issue of the American Journal of Health-System Pharmacy.

The inclusion of a pharmacist on patient rounds also reduces the duration of medication errors, the study says.

In this study, a clinical pharmacist took part in daily patient rounds in an academic medical center for a month. The pharmacist investigated patient allergy information, monitored laboratory tests, and reviewed medication orders to ensure appropriate selection and dose.

In addition, the pharmacist reviewed drug indications, the medication administration record and patient age, weight and organ function.

At the same time, a team of reviewers examined patient medical charts for errors. The study found there were 46 medication errors in patients when the pharmacist was part of daily rounds and 94 errors in the control group where there was no pharmacist on daily rounds.

The study also found that when a pharmacist took part in daily rounds, medication errors persisted less than a day and with less than one dose of medication. In the control group, errors persisted for 2.4 days and with two doses of medication.

More information

The U.S. Food and Drug Administration (news - web sites) has more information about medication errors.

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Skin Cancer Not Rare in Elderly Black Women: Study

Reuters Health

Friday, November 8, 2002

NEW YORK (Reuters Health) - Elderly African-American women may be at higher risk of developing squamous cell carcinoma--one of the most common types of skin cancer--than previously thought, new study findings suggest.

Squamous cell carcinoma is more common among whites, affecting roughly 100 to 150 people per 100,000; however, it is also the most common form of skin cancer among blacks, occurring in about 3 people per 100,000.

Now, two doctors who conducted a small study at their dermatology clinic in Atlanta, Georgia, are reporting that "squamous cell carcinoma is not rare on the legs of elderly African-American women."

"It can present with atypical features, and physicians must be alert to this possibility," according to Drs. Calvin O. McCall and Suephy C. Chen of Emory University School of Medicine. Their report is published in the October issue of the Journal of the American Academy of Dermatology.

After reviewing medical records for a 5-year period, the team identified 35 African-American women who had "biopsy-proven" cases of squamous cell carcinoma. All of the women were elderly and 16 of them had lesions on their legs, the report indicates.

"These squamous cell carcinomas can be very darkly pigmented and their appearance creates the risk of them being dismissed as benign neoplasms and ignored at a time when surgical intervention would be most effective," McCall and Chen write.

In whites, squamous cell carcinomas usually appear on sun-exposed areas of the body, such as the face, ears, neck, lips, and backs of the hands. However, in blacks, they are more likely to occur in areas that aren't as likely to be exposed to the sun, such as on the legs, feet or genital area. In the study, only 6% of whites had squamous cell carcinomas in sun-protected areas, while 69% of black patients did.

Squamous cell carcinomas account for about 20% of all skin cancers, and very few spread to lymph nodes and/or other organs, according to the American Cancer Society (news - web sites).

Source: Journal of the American Academy of Dermatology 2002;47:524-529.

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Babies See More Than We Bargained For

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Friday, November 8, 2002

FRIDAY, Nov. 8 (HealthScoutNews) -- Babies as young as 1 year old understand visual communication better than many of us may realize.

So says a new study that suggests that 12-month-olds are as interested in looking at things as we are. And at 14 months, they know when we're looking at something, and they point and try to "talk" to us by focusing on the same object.

"I think it's great for us to know that at 12 months they're singling out what we're looking at," says Rechele Brooks, author of the study that appears in the new issue of Developmental Psychology. "This should help with language and social interaction."

Older babies even babble and point when they think we are looking at something, showing that "they recognize the social aspect" of communicating, adds Brooks, a research associate at the University of Washington's Center for Mind, Brain, and Learning.

The researchers looked at 96 infants, divided into three age groups; 32 babies who were 12 months old, 32 who were 14 months old, and 32 who were 18 months old.

For the first experiment, half the babies in each group were randomly assigned to be in a "closed-eyes" group, the others in an "open-eyes" group. After making eye contact with the infant, a researcher would either close her eyes and turn her head at a certain angle toward a toy, or keep her eyes open and turn her head toward the toy. The babies were considered to be looking at the same toy as the researcher if they turned their heads in the same position and looked at the toy for a minimum of one-third of a second. This is termed "gaze following," Brooks says.

The experiment was repeated four times.

Babies were much less interested in seeing what the researcher was looking at if her eyes were closed. "They noticed your eyes need to be open," Brooks says.

The babies in all three age groups performed similarly. "Ninety percent of babies were looking at toys with me with my eyes open, but only 46 percent when my eyes were closed," she says.

Brooks says it's unlikely that babies nine months of age would realize the significance of the researcher having her eyes open or not. While a 9-month-old can play with a toy or a parent, it's only a bit later that they start to notice that what you are looking at may tell them things, Brooks says.

For the second experiment, a researcher put on a bandana. For half the babies, the researcher placed the bandana on her forehead; for the others she used it to cover her eyes. In both instances, the researcher turned as if to look at something.

The differences in how the babies reacted depended on their ages.

The 12-month-old babies looked about half the time, no matter where the bandana was placed. Among the 14-month-olds, 77 percent of them turned and looked when the researcher could see, and sometimes also cooed or pointed. But when the researcher was blindfolded, they looked only 56 percent of the time, Brooks says.

Eighteen-month-olds performed similarly.

Henry Wellman, a professor of psychology at the University of Michigan, says Brooks' study shows that at a young age, babies are starting to understand how communication works. "Babies understand that even if you're oriented to something but your eyes aren't open, you can't see. This is important."

This finding should help researchers understand how babies learn to talk. Words are about things, and "vision is about that thing," and now we know babies make that connection, Wellman says.

"At an intriguingly early age, babies make visual reference," he says.

What To Do

To read more about babies and communication, visit Charles Sturt University in Australia, or Boys Town National Research Hospital.

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Bone Disease Diagnosis From Where You'd Least Expect It

HealthScoutNews

Friday, November 8, 2002

FRIDAY, Nov. 8 (HealthScoutNews) -- A visit to your dentist can help reveal early signs of osteoporosis.

When a dentist notices bone loss in a person's jaw, it may be a sign of bone loss in other parts of the body, says Barbara J. Steinburg, a clinical professor of surgery and medicine at Drexel University College of Medicine in Philadelphia.

She says a dentist may be the first health professional to suspect osteoporosis in a patient. If that's the case, the dentist can refer the patient for medical assessment.

A person with osteoporosis who has bone loss in the jaw may also be at risk for bone loss around the teeth.

Osteoporosis may be the culprit when post-menopausal women complain that their dentures don't fit properly, Steinburg says. Studies show that post-menopausal women with osteoporosis needed new dentures three times more often after age 50 than women without osteoporosis.

Bone loss in these women can become so severe that it makes it impossible to create functional dentures for them. That means they may be unable to chew many kinds of food and could suffer serious nutritional deficiencies.

Dentists can also detect signs of bulimia in their patients. That's because the constant self-induced vomiting done by bulimics exposes their back teeth to powerful stomach acids. The teeth can become smooth and glassy as the enamel and dentin layers are eroded by those stomach acids.

Steinburg says dentists need to be aware of such signs so that they can refer patients to appropriate health-care professionals.

More information

Here's where to go to learn more about osteoporosis and bulimia.

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Showing Babies How Objects Work Aids Learning

y Amy Norton

Reuters Health

Friday, November 8, 2002

NEW YORK (Reuters Health) - Babies as young as 14 months can begin to group objects in their environment when an adult names the objects and gives a short demo of how they work, according to researchers.

They say such understanding of how infants make sense of the whirlwind of information around them could provide ways of helping young children with delays in language and overall cognitive development.

In two studies of 14- and 18-month-old babies, the Northwestern University researchers found that the babies were able to use object names and functions to recognize when objects belonged to the same "category." Such categorization is how babies, and humans in general, "impose some order" on the complex world around them, one of the study authors, Amy E. Booth, explained in an interview with Reuters Health.

She and Sandra Waxman, a colleague at the Evanston, Illinois university, report the findings in the November issue of Developmental Psychology.

In one of the studies, the researchers familiarized the babies with pairs of objects belonging to the same category, meaning they were similar in overall shape, color and parts. Under one condition, the babies were given the object names ("This one is a dax and this one is a dax."); under another condition, the infants were shown the objects' function ("Look what I can do with this one, and look what I can do with this one.") In a third "no-cue" condition, the babies were simply told, "Look at this one and look at this one."

After the babies were familiar with these new objects, they entered the "test phase," where they were shown an object and then asked to "find another one of these."

The researchers found that 18-month-old babies were better able to "find another one" when they had been familiarized with the target object's name or function. For the 14-month-olds, the same was true when they had seen the object's function, but having heard the object's name was not enough.

However, in the second study, Booth and Waxman found that the younger babies could indeed use names to help them group objects when they were given a "hint" about how the objects in a given group functioned. The hint involved naming each object in a group, then showing the babies how just one member of the group worked. The researchers found that the 14-month-olds were better able to later group the objects when they had heard the names and seen the hint, as opposed to only seeing the hint.

Booth said that a possible explanation for the findings is that, when an object is completely new to a 14 month old, the baby needs to be able to "infer some meaning" for the object. Names alone, she explained, may not "stick."

"By 18 months," Booth said, "infants may have enough experience with language that when an adult (names) an object, they assume it has some meaning."

Knowing how babies categorize objects, and everything else in their environment, aids (news - web sites) in understanding normal human development, Booth noted. If researchers know how babies normally break their surroundings into "meaningful and manageable" categories, they may be able to better help children with developmental delays, she said.

And even when there's no learning problem, the researcher added, parents may be able to enhance young babies' learning by "making a special effort" to show how an object functions, along with naming it.

Usually, though, Booth said, the "basic environment" a baby is in is enough for normal learning and development.

Source: Developmental Psychology 2002;38:948-957.

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Not Tonight, Honey, I'm About to Have an Explosive Headache

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Friday, November 8, 2002

FRIDAY, Nov. 8 (HealthScoutNews) -- Who's more likely to say, "Sorry honey, I have a headache?" A man or a woman?

 A woman, you guessed? Wrong.

Neurologists in Germany found that men were three times more likely to suffer from sexual headaches -- usually a sharp, severe pain that comes on suddenly when the person is nearing orgasm.

"It's not that common, but it does occur and it's quite distressing to those who have them," says Dr. Arthur Elkind, director of the Elkind Headache Center in Mount Vernon, N.Y. "If every time you have sex you get a terrible headache, it can really interfere with your life."

Researchers aren't sure about the precise cause of the headaches, although they're probably a type of "exertional" headache, in which the pain comes on during vigorous physical activity, Elkind says.

Blood-vessel changes in the brain during physical activity could be to blame, says Elkind, an assistant clinical professor of medicine at New York Medical College in Valhalla, N.Y.

During sex (or vigorous exercise), heart rate increases, blood pressure increases and the body releases catecholamines, chemicals that increase metabolic activity, Elkind says.

"It's possible that these chemicals could act as a trigger on the blood vessels in susceptible persons, or that the chemicals could act on certain sensitive areas of the brain to trigger a migraine," Elkind says.

Men who get sexual headaches, technically called "orgasmic cephalalgia," also tend to suffer from migraines, according to the new study, which was presented at the recent European Federation of Neurological Societies Congress in Vienna, Austria.

The German researchers examined 35 men and 12 women who had sexual headaches. They did tests to rule out other, more serious causes of the headaches, including bleeding in the brain, stroke or tumor.

They found two peaks in the ages at which men were at their highest risk of getting the headaches -- 20 to 24 and 35 to 44.

For most men, the pain came on suddenly and severely, says study author Dr. Achim Frese, of the University of Munster in Germany. A few suffered from a dull, throbbing headache that increased gradually as they came closer to orgasm.

What can a sexual headache sufferer do?

If you get them frequently, see a doctor to rule out a more serious condition, Elkind says.

About half of the people in the German study said they could avoid some headache attacks by slowing down their sexual activity and increasing their excitement more gradually.

Some patients were helped by indomethacin, a painkiller and anti-inflammatory drug first developed for arthritis that's now used to treat headaches. Others had success with beta blockers, used to treat migraines.

Beta blockers have to be taken for at least several days before they begin to work, Elkind says.

For many people, the headaches go away on their own. They suffer several attacks, and then the headaches never return, Elkind says.

"From the patients' point of view, it gives clear information about the benign prognosis of the disorder and demonstrates that it is treatable," Frese says.

What To Do

To learn more about sex-related headaches, visit the National Headache Foundation or the State University of New York Upstate Medical University.

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Patients Seek Internet Rx

HealthScoutNews

Friday, November 8, 2002

FRIDAY, Nov. 8 (HealthScoutNews) -- People seeking information about medical procedures are more than twice as likely to get it from the Internet as they are from their doctors, says a survey by the American Academy of Dermatology.

However, a doctor's recommendation carries the most weight in a person's decision about choosing a medical procedure, the survey says.

The telephone survey of 800 adult men and women revealed that 67 percent of them consider the Internet their preferred source of information about medical procedures. Only 33 percent said they consult their doctor for such information. However, 70 percent said it's their doctor's advice that influences their final decision about a medical procedure.

Other sources of information concerning medical procedures include: family, friends and other people who have had the procedure (39 percent); medical journals and books (32 percent); registered nurses or other health-care professionals (16 percent); public libraries, encyclopedias (16 percent); and magazines, newspapers and television (13 percent).

The survey also found that 62 percent of the respondents said they feel their decisions about health care in general are very well informed, and 76 percent said they do their own research when making a decision about a medical procedure.

Fifty-four percent of the respondents said they ask their doctors about their experience with medical procedures, and 39 percent said they ask their doctors about their credentials.

The academy recommends that when people are researching medical procedures, they ask their doctors about their experience and credentials. That includes asking how many of the procedures the doctor has performed, what kind of results can be expected, potential risks, cost, and where the doctor will perform the procedure.

More information

The Journal of the American Medical Association (news - web sites) has a patient education page.

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Pass the Stuffing -- and the Antioxidant -- Please

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Friday, November 8, 2002

FRIDAY, Nov. 8 (HealthScoutNews) -- Your Thanksgiving table may be laden with more than turkey and the trimmings -- it may be rich in disease-fighting antioxidants, too.

It isn't necessarily in the dishes you would expect, such as sweet potatoes or cranberries, but in the stuffing.

German researchers have discovered that during the baking of bread, an antioxidant called pronyl-lysine is created, especially in the crust.

"[Pronyl-lysine] is more present in the crust because you need higher temperatures to generate that compound," says study author Thomas Hofmann, a professor and head of the Institute for Food Chemistry at the University of Muenster.

Results of the study appear in the new issue of the Journal of Agricultural and Food Chemistry.

Antioxidants are healthful compounds found in many foods. Vitamins C and E are two examples of antioxidants. These compounds are believed to help fight cancer and other diseases, according to the American Dietetic Association.

Hofmann and his colleagues analyzed a sourdough bread mixture that contained rye and wheat flour, and discovered the pronyl-lysine after baking. The antioxidant was not present in the flour used to make the bread.

The antioxidant is created during a chemical reaction between the amino acid L-lysine and starch and sugars in the bread. This same reaction causes the crust to have a darker color than the rest of the bread, Hoffmann says.

Pronyl-lysine is also found in malt, as well as in beer. The antioxidant is present in higher amounts in dark bread and beer, Hofmann says.

He adds that pronyl-lysine is formed in bread with yeast or without, but it is more abundant when the bread is baked in smaller pieces, as it might be for used in stuffing.

Once the scientists identified the antioxidant, they tested it on human intestinal cells in the lab and found that pronyl-lysine increased the amount of certain enzymes that are believed to play a role in the prevention of some cancers.

The next step in the research is to learn if the antioxidant is actually absorbed into the blood during digestion, where it might be able to help fight disease. The researchers are currently conducting animal tests to see if this occurs.

Of course, this doesn't mean you can gorge yourself with stuffing on Thanksgiving, guilt-free.

"People who like to complement their Thanksgiving meal with stuffing need to remember that stuffing is usually soaked with butter and gravy. And antioxidants can't counteract those things," says Samantha Heller, a senior clinical nutritionist at New York University Medical Center in New York City.

Heller also points out the German study is only the first step in the research. Now, she says, the scientists need to learn what the antioxidant does when it's in the body and how available it is in the blood after digestion.

Bread, and its crust, can be part of healthy diet, however, adds Heller. She says fiber, which is found in whole grain breads, fruits and vegetables, is a known disease fighter and it helps keep you feeling full.

What To Do

To learn more about antioxidants, visit the American Dietetic Association. The Physicians Committee for Responsible Medicine offers these recipes for a healthier Thanksgiving meal.

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Schizophrenia Medication Linked to Heart Risk

By Alison McCook

Reuters Health

Friday, November 8, 2002

NEW YORK (Reuters Health) - People who take antipsychotic drugs to control schizophrenia appear to have a slightly higher than average risk of experiencing heart problems, new study findings suggest.

Dr. Sean Hennessy of the University of Pennsylvania in Philadelphia and his colleagues found that patients who took antipsychotic drugs--most commonly, haloperidol (Haldol) and thioridazine (Mellaril)--were between 1.7 and 3.2 times as likely as non-schizophrenics to experience cardiac arrest or an irregular heart rhythm.

However, the authors note in the November 9th issue of the British Medical Journal, it is not clear whether the increased risk is due to the schizophrenia or its treatment.

Hennessy told Reuters Health that regardless of the cause of the heart problems, people with schizophrenia should continue their medication.

"The risks shown in the study are really pretty small, and the benefit of antipsychotic drugs strongly outweigh this small risk," he said.

Schizophrenia is a widespread and debilitating form of mental disease with symptoms ranging from delusions and an altered sense of self to apathy and social withdrawal. It affects around 1% of people.

During the study, Hennessy and his colleagues followed a group of more than 100,000 people, many of whom were schizophrenics who took different antipsychotic treatments, and noted if they experienced cardiac arrest or ventricular arrhythmia, a potentially life-threatening condition in which the heart rhythm becomes irregular. During cardiac arrest, the heart unexpectedly stops beating.

Patients appeared to experience the same risk of heart problems whether they were taking haloperidol or thioridazine, but the authors noted that the risk of problems appeared to increase at higher doses of thioridazine.

In an interview with Reuters Health, Hennessy explained that some antipsychotic medications can prolong the so-called QT interval. The QT interval represents a portion of an electrocardiogram (ECG), the tracing of the heart's electrical activity. Although what the effect of prolonging this interval may be on the heart remains unclear, some researchers suspect that it may increase the risk of cardiac arrest.

Alternatively, Hennessy said that schizophrenia itself may cause cardiac arrest because patients with the condition often have abnormal levels of salts in the blood, such as potassium. "There are also many poorly understood relationships between brain and body," he noted.

Nevertheless, to protect patients, Hennessy and his colleagues recommend that doctors treating patients with thioridazine try to keep the dose as low as possible, without sacrificing its benefits.

Source: British Medical Journal 2002;325:1070-1072.

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Diet Lowers Heart Risk for Asians

HealthScoutNews

Friday, November 8, 2002

FRIDAY, Nov. 8 (HealthScoutNews) -- A Mediterranean-style diet may help reduce the risk of coronary artery disease in Asian people, especially those living in western nations, according to new research.

Coronary artery disease (CAD) is a major public health problem facing South Asian people. But that danger can't be explained by conventional risk factors such as high blood pressure or cholesterol.

A study by Indian and Israeli researchers, appearing in tomorrow's issue of The Lancet, included 1,000 people with a history of health problems associated with CAD, including angina (news - web sites), heart attack and diabetes. Half the people were given a Mediterranean-style diet that included whole grains, fruits, vegetables, walnuts and almonds.

That diet is rich in alpha-linolenic acid, believed to benefit the heart.

The other half of the people in the study, the control group, ate a conventional Asian diet.

At the end of two years, the group given the special diet had doubled their daily intake of alpha-linolenic acid. The study group had half the number of sudden cardiac death cases and non-fatal heart attacks compared to the control group.

More information

The American Heart Association (news - web sites) has more on the Mediterranean diet.

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Tired Traveler Tips

HealthScoutNews

Friday, November 8, 2002

(HealthScoutNews) -- Jet lag is an inevitable offshoot of travel. But according to the American Academy of Family Physicians (news - web sites), you can lessen its effects if you:

  • Get lots of shut-eye before you travel.
  • Avoid too much alcohol.
  • Eat well-balanced meals.
  • Don't overeat.
  • While away, exercise as much as you can.

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Stem Cell Research May Offer Hope for Parkinson's

By Dana Frisch

Reuters Health

Friday, November 8, 2002

NEW YORK (Reuters Health) - Stem cells derived from neurological tissue can be coaxed into a type that produce dopamine, the chemical communicator missing in Parkinson's disease (news - web sites), researchers reported this week at the meeting of the Society for Neuroscience in Orlando, Florida.

However, the cells tend to die when transplanted into rats, said Dr. Lorraine Iacovitti. The cells may have been too mature to make the transition from laboratory dish to animal, she said.

"I think we have to go back in time so they aren't quite as developed as they are now," said Iacovitti, who is a professor of neurology and the associate director of the Farber Institute for Neurosciences at Jefferson Medical College in Philadelphia, Pennsylvania.

Treating Parkinson's by transplanting stem cells is still a good while away, Iacovitti told Reuters Health.

"I think that this is good because the more we know about the cells and how to keep them the way we want, the more we can accurately define how to keep them that way once they're transplanted."

Parkinson's disease is caused by the gradual loss of dopamine-producing cells. Dopamine helps control movement, and its loss contributes to the characteristic tremors, muscle stiffness and movement problems associated with Parkinson's disease.

Drugs like levodopa help alleviate some of the symptoms of Parkinson's disease but do not slow the disease's progression. Research has focused on stem cells, which are 'master' cells capable of developing into different types of tissue, as a means of replenishing the supply of dopamine.

In the study, Iacovitti used human fetal stem cells from between 6 and 8 weeks of gestational age. These are similar to embryonic stem cells but are not the ones mired in controversy, which are taken from discarded embryos from in vitro fertilization clinics. These ones are older and are available commercially noted Iacovitti.

Of the millions of cells Iacovitti and her team grew in culture, 25% developed into dopamine-producing cells in a lab dish. She said the key will be figuring out the best time to transplant the cells into the rat so they survive.

"We feel very encouraged that we've gotten this far. And now, it is just a matter of getting them to stay alive once we transplant them," said Iacovitti.

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Handling Heartburn

HealthScoutNews

Friday, November 8, 2002

(HealthScoutNews) -- If you get a burning sensation in your chest along with a sour taste in your mouth, especially after eating a big meal, you could be suffering from heartburn.

 According to the American Academy of Family Physicians (news - web sites), you might be able to ward off heartburn by making some lifestyle changes:

  • Raise the head of your bed.
  • Eat at least 2 to 3 hours before lying down.
  • Lose weight if you need to.
  • Don't overeat.
  • Stick to high-protein, low-fat meals.
  • Avoid tight clothes and tight belts.
  • Know what foods bring on your heartburn and cut them from your diet.

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THURSDAY, NOVEMBER 7, 2002

Stroke Fighters

 HealthScoutNews
Thursday, November 7, 2002

THURSDAY, Nov. 7 (HealthScoutNews) -- American researchers have developed several experimental drugs that may protect the brain against stroke, as well as Parkinson's and Alzheimer's disease (news - web sites).

The drugs, which have shown promise in animal studies, were developed by scientists at the U.S. National Institutes of Health (news - web sites) (NIH). Called p53 inhibitors, they attack a protein that's involved in nerve cell death.

The researchers say it's a new strategy for preserving brain function after a sudden injury or chronic disease. Their findings appear in today's issue of the Journal of Medicinal Chemistry.

Studies of p53 inhibitors have been limited to cells and animals, but human clinical trials could begin within two to three years, says researcher Nigel H. Greig, of the National Institute on Aging.

Current drugs used to treat brain injury and damage from brain diseases offer symptom relief but don't stop or slow the actual cause of the brain damage. However, the p53 inhibitors do that by preventing the death of brain cells.

The drugs target the p53 protein, which triggers the biochemical events that result in cell death.

In laboratory tests, brain cells exposed to toxic chemicals survived longer when they were given p53 inhibitors. The drugs also reduced the severity of stroke damage in rodents.

More information

To learn more about stroke and neurodegenerative diseases such as Alzheimer's, go to the U.S. National Institute of Neurological Disorders and Stroke.

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Study: More Supermarkets Linked to Healthier Diets

Reuters Health
Thursday, November 7, 2002

NEW YORK (Reuters Health) - Opening more supermarkets in African-American neighborhoods may be a good way to encourage residents to eat more fruits and vegetables and otherwise maintain a healthy diet, study findings suggest.

"These data show that the local food environment is associated with meeting dietary recommendations for some individuals," writes lead study author Dr. Kimberly Morland of Mount Sinai School of Medicine in New York City and her colleagues.

Also, the findings show that "it's important to consider the context in which people live and their physical environment in terms of their behaviors," she added in a statement. Morland conducted the study while at the University of North Carolina, Chapel Hill.

In Morland's previous research she found that poor neighborhoods have fewer supermarkets and food service places than wealthier areas, and that neighborhoods with predominately white residents had four times as many supermarkets as those with predominately black residents.

Building on these findings, Morland and her team evaluated the association between local food environments and healthy diets in a study involving residents of 208 neighborhoods in Maryland, North Carolina, Mississippi and Minnesota.

Similar to previous research, they found that white neighborhoods had five times as many supermarkets as black neighborhoods. In fact, fewer than 1 in 10 blacks said that their neighborhood had at least one supermarket, in comparison to nearly one third of whites, the investigators report in the November issue of the American Journal of Public Health, the journal of the American Public Health Association (news - web sites).

Blacks who did have a supermarket in their neighborhood, however, reported a 30% higher intake of fruits and vegetables than their peers, and those who lived near two or more supermarkets reported eating twice as many fruits and vegetables as their peers. This corresponds to a 32% increase in fruit and vegetable intake with each additional supermarket in the neighborhood, the report indicates.

Further, the association between neighborhood supermarkets and fruit and vegetable intake remained true even when the residents' education and income were taken into consideration, the authors note.

Whites who lived in neighborhoods with at least one supermarket, on the other hand, were 11% more likely to meet dietary recommendations for fruits and vegetables and 10% more likely to meet recommendations for saturated fat.

"We don't know why we saw a larger influence of supermarkets on the diets of black Americans compared to white Americans," Morland said. "Based on our previous research showing a lack of private transportation in predominately black neighborhoods, we suspect that white Americans may have a larger geographic area in which to select places to patronize."

Although nearly 75% of blacks and 42% of whites had at least one small grocery store in their area, its presence did not seem to be associated with either groups' dietary habits. The roughly 80% of blacks who lived near full-service restaurants, however, were 26% more likely to meet dietary recommendations for saturated fat.

Overall, total fat and saturated fat intake was similar among blacks and whites, but blacks reported higher intakes of cholesterol than did whites, and they also reported eating more fruits and vegetables.

Commenting on the study, Morland's co-author, Dr. Steve Wing, said, "Part of the significance of this study is that it promotes an environmental understanding of nutrition, instead of just holding people responsible individually for what they eat."

He added, "This work shows that if you don't live in an area where it's possible to have easy access to reasonably priced, nutritious foods, then it's not your fault that you're not eating as healthfully as people are in other areas."

Source: American Journal of Public Health 2002;92:1761-1767.

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The Pitfalls of Over-the-Counter Painkillers

HealthScoutNews
Thursday, November 7, 2002

THURSDAY, Nov. 7 (HealthScoutNews) -- Your over-the-counter anti-inflammatory pain medications may not just kill pain -- they may kill you.

More than 16,500 people die each year and 103,000 are hospitalized for serious complications caused by pain relievers known as non-steroidal anti-inflammatory drugs (NSAIDs), says the National Consumers League (NCL).

"People mistakenly assume that if a prescription is not required for a medication that is sold in a drugstore or a supermarket, then it must be safe," NCL president Linda Golodner says in a news release.

"As a result, consumers who too often self-diagnose and self-treat without seeking a doctor's advice unwittingly put themselves at risk for potentially deadly consequences," Golodner says.

The NCL has started a campaign to educate the estimated 30 million Americans who use NSAIDs about the possible dangers of the products. As part of the campaign launch, the NCL released results of national survey of people who use NSAIDs.

The survey found that 64 percent of the survey respondents are unconcerned about possible serious side effects caused by NSAIDs, including stomach bleeding or ulcers.

Only 5 percent of the respondents talked with their doctor about potential risks for serious side effects caused by NSAIDs (stomach bleeding, ulcers, kidney and liver problems), and two of five respondents said they'd never talked with a doctor, pharmacist or health professional about such medicines.

Nearly 30 percent of the respondents said they don't usually read instructions on the labels because they think they already know what to take.

The NCL campaign to educate people about the dangers of over-the-counter painkillers will include public service announcements and consumer education. A new brochure about the painkillers is available at the NCL.

More information

The U.S. Food and Drug Administration (news - web sites) has more information about over-the-counter drugs.

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Pre-Pregnancy Diabetes Ups Risk of Birth Defects

By Alison McCook
Reuters Health

Thursday, November 7, 2002

NEW YORK (Reuters Health) - Pregnant women who were diagnosed with diabetes before their pregnancy are more likely than women without the condition and those who develop it during pregnancy to give birth to infants with birth defects, researchers report.

The most common birth defects identified in the study involved the brain, spinal cord, heart, and gastrointestinal tract.

However, lead author Dr. Jeanne S. Sheffield of the University of Texas Southwestern Medical Center in Dallas told Reuters Health that this finding does not mean that all women with diabetes should fear for their unborn children. There are ways for diabetic women to reduce their risk; previous research has shown that the more women control their blood sugar (glucose) levels the less likely their babies are to have birth defects.

"If (diabetic women) are even thinking about getting pregnant, the best thing they could do is to get their sugars under control," Sheffield advised.

The investigators gathered information on all women who delivered babies at Parkland Hospital in Dallas between January 1991 and December 2000. They identified women who had diabetes and determined whether they were diagnosed before becoming pregnant or during the pregnancy. Some women develop diabetes during pregnancy, a condition called gestational diabetes. The team considered gestational diabetes to be mild if the women did not need insulin to control their glucose levels, instead relying solely on regulating their diets.

In the November issue of Obstetrics & Gynecology, Sheffield and her colleagues report that out of 145,196 women who delivered babies during the study period, 2,687 (almost 2%) had diabetes. Of those, 410 (0.3%) were diagnosed with diabetes before they conceived.

Infants were born with malformations to 1.5% of women without diabetes, to 1.2% of women with mild diabetes that developed during pregnancy, and to 4.8% and 6.1% of women with more severe forms of diabetes diagnosed during pregnancy and those with pre-existing diabetes, respectively.

Sheffield and colleagues calculated that women with pre-existing diabetes or severe diabetes that develops during pregnancy are between 3 and 4 times more likely than other women to give birth to infants with birth defects.

In an interview with Reuters Health, Sheffield explained that the risk of birth defects in women with diabetes results from the mother's relatively high glucose levels right before conceiving and during the first few months of pregnancy.

She added that doctors have long known that women with diabetes have a higher than average risk of giving birth to a child with birth defects. However, Sheffield explained that this study has advantages over previous investigations because it includes a relatively large number of women who were treated in the same environment, and the research was conducted by the same people, reducing the risk of confounding influences.

Sheffield noted that women with mild diabetes that develops during pregnancy should be encouraged by the current study findings. "Their risk is no different than the general population," she said.

Source: Obstetrics & Gynecology 2002;100:925-930.

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Actively Aging

HealthScoutNews
Thursday, November 7, 2002

(HealthScoutNews) -- Staying active as you age helps you remain healthy and feel better. But you need to exercise safely.

The American Academy of Orthopedic Surgeons suggests these tips to prevent injury:

  • Wear the appropriate safety gear.
  • Warm-up before you exercise.
  • Exercise for at least 30 minutes a day, even if you break this into briefer workout periods.
  • Never increase your program more than 10 percent a week.
  • Vary your fitness routine.
  • Stop exercising if you have pain or swelling.

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Scientists Pinpoint Brain's Fear Control Area

By Patricia Reaney
Reuters

Thursday, November 7, 2002

LONDON (Reuters) - Scientists have pinpointed an area of the brain involved in overcoming fear which may help to improve treatments for people suffering from post-traumatic stress disorder and anxiety attacks.

When they stimulated the region of the brain in laboratory rats who had been conditioned to associate a sound with a small electrical shock, their fear diminished.

"We've found an area of the brain that is activated, or turned on, when fear is reduced. Consistent with that, if we stimulate that area electrically we can reduce fear," said Gregory Quirk of the Ponce School of Medicine in Puerto Rico.

Fear is a reaction to danger and a survival instinct in animals and humans. Scientists had suspected there was a system in the brain that reduced fear without completely erasing the memory of it, but until now they did not know where it was.

"We think we found it because in this part of the prefrontal cortex (of the brain) it is the first time an area has been activated, or turned on, when fear is reduced," he added in an interview.

Learning Not To Be Afraid

Quirk and his colleague Mohammed Milad think the job of the prefrontal cortex, which they found by studying recordings of nerve cells in the brains of rats, is to inhibit the fear response.

They suspect the prefrontal cortex reduces fear by inhibiting the amygdala, a hub of fear memory deep in the brain.

The rats in the study were taught to associate a sound with an electrical shock and froze when they heard it. All animals and humans learn fear associations.

When the rats heard the tone without the shock several times they learned not to be afraid -- a process called extinction. But the original fear association was not erased because it is important for survival but overtaken by the new memory.

"Our data suggest that the rats that were shown the tone-fear stimulus again and again with stimulation of this area had very low fear," said Quirk, whose research is reported in the science journal Nature.

People with post-traumatic stress disorder appear to have weak activity in the prefrontal cortex of the brain, according to the scientists. They believe a painless experimental technique called transcranial magnetic stimulation might help them control fear.

"Now that we have identified the area it should be straightforward to strengthen the connections in this area so they have stronger safety memory," Quirk said.

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Easy on the Juice 

HealthScoutNews
Thursday, November 7, 2002

(HealthScoutNews) --According to the American Academy of Pediatrics, too much fruit juice can cause tooth decay, diarrhea and stomach problems. Here are some tips to help keep your child's fruit juice intake in check:

  • Don't give fruit juice to babies younger than 6 months.
  • Don't give older infants bottles or cups that allow them to drink continuously through the day.
  • Avoid any sugar drink at bedtime.
  • For kids ages 7 to 18, restrict their juice intake to a daily 8 to 12 ounces.

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Diabetes Drugs May Help Cushing's Syndrome

By Keith Mulvihill
Reuters Health

Thursday, November 7, 2002

NEW YORK (Reuters Health) - A new study in mice is helping researchers zero in on a potential treatment for Cushing's syndrome, a hormone disorder that can be caused by a tumor in the brain's pituitary gland.

While such tumors can be removed surgically, this may not always cure the disease and there are no drugs suitable to treat the condition. The new study suggests that commonly used diabetes drugs may help such patients, according to a report in the November issue of the journal Nature Medicine.

Cushing's syndrome results from high levels of the hormone cortisol, and can cause fat accumulation in the upper body and face, and thinning of the arms and legs. Patients can experience high blood pressure and high blood sugar, along with depression, fatigue, irritability and weakened bones.

Cortisol levels rise when another hormone, called adrenocorticotropic hormone (ACTH), is overproduced by the brain's pituitary gland. ACTH stimulates the adrenal glands, which sit on top of the kidneys, to produce the cortisol, explained lead author Dr. Anthony P. Heaney of the Cedars-Sinai Medical Center in Los Angeles, California during an interview with Reuters Health.

Cushing's syndrome can be caused by a tumor of the pituitary gland, a tumor of the adrenal gland or by long-term use of drugs, called corticosteroids, commonly used to treat illnesses, such as rheumatoid arthritis and asthma.

In the current study, Heaney and colleagues found that a protein called PPAR-gamma, which is found on pituitary gland tumor cells, appears to be linked to overproduction of ACTH.

The researchers injected mice with ACTH-secreting pituitary tumor cells and then treated them with commonly used diabetes drugs, rosiglitazone (Avandia) and troglitazone, or an inactive placebo. Such drugs are known to inhibit PPAR-gamma, which also plays a role in sugar metabolism. Troglitazone (Rezulin) was withdrawn from the US market in 2000 after it was linked to liver damage and deaths in some patients.

The investigators found that production of ACTH, as well as the chemical equivalent of human cortisol in mice, dropped substantially.

"We saw pretty dramatic reduction in ACTH and cortisol-like hormone in the mice that got either of the drugs," Heaney told Reuters Health. "There was an 85% reduction in ACTH and a corresponding 96% reduction in their cortisol-like hormone."

In addition, the drugs caused the tumor cells to die and the overall size of the tumors to shrink, Heaney explained.

"Since we know that PPAR-gamma plays a role in the pituitary tumors that cause Cushing's syndrome, we may be able to treat the illness effectively with (the diabetes drugs)," he added.

The study was funded by the Doris Factor Molecular Endocrinology Laboratory, the Annenberg Foundation, and a National Institutes of Health (news - web sites) grant.

Source: Nature Medicine 2002;8:1281-1287.

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Gorging Grandpas Bode Ill for Grandkids

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews

Thursday, November 7, 2002

THURSDAY, Nov. 7 (HealthScoutNews) -- Can the excesses of grandfathers be visited on their grandchildren?

People from Sweden whose paternal grandfather enjoyed a surplus of food during a particular period of their childhood had higher death rates from diabetes, according to new research appearing in the November issue of the European Journal of Human Genetics.

The implication is that a surplus of food leads to overeating, which, in turn, may lead to changes in the genes carried by sperm. The altered genes are then passed from generation to generation.

Earlier research has shown that food scarcity during a grandfather's "slow growth period," which occurs before puberty, led to longer lives for the grandchildren. An abundance of food had the opposite effect: shorter life spans.

For the study, the researchers used relatively low-tech methods to reach their startling conclusions. Survival statistics for groups of people born in 1890, 1905 and 1920 in an isolated community in northern Sweden were correlated with historical information on annual harvests and food prices, among other things.

The grandchildren of men who had had plentiful food supplies during the slow-growth period of their childhood were four times more likely to die of diabetes, says Dr. Gunnar Kaati, lead author of the study and an associate professor of social medicine at Umeδ University in Umeδ, Sweden. When the paternal grandfather lived through a famine during this same pre-pubescent period, the grandchildren were less likely to die of diabetes, a disease often caused by being overweight.

Additionally, when the father and the paternal grandmother were exposed to famine, children and grandchildren had reduced death rates from cardiovascular disease. And if a mother experienced an excess of food, her children's death rates from cardiovascular disease, but not diabetes, decreased, the study says.

How does this work?

There are a number of possible explanations, including genetic selection, but the one put forward in the new study suggests that some kind of "imprint mechanism" on the genes is involved.

"Nutrition affects ovaries and testes from the moment they form during fetal life through maturity," Dr. Marcus Pembrey, of University College London, writes in a commentary accompanying the study. "These are, potentially, very important findings hinting at some as yet undiscovered, transgenerational mechanism that 'captures' nutritional information from the previous generation(s)."

Dr. Steven Heymsfield is deputy director of the New York Obesity Research Center at St. Luke's-Roosevelt Hospital in New York City. He says the new study "does seem very interesting, that through some kind of imprinting the metabolic memory of what happened before is preserved."

Heymsfield adds that in light of other, related, theories, this one does not seem so farfetched. Other experts have postulated that dietary protein change while the fetus is in the uterus has delayed effects on the child's pancreas and insulin secretion, both of which play key roles in weight and the development of diabetes.

"Intrauterine changes predestine the child to metabolic illnesses," Heymsfield says. "People no longer think this is ludicrous."

The problem with the new study is in the proof. Proving this theory is likely to be very difficult, as there are so many variables to consider.

However, there could be important implications for prevention of diabetes.

"We cannot give the current children and parents or public health officials any serious advice out of the study," Kaati says. "Further insight might make this possible in the not too far future."

What To Do

For more information on the genetics of diabetes, visit the American Diabetes Association. For more on diabetes, check with the U.S. National Library of Medicine.

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Scientists Find How Cancer Virus Evades Detection

By Richard Woodman
Reuters Health

Thursday, November 7, 2002

LONDON (Reuters Health) - Scientists said on Thursday they had discovered how the papillomaviruses responsible for cervical cancer hide from the immune system.

The discovery was made using a type of virus that infects cows, but the researchers believe the results also apply to human papillomavirus (HPV), the sexually transmitted virus thought to be the cause of most cases of cervical cancer in women.

The team, led by Professor Saveria Campo at the Institute of Comparative Medicine, Glasgow University, expressed hope that the finding could lead to a new treatment for the disease in its earliest stages.

The research, published in Oncogene, shows that a papillomavirus protein called E5 blocks the transport of the MHC class 1 molecule to a cell's surface. This molecule would normally act as an alarm signal to the body's immune system that a virus was lurking about.

"We know the viral E5 protein is present in high risk types of HPV. Now (that) we understand how it works, it could lead to treatments that will target this protein and inhibit it. The body will then make an effective immune response--stopping infection early and preventing the development of cancer," Campo said in a statement.

Cancer Research UK, which helped fund the research, said that around 99% of cervical cancer biopsies contain certain strains of HPV. The virus is also believed to be responsible for between 30% to 50% of vulval cancers.

Source: Oncogene 2002;21:7808-7816.

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Fungal Infections a New Health Threat

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews
Thursday, November 7, 2002

THURSDAY, Nov. 7 (HealthScoutNews) -- While the spotlight has been focused on the dangers of hospital-acquired infections from resistant bacteria, fungal infections have also been making silent and deadly inroads.

This is part of the dark side of advances in medical technology: Yeast and mold infections that can invade the blood stream via a contaminated catheter or simply by breathing the air around you.

The rate of invasive aspergillosis, which is caused by a fungus called Aspergillus, is 5 percent to more than 20 percent in high-risk groups, including people with compromised immune systems, such as HIV (news - web sites) patients, cancer patients and organ transplant recipients.

According to the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC), Aspergillus is found throughout the environment -- in soil, decomposing plant matter, household dust, building materials and ornamental plants, as well as food and water.

"It's like bread mold. You will see it in the shower or eating in your house or in your refrigerator. We all breathe it in," says Dr. Thomas Patterson, a professor of medicine at the University of Texas Health Science Center at San Antonio.

The problem is treating it. Particularly in the high-risk groups, who are prone to infection while hospitalized.

"We were faced with a kind of double dilemma," Patterson admits. "On one hand, infections had increased dramatically in numbers because of what we're doing to patients to make them live longer, but most of our therapies were in the dark ages. The therapy we use for this disease was developed in the late 1950s."

That therapy is a drug called amphotericin B.

However, a new drug has been shown to be more effective and was approved by the U.S. Food and Drug Administration (news - web sites) earlier this year for the treatment of aspergillosis. A randomized study published recently in The New England Journal of Medicine (news - web sites) showed that voriconazole -- or VFEND -- was superior to amphotericin B.

At 12 weeks after the start of treatment, the survival rate in the voriconazole group was almost 71 percent, while the survival rate in the amphotericin B group was just under 58 percent. VFEND also has fewer side effects.

"The results were striking. They showed that the new drug prolonged survival in a dramatic fashion. One in seven getting the new drug survived that would have died," says Patterson, who was one of the lead U.S. investigators in this multi-nation trial.

"This is the first time that any drug compared to the standard therapy had shown better survival," he adds. "It's also pretty remarkable that these are very sick patients who have a lot of other complications, so to show better survival is quite an achievement."

However exciting the drug results are, some feel they're only a Band-aid on the much larger problem of combating hospital-acquired infections.

"My own view here is that fungal infections are a minor subgroup of the bigger problem," says Dr. Robert Haley, a professor of internal medicine and chief of epidemiology at the University of Texas Southwestern Medical Center in Dallas. Hospital-acquired infections affect anywhere from 2 percent to 10 percent of hospital patients, a large number by any standard.

The underlying problem, says Haley, is that "managed care and budget cuts are preventing hospitals from investing in computer surveillance of infection, and feedback of infection rates to doctors and nurses to reduce the problem."

While the tools to control hospital infections are out there, they're underutilized, Haley says.

In particular, Haley is referring to techniques studied and recommended by the CDC in the 1980s. One technique was an ongoing program to monitor the rates of the most important types of infections to determine if the rates were increasing or decreasing.

In fact, the CDC has had a benchmarking program for the past 30 years in which about 70 hospitals report their infection rates so other hospitals can make comparisons. Seems simple enough but few hospitals, perhaps no more than 25 percent or 30 percent, are taking advantage of it.

The techniques studied by the CDC showed, on average, a 32 percent reduction in serious hospital-acquired infections.

The most essential and most expensive part of any infection-control system is the personnel. Factor in managed care and budget cuts, and you have at least part of the reason why doctors of different stripes say they are talking these days about formerly arcane topics such as aspergillosis.

Patterson jokes that, once upon a time, the only people who knew about fungal disease were the ones who stayed awake for the last two minutes of class.

"A few years ago, aspergillosis was a weird thing to talk about," he says. "But it has gotten a lot of attention in recent years because of its importance in high-risk populations. It's not something that can be relegated to a few specialized doctors."

What To Do

For more information on hospital-acquired infections, visit the U.S. Centers for Disease Control and Prevention. To learn more about aspergillosis, check the National Library of Medicine.

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Stem Cells May Have Potential in Stroke Treatment

By Paula Moyer
Reuters Health

Thursday, November 7, 2002

NEW YORK (Reuters Health) - Human fetal neural stem cells are able to survive transplantation into a rat brain, and then go on to migrate to a stroke site and differentiate into neurons, according to Dr. Gary K. Steinberg, who spoke yesterday at the 32nd annual meeting of the Society for Neuroscience.

While the findings of this pilot study are preliminary, if the results can be duplicated in other studies it may suggest that stem cells have a potential role in stroke treatment, he and his co-investigators reported.

Steinberg is chair of the neurosurgery department at Stanford University, where he is the co-director of the Stanford Stroke Center. The study was funded by the National Institute of Neurological Disorders and Stroke (NINDS).

"The study was designed to ascertain the survival, migration, differentiation and functional outcome of human fetal central nervous system cells," Martin M. McGlynn told Reuters Health. He is the CEO of StemCells, Inc., which supplied the stem cells. "The cells were transplanted into a rat model of cortical stroke."

The investigators gave the rats immunosuppressive drugs, which reduce the chance that the immune response will reject cells transplanted from a different species. The researchers then induced strokes in the rats. One week after the stroke, the rats underwent transplantation of stem cells from human fetuses that were placed in three areas in the vicinity of the stroke site.

The team conducted behavioral testing before the stroke, on days 2 and 7 after the stroke and before transplantation, and on days 14, 21, 28 and 35 after transplantation.

They did not observe improvement in the rats' ability to function. The investigators attributed the lack of improvement to the fact that the time points were too early to expect such an outcome. "We first needed to know whether the cells would survive before going on to determine if the transplant is linked to improvement," said McGlynn.

Five weeks after the stroke, the animals were sacrificed and the brains removed. Preliminary data collected 1 week after transplantation had shown that the transplanted cells survived but had not begun to migrate to the site of the stroke. However, in subsequent studies, most of the cells had migrated.

"The choice of transplant site appears to be a crucial parameter for cell survival," said McGlynn. "If the cells were transplanted too close to the lesions, fewer were inclined to survive than if the cells transplanted further from the lesion site. My understanding is that this difference is due to an inflammatory response in the rat brain caused by (inducing the stroke). So the cells are attacked and damaged within the inflammatory response of the rat."

As the cells migrated toward the site of the stroke (lesion), the process of differentiation into neurons was observed. "This suggests that proximity to the lesion influences the differentiation of the cells. The location of the transplant site is a balancing act. It cannot be close enough to be affected by the inflammatory response, but has to be close enough to allow the cells to migrate."

McGlynn stressed that it would be necessary to conduct a second, larger study, using the same animal model and later time points, in order to evaluate functional improvements and to correlate such improvements with survival of transplanted cells.

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Coffee Drinkers at Lower Risk for Type II Diabetes

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews
Thursday, November 7, 2002

THURSDAY, Nov. 7 (HealthScoutNews) -- New research will provide a pick-me-up of health news for coffee lovers: People who drink lots of it may be at a lower risk of developing blood sugar problems.

Drinking a liter or more of coffee a day, or about four 8-ounce cups, cut the risk of Type II diabetes in half compared with those who consume two or fewer cups daily, Dutch researchers found.

The news is somewhat surprising, experts say, since recent evidence shows a modest amount of caffeine can impair the ability of cells to use blood sugar. However, the scientists say other substances in coffee may overcome this effect. These substances include chemicals called chlorogenic acids, which retard glucose absorption in the gut and reduces the liver's sugar output.

"We now need to do an intervention study" to compare the effects of coffee on diabetes risk as if it were a drug, says Rob van Dam, a nutrition expert at Amsterdam's Vrije University and a collaborator on the latest work. "I think you need that kind of data before you really give advice to the general public on this issue."

The scientists report their findings in a research letter appearing in this week's issue of The Lancet.

Van Dam and a former co-worker, Edith Feskens, of the National Institute for Public Health and the Environment in Bilthoven, compared daily coffee consumption and the risk of Type II diabetes in 17,111 Dutch men and women between the ages of 30 and 60.

More than 4,200 reported drinking at least seven 125-milliliter cups (about four ounces each) of coffee a day. These people were fatter, less active, smoked more and ate worse than those who drank less coffee. Yet their risk of developing Type II diabetes was half as high as that of men and women who said they drank two or fewer cups of coffee a day.

The Dutch tend to drink stronger coffee than North Americans. The researchers didn't look at caffeine intake. However, they found no link between tea and diabetes risk -- suggesting that whatever benefit coffee may confer is unrelated to its caffeine content.

Dr. Peter R. Martin, a psychologist who studies coffee at Vanderbilt University Medical Center in Nashville, Tenn., says the latest work blends nicely with experiments he and his colleagues have done showing that chlorogenic acids could help regulate sensitivity to insulin.

"The question is, if caffeine causes insulin resistance, why is coffee negatively associated with diabetes? Coffee is complex and maybe it has within it naturally opposing chemicals that make it non-dangerous or neutral," Martin says.

Martin, who directs Vanderbilt's Institute for Coffee Studies -- which receives java industry funding -- says it doesn't necessarily follow that if regular coffee is a wash, decaf is better. "It's probably an interaction of a number of compounds" that together may protect against diabetes, he says. "If you decaffeinate, you lose some of these."

Americans drink an average of 1.6 cups of coffee a day, down from 1.87 cups a day in 1993, says Jay Molishever, a spokesman for the National Coffee Association of U.S.A. in New York City. Molishever blames "misapprehensions" about the health risks of coffee for the slight decline in consumption over the past decade.

"We are now beginning to see more and more studies, such as this one, which show that rather than something to be concerned about, coffee has many health benefits," Molishever says. These include possible protection from colon cancer and Parkinson's disease (news - web sites) and improvements in cognitive function.

What To Do

For more on diabetes, try the American Diabetes Association or the U.S. Centers for Disease Control and Prevention. For more on coffee, try the National Coffee Association.

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FDA Approves HIV Test That Gives Results in Minutes 

By Brian Reid
Reuters Health

Thursday, November 7, 2002

WASHINGTON (Reuters Health) - The US Food and Drug Administration (news - web sites) (FDA) said Thursday that it has cleared for marketing a rapid HIV (news - web sites) test that government officials said could revolutionize the battle against the virus that causes AIDS (news - web sites).

The OraQuick Rapid HIV-1 Antibody Test requires only a drop of blood and can give accurate results in as little as 20 minutes. That's an improvement over tests used widely now, which require complex analysis that can take up to 2 weeks for results, said Secretary of the Department of Health and Human Services (news - web sites), Tommy Thompson.

"It's simple, accurate and very fast," said Thompson, who announced the FDA's decision at a Washington, DC news conference. "Countless more Americans will be able to learn their HIV status."

About 950,000 people in the US are HIV infected, but one in every four is unaware they have the virus, Thompson said, making an easier test that can be widely used an important public health tool. Efforts to stem the AIDS epidemic are now focusing both on preventing new cases of the disease as well as keeping those with the virus from spreading HIV, an endeavor that should be made easier with OraQuick.

FDA and National Institutes of Health (news - web sites) officials said that the approval will overcome one of the most daunting problems with the current state of HIV testing--the lag between the test and the results. The lag time not only drives patients to avoid testing altogether, but about 8,000 patients a year are tested but never return for their results.

"We have a problem with some of the tests we have now--there's a wait of up to 14 days," said Murray Lumpkin, the senior associate commissioner at the FDA. "Having this test will address this kind of situation."

Lumpkin noted that the test appears more than 99% accurate, both in spotting positive results and in identifying negative results. The test's lone drawback is that because it detects a protein made by the body in response to the virus, not the virus itself, it may take as long as 3 months after infection for the OraQuick test to come back positive.

There is another FDA-approved rapid HIV test, but the product needs to be refrigerated before use and requires blood to be drawn from a vein. The OraQuick test needs no refrigeration, and the blood can be obtained from a single finger stick similar to those used in blood-donation screening.

The test can now only be used by experienced technicians in certified laboratories, but Thompson and Lumpkin urged OraQuick's maker to apply for a waiver that would allow wider use of the test.

The company that makes the product, OraSure Technologies, specializes in diagnostic tests. OraQuick will be distributed by medical product giant Abbott Laboratories.

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Genetic Shield Found for Malaria

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews
Thursday, November 7, 2002

THURSDAY, Nov. 7 (HealthScoutNews) -- Scientists have pinpointed a gene mutation that helps protect people from the worst ravages of malaria.

The finding has important implications for both preventing and treating the disease, which strikes half a billion people and kills 3 million worldwide every year.

"We're excited by it," says Dr. Brice Weinberg, a co-investigator of the trial and a professor of medicine at VA and Duke University Medical Centers. "This is not the only factor that operates in people to help protect them against severe disease. There are other genetic variations like sickle cell trait but, in looking at the degree of protection of known genetic variations, this appears to be as powerful as any of them identified. So it is important."

The results appear in this week's issue of The Lancet.

People with sickle cell trait (those who carry a gene for sickle cell anemia but who do not actually have the disease) are less susceptible to malaria.

Other experts in the field are also excited by the news.

"It looks like it's a really large effect, so that makes it particularly important because then it's reasonably likely to point to a mechanism that can protect people from the most severe consequences of malaria infection," says Kenneth Vernick, an associate professor of medical and molecular parasitology at New York University School of Medicine. "It could be possible to design a way to reproduce that effect in people who don't have the gene."

Earlier researchers had already shown that nitric oxide could inhibit the growth of parasites in test tubes. The next logical step -- and the one undertaken by the international team involved in this study -- was to search for variants of the gene, called NOS2, that regulates the production of this gas.

The efforts paid off: After examining the DNA of 1,291 Tanzanian and Kenyan children, some of whom were healthy and some of whom had malaria, the investigators found that the children with a specific mutation (or polymorphism) in the NOS2 gene were much less likely to get severely ill. In fact, Tanzanian children with the gene variant had an 88 percent lower risk of becoming ill than those without the variant. Kenyan children with the mutation had a 75 percent lower rate of developing severe malarial anemia.

Children with the mutation did indeed produce more nitric oxide, which could be protecting against severe disease in one of a number of ways. It could be preventing the infected red blood cells from sticking to the lining of the blood vessels and clogging blood flow to various tissues, such as the brain. It could be reducing the malaria parasites' ability to multiply in liver and blood cells or it could be reducing the production of certain inflammatory chemicals (cytokines) that can exacerbate the disease.

Although excessive nitric oxide can result in inflammation, this effect was not seen here. It's possible those with the gene polymorphism are able to produce higher levels of nitric oxide in response to infection.

The gene mutation is a good example of evolutionary selection at work. "The gene is favored because it produces more nitric oxide, which protects against malaria, so there's a greater chance of not dying, having children and passing the variant gene on to the next generation," Weinberg explains.

Interestingly, nitric oxide also plays a role in malaria infection in mosquitoes, which are the vector of the disease, Vernick says.

"A variation in nitric oxide is associated with decreasing the ability of the mosquitoes to transmit the infection," he says. "To find a similar mechanism in humans suggests that there's something here that malaria parasites really don't like in any developmental stage of the life cycle."

Other important aspects of the research are that the gene variant was found in two different countries and that it was protective against two separate forms of malaria. New research will be looking at whether the gene is present in individuals in Indonesia. That research will be done in collaboration with Indonesia's National Institute for Health Research and Development.

Prevention and treatment strategies would seek to reproduce the mechanism of the mutated gene. This could happen any number of ways. One would be to develop a drug that would increase nitric oxide levels in the right place (for instance, blood cells, liver cells and blood vessels) at the right time. Another would be to stimulate the body somehow to produce the needed nitric oxide. Drugs that provide nitric oxide are already used in cardiology but would not be appropriate to treat malaria.

Nitric oxide may also play a role in prevention, with nitric oxide production in response to malaria vaccines playing an important role in the development of immunity to malaria, say both Weinberg and a co-investigator, Dr. Nicholas Anstey, an associate professor of medicine at Menzies School of Health Research and Flinders University Northern Territory Clinical School in Darwin, Australia.

The new research comes close on the heels of the announcement last month that researchers had mapped the genetic blueprints of both the main malaria parasite and the mosquito that most frequently transmits it to humans.

"This complements that because we think it's an important finding in understanding the other part of the triangle, how humans respond to the malaria parasite," Anstey says. "It's an important part of the jigsaw of understanding of why some people get severe malaria and why other people get a bit of a fever and why some people die. It's an important part of that jigsaw."

It may also be applicable to other infectious diseases such as tuberculosis, Weinberg says.

What To Do

For more on the global threat of malaria, visit the World Health Organization or the Malaria Vaccine Initiative. Learn about how to avoid malaria while traveling to endemic areas from the U.S. Centers for Disease Control and Prevention.

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Teen Girls More Prone to Depression Than Boys

By Charnicia E. Huggins

Reuters Health
Thursday, November 7, 2002

NEW YORK (Reuters Health) - While most parents and adolescents might agree that the teen years are a very difficult period, new study findings show that those years may be tougher for adolescent girls than it is for boys.

"Although both boys and girls face difficulties during adolescence, girls are more likely to become depressed during this time," study author Dr. Jean M. Twenge of San Diego State University in California told Reuters Health. "For girls, adolescence is more ambivalent and more conflicted."

This finding is based on a review of hundreds of studies involving a total of 61,424 children and adolescents aged 8 to 16. The studies were conducted from 1980 to 1998.

Overall, Twenge and her co-author, Dr. Susan Nolen-Hoeksema, found that girls consistently had low levels of depressive symptoms during their early preteen years, and they experienced an increase in symptoms as they approached adolescence at age 12. The findings are reported in the November issue of the Journal of Abnormal Psychology.

Further, the girls reached their peak number of depressive symptoms at 15 years of age, and they still experienced a high number of symptoms 1 year later, study findings indicate.

Boys, in comparison, exhibited more depressive symptoms than girls during their childhood years, but much fewer symptoms during adolescence.

"This makes girls' increases in depression during adolescence even more striking," Twenge said. "Girls are doing fairly well during childhood but become depressed as adolescence continues."

A possible reason for the increased depressive symptoms in girls is that "their bodies are undergoing changes that their parents, peers, and culture seem ambivalent about, (and) girls' social worlds are becoming restructured as attention from boys becomes more important," Twenge said. Furthermore, "hormonal changes are also taking place, and these might also be influential."

In other findings, socioeconomic status did not seem to have an effect on the children's depressive symptoms, and there was no difference in symptoms between black and white children.

Hispanic youth, however, reported experiencing a much higher number of depressive symptoms than did their white or black peers, study findings indicate. The reason for this is unknown.

Finally, contrary to previous study findings, Twenge and her colleagues found that symptoms of depression were not increased in later generations of children versus their earlier counterparts.

In fact, symptoms of depression decreased among boys from 1980 to 1998 and remained consistent among girls, the report indicates.

"We expected that children's depression would increase over time between the 1980s and now, but it did not," Twenge said. "This is good news--depressive symptoms in children have not increased since the 1980s."

Source: Journal of Abnormal Psychology 2002;111:578-588.

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Prostate Cancer Drugs May Spur Tumors

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews
Thursday, November 7, 2002

THURSDAY, Nov. 7 (HealthScoutNews) -- A family of drugs that men with advanced prostate cancer (news - web sites) take to suppress their disease may, after time, promote cancer cell production.

The medications are called anti-androgens, say researchers at the University of Rochester.

The discovery of this unwelcome side effect is of more value to scientists than to prostate cancer patients -- at least for now. The reason: Anti-androgens are currently one of the most effective treatments for men with advanced prostate cancer, says University of Rochester urologist Dr. Edward Messing.

"It is a big finding from a biological point of view, but from a clinical point of view, while it could be potentially beneficial, more work has to be done," Messing says.

The standard treatment for men with advanced prostate cancer -- defined as the spread of the cancer beyond the prostate gland -- is to take anti-androgens. These drugs block the production of the male hormone testosterone, which prostate cancer cells need to grow. Without the hormone, the cancer cells die, the researchers say.

Doctors have long known that for some reason, the cancer-suppressing effect of anti-androgens stops after a period of time, usually between 18 to 24 months. The patients' cancer then reappears.

The researchers at the University of Rochester's George Whipple Laboratory for Cancer Research have found that anti-androgens, while suppressing testosterone production, also activate a molecule known to cause cancerous cells to grow.

"We never thought this drug had a second role," says Chawnshang Chang, a urology professor who headed the research. "It suppresses the androgen, but also activates a molecule known as MAP kinase that has been linked to tumor growth."

Chang says the anti-androgen drugs, like hydroxyflutamide, successfully block testosterone production by suppressing the protein that acts as an androgen receptor. But the researchers found that, after time, as testosterone production declines, MAP kinase activation becomes more pronounced.

"We don't know the mechanism for this," he says. "We know the outcome, but not the mechanism."

The Rochester researchers' finding, which earned an award for outstanding research from the American Urological Association, is described in the new issue of Cancer Research.

There are about 2.8 million cases of prostate cancer diagnosed annually in the United States, and 30,000 deaths a year from the disease, according to National Vital Statistics reports. There has been intensive research into the causes of and potential cures for the disease.

Chang has long been interested in discovering why the anti-androgens eventually lose their power to combat the cancer.

He and his colleagues studied cancer cells from four men with advanced prostate cancer, comparing cells from early in their disease to cells after the anti-androgen therapy became ineffective. They found that the levels of the molecule MAP kinase were much higher in the cells of the men after they had had the hormone therapy.

"Before taking the drug, the levels were really low. Afterwards the levels were really high," Chang says.

Messing, who worked with Chang on the findings, says, they "found that cells that had no androgen in them at all were still replicating. The hydroxyflutamides can turn on signals that eventually make the cells divide in the absence of the androgen receptor."

Chang says the finding should spur drug companies to create new types of anti-androgen drugs that don't activate the MAP kinase molecule, or to perhaps combine the existing anti-androgen drugs with another drug that might suppress the MAP kinase molecule.

But for now, he says, "There is no good drug available."

Dr. Edward Gelmann, professor of oncology at the Georgetown University Medical Center's Lombardi Cancer Center, says there are experimental drugs that could be used to thwart the MAP kinase molecule.

"There are no [such medicines] in clinical trials, but there are experimental medicines," he says.

In the meantime, Messing says, the new findings should prod doctors to carefully monitor their prostate cancer patients to determine when the anti-androgen drugs may no longer be suppressing androgen, but activating the MAP kinase molecule. A good measure is a blood test called the PSA count, which gauges levels of prostate specific antigen.

"When the PSA goes up, don't wait to stop the drug," Messing says.

This is already the clinical strategy, Gelmann says. "We do that anyway."

What To Do

For more information on the prostate gland, visit the Agency for Healthcare Research and Policy. The American Cancer Society has information on early diagnosis of prostate cancer.

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Motherhood Makes Women Smarter, Study Suggests

By Maggie Fox
Reuters

Thursday, November 7, 2002

WASHINGTON (Reuters) - Motherhood may make women smarter and may help prevent dementia in old age by bathing the brain in protective hormones, US researchers reported on Thursday.

Tests on rats show that those who raise two or more litters of pups do significantly better in tests of memory and skills than rats who have no babies, and their brains show changes that suggest they may be protected against diseases such as Alzheimer's.

University of Richmond psychology professor Craig Kinsley believes his findings will translate into humans.

"Our research shows that the hormones of pregnancy are protecting the brain, including estrogen, which we know has many neuroprotective effects," Kinsley said.

"It's rat data but humans are mammals just like these animals are mammals," he added in a telephone interview. "They go through pregnancy and hormonal changes."

Kinsley said he hoped public health officials and researchers will look to see if having had children protects a woman from Alzheimer's disease (news - web sites) and other forms of age-related brain decline.

"When people think about pregnancy, they think about what happens to infants and the mother from the neck down," said Kinsley, who presented his findings to the annual meeting of the Society of Neuroscience in Orlando, Florida.

Hormones Washing The Brain

"They do not realize that hormones are washing on the brain. If you look at female animals who have never gone through pregnancy, they act differently toward young. But if she goes through pregnancy, she will sacrifice her life for her infant--that is a tremendous change in her behavior that is manifested in genetic alterations to the brain."

Kinsley's team tested rats that had never had a litter of pups, had raised one litter, or had raised two or more litters. The rats ranged in age up to 2 years--the equivalent of 70 to 80 years in a human, Kinsley said.

The rats were given two tests involving finding food inside and outside a maze. They were retested several times over two years.

"Females who had two reproductive experiences were able to learn and remember the maze better than females with one or zero," Kinsley said. "Females with zero (pregnancies) were not able to do the maze as well as females with one (pregnancy)."

The team later killed the rats and looked at their brains--specifically at the hippocampus, the region of the brain associated with learning and memory. The rats that had several pregnancies had lower levels of a protein called amyloid precursor protein--which, in humans, is associated with the development of Alzheimer's.

Kinsley needs to do more tests, but he believes the effect may be even stronger in human females, who invest much more time and effort in raising offspring.

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Stroke Risk Among Young Men Varies by Ethnicity

Reuters Health
Thursday, November 7, 2002

NEW YORK (Reuters Health) - Young blacks and Hispanics in the US have 2 to 3 times the risk of stroke as their white counterparts, new study finding show.

While many previous studies have found ethnic differences among those likely to have a stroke, only one other study has focused on young adults, according to a report published online in the November 7th rapid access issue of Stroke: Journal of the American Heart Association (news - web sites). Strokes are relatively rare in people in this age group.

In the current study, lead author Dr. Bradley S. Jacobs of Wayne State University School of Medicine in Detroit, Michigan and colleagues looked at the number of strokes in young men between the ages of 20 and 44 living in the northern section of Manhattan in New York City.

Over the 4-year study period, there were a total of 74 first strokes in young adults in a community of roughly 210,000 people, the authors report.

Blacks were 2.4 times and Hispanics were 2.5 times more likely to have a stroke than their white peers in the community, the report indicates.

"Young people should be aware of the risk factors, signs and symptoms of stroke," said Jacobs in a statement from the American Heart Association. Risk factors for stroke include high blood pressure, diabetes, high cholesterol and cigarette smoking.

According to experts, the five major signs of stroke are: sudden numbness or weakness (particularly on one side of the body); sudden dimness or loss of vision; sudden dizziness or loss of balance; sudden severe headache (often described by people as the worst headache of their entire lives); and confusion or difficulty speaking.

When a person has one of these five symptoms they should dial 911 immediately. If you are having an ischemic stroke--and 80% of strokes are this type--the patient needs to reach the hospital within 3 hours to receive a type of treatment that could potentially reduce disability.

Ischemic stroke occurs when a clot or blocked artery cuts off blood flow to the brain.

Source: Stroke 2002;10.1161/01.STR.0000036968.64376.3A.

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Even Light Drinking Impairs Performance: Report

By Alison McCook
Reuters Health

Thursday, November 7, 2002

NEW YORK (Reuters Health) - A group of Dutch researchers have discovered that people with even relatively low levels of alcohol in their blood are less able to realize they have made errors, and to adjust their actions to prevent additional mistakes.

This impairment may have a significant impact on how people respond to dynamic and demanding situations, such as driving, lead author Dr. K. Richard Ridderinkhof of the University of Amsterdam and Leiden University in the Netherlands told Reuters Health.

In the current study, Ridderinkhof and his colleagues discovered that people with a blood alcohol content of 0.04%--below the legal limit to drive--were less able than their completely sober peers to realize they had made mistakes during a test of cognitive functioning. Low alcohol blood levels also appeared to prevent people from adjusting their behavior after mistakes in order to prevent new errors, according to Ridderinkhof.

A blood alcohol level of 0.04% is roughly equivalent to two glasses of wine in an adult man. Several states in the US and the UK require that drivers have blood alcohol levels below 0.08%, while the Netherlands sets that limit at 0.05%.

Ridderinkhof said that these results suggest that even drivers whose blood alcohol level is within the legal limit may be more likely than completely sober drivers to make mistakes while on the road. Specifically, the researcher said that light drinkers may react too slowly to other drivers' actions, respond to traffic lights from other lanes, and not realize quickly enough that the car is drifting toward the other lane.

Although the study did not administer driving tests to people with different blood alcohol levels, Ridderinkhof said he believes authorities should lower the blood alcohol limit that allows light drinkers to legally drive.

"Although there are obvious constraints to direct generalization from results from a laboratory task to realistic real-life situations, the ultimate implication should be that the maximum blood-alcohol concentration in traffic should be below 0.04%; alcohol should probably be banned altogether from traffic," Ridderinkhof said.

He and his colleagues report their findings in the November 7th issue of Sciencexpress.

During the study, the investigators asked people to perform a task in which they had to point in the same direction as an arrow that was flanked by other arrows that were designed to distract them.

The researchers found that people with blood alcohol levels of 0.04% had lower levels of brain activity after making a mistake--in this instance, pointing their arm in a different direction than the arrow--than did people with no alcohol in their systems. This finding indicates that the region of the brain that usually detects errors was less able to detect the mistake, the authors note.

Furthermore, those with blood alcohol levels of 0.04% did not tend to slow down after making a mistake during the test, a common behavior in sober people, who often realize they may need to slow down to improve their performance.

"Our study showed that even at 0.04%, the negative effects were significant," Ridderinkhof said.

Source:  Sciencexpress 2002;10.1126/1073619, 1076929.

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FDA OKs Assist Device for Advanced Heart Failure

By Ori Twersky
Reuters Health

Thursday, November 7, 2002

WASHINGTON (Reuters Health) - The US Food and Drug Administration (news - web sites) (FDA) approved on Wednesday the use of a heart pump implant to permanently help terminally ill patients with congestive heart failure who are ineligible for transplant.

The device, the Pleasanton, California-based Thoratec Corporation's HeartMate, was previously approved as a temporary measure for patients awaiting a heart transplant.

The approval expands the availability of HeartMate to include the estimated 20,000 to 30,000 Americans with the most severe form of the life-threatening cardiovascular disease, according to FDA figures.

HeartMate is known as a left ventricular assist device because it helps the left ventricle--the heart's main pumping chamber--circulate blood throughout the body. The device consists of a pump that is implanted in the abdomen, which has an electrical cable and air vent that connects to external battery packs. The packs are worn on the shoulders and electronic controls are worn on the belt.

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.

The FDA approval was based on a clinical trial showing that HeartMate doubled the one-year survival rate of patients when compared to drug treatment. At one year, the FDA said, 50% of those receiving the implant were still alive, compared to 28% of those receiving drug therapy.

But the agency cautioned that the increased survival rate came amid other risks. Because implanting the device requires major surgery in already seriously ill people, the FDA said, about one third of the patients experienced bleeding that required re-operation, 41% developed an infection and 10% suffered a stroke.

As a result, the FDA said it would also require Thoratec to continue to study the device's long-term safety and effectiveness for permanent use.

In a separate statement, Thoratec said it has applied for Medicare coverage of the device as a permanent therapy, which the firm expects would increase use of the device at implant centers. Coverage guidelines are expected to be issued during the second half of 2003.

Thoratec makes air-driven and electric heart assist devices that have been implanted in more than 3,400 patients in 22 nations, the company said.

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WEDNESDAY, NOVEMBER 6, 2002

No Evidence Vaccine Causes Autism

The Associated Press
Wednesday, November 6, 2002

BOSTON (AP) - A large study from Denmark offers reassuring evidence that the widely used measles, mumps and rubella vaccine does not cause autism, as some fear.

Some have speculated that the measles portion of the vaccine might trigger autism, in part because autism often becomes apparent during the second or third year of life, around the same time the shots are given.

However, several large careful studies have turned up no proof of this, and the latest of these was published in Thursday's issue of the New England Journal of Medicine (news - web sites).

Dr. Kreesten Meldgaard Madsen and others from the Danish Epidemiology Science Center in Aarhus reviewed the records of 537,303 children born in Denmark during the 1990s. The risk of autism was the same for those who got the vaccine and those who did not.

Autism cases have risen substantially during the past 20 years, although some speculate this is a result of better recognition of the disorder, not a true increase.

A review by Dr. Edward Campion, the journal's senior deputy editor, said the latest study is unlikely to put an end to the controversy, although "the association of autism with MMR vaccination appears to be only a predictable coincidence."

On the Net: http://content.nejm.org/

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Study Confirms Wine Can Cause Cirrhosis, Too

By Pat Hagan

Reuters Health
Wednesday, November 6, 2002

LONDON (Reuters Health) - Wine lovers are just as likely to develop cirrhosis of the liver if they drink to excess as those who prefer beer or spirits, according to research that contradicts an earlier study suggesting wine harmed the liver less.

A study published earlier this year by Danish researchers showed that wine drinkers were up to 70% less likely than drinkers of other alcoholic beverages to develop life-threatening cirrhosis.

It was thought wine's protective effects came from its antioxidant properties, which could be alleviating liver toxicity caused by the ethanol in drink.

But the latest investigation, published in the journal Alcohol & Alcoholism by a team of French researchers, shows no difference in risk between different groups of heavy drinkers.

To see if the Danish findings would be repeated in a French study group, 102 men classed as heavy drinkers were recruited to take part in the new study. Forty-two had cirrhosis and 60 were free of the disease. All the volunteers were assessed for liver status and questioned about their drinking habits.

Dr. Stephanie Pelletier from the CHU Caremeau Hospital in Nimes and colleagues said their findings "did not fit" with the Danish study. In fact, patients with cirrhosis were more likely to prefer wine as their favorite tipple than those free of disease.

They said in their paper: "In our series, the relative percentage of (pure) alcohol drunk in wine was significantly higher in cirrhotic, than in non-cirrhotic, patients."

However, they stressed that cirrhosis might also be dependent on other factors, such as genes, nutrition and age. For example, their results showed patients with disease were on average 7 years older than healthy controls--51 years compared to 44.

"Altogether, drinking heavily after the age of 45 might be critical for the liver, particularly, also in view of the age-related immunological disturbances," they write.

"In conclusion, wine--as with other alcoholic beverages--can lead to alcoholic cirrhosis when consumed heavily."

Cirrhosis of the liver has become a major health concern in the UK. The number of deaths from the disease rose to 1,600 a year by 2001 from 1,200 in the mid-1990s.

The government is so concerned that the Chief Medical Officer Professor Sir Liam Donaldson has called for alcohol advertisements to carry warnings similar to those for tobacco products.

Source: Alcohol & Alcoholism 2002;37:618-621.

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Bills to Study Rare Diseases Signed

The Associated Press
Wednesday, November 6, 2002

WASHINGTON (AP) - President Bush (news - web sites) on Wednesday signed two bills meant to focus medical research and funds on rare diseases.

One measure creates an Office of Rare Diseases at the National Institutes of Health (news - web sites) and establishes regional centers of excellence for research on diseases or medical conditions that affect fewer than 200,000 Americans.

The second bill that Bush signed into law without comment authorizes — but does not actually provide — federal money to be spent on grants and contracts for the development of drugs to treat such rare diseases.

On the Net:

The text of the bills, H.R. 4013 and H.R. 4014, can be found at http://thomas.loc.gov/

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Chronic Stress May Hinder Immune Response

By Keith Mulvihill

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - A study of parents with children being treated for cancer suggests that chronic stress may hamper a naturally occurring anti-inflammatory response in the body.

Many previous studies have implicated stress as playing a role in a plethora of ills including upper respiratory infections, progression of heart disease and autoimmune diseases, according to Dr. Gregory E. Miller of Washington University in St. Louis, Missouri, and colleagues.

To further understand the relationship between stress and the immune system, Miller and colleagues studied the effects of stress hormones on white blood cells used by the body to fight infection.

Ordinarily, white blood cells will concentrate in the area of injury or infection where they release chemicals called cytokines to fend off the invaders--a process generally known as inflammation. While inflammation can help fight infection, too much can actually be damaging. The process is naturally stopped in the body when levels of a stress hormone, cortisol, begin to rise.

In the current study, Miller's team took blood samples from 25 parents who had children with cancer--and presumably were undergoing a lot of stress--and compared their white blood cell response to that of 25 parents with healthy children. The researchers treated the cells with a synthetic hormone to mimic the process that would occur in the body. All of the parents were in otherwise good health, according to the report published in the November issue of the journal Health Psychology.

The researchers found that the white blood cells of stressed parents were less responsive to the hormone, and less likely to shut down an inflammatory response, than the less stressed parents, Miller said in an interview with Reuters Health.

"Their cells kept producing more cytokines," he said.

The findings highlight the fact that "stress may interfere with the body's ability to shut down its own immune response after it gets started," Miller said.

The good news, according to Miller, is that stressed parents who reported having a "good support system" were shown to have an immune response similar to the relatively stress-free parents.

Parents who reported having a lot of support, such as having someone to help with other family members, had similar responses as those who reported no stress, Miller explained.

Source: Health Psychology 2002;21:531-541.

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FDA Expands Use of Heart Pumps

The Associated Press
Wednesday, November 6, 2002

WASHINGTON (AP) - A battery-powered pump long used to help heart-failure patients survive the wait for a transplant won government approval Wednesday as a permanent heart-beater for thousands too ill to consider a transplant.

Thoratec Corp.'s HeartMate will be an option for some 20,000 to 30,000 people with end-stage heart congestive heart failure — those expected to die within two years — who don't qualify for a scarce heart transplant, the Food and Drug Administration (news - web sites) said.

Called a "left ventricular assist device," the HeartMate is hooked up to the heart and takes over the job of pumping blood that the organ's diseased left side can no longer perform. Although sometimes mentioned in the quest for an artificial heart, the pump works only as half a heart — it can't take over the separate action of the heart's right side.

The FDA approved the HeartMate and a similar competitor in 1998 as a way to help patients survive the wait for a heart transplant, and do it at home instead of tethered to huge machines in a hospital.

A major study released last year showed the HeartMate also could add months to the lives of heart-failure patients who can't get a transplant and have no other options.

Sixty-eight end-stage patients got the HeartMate implant. Half were still alive a year later, compared to 28 percent of another 61 patients who got standard drug therapy for heart failure. After two years, 27 percent of HeartMate recipients were still alive, compared with 10 percent of the drug-treated patients.

The FDA warned that the pump isn't easy fix: It requires major surgery to implant, and can cause life-threatening side effects. Ten percent of HeartMate recipients suffer a stroke, 41 percent get an infection and a third experienced bleeding so severe they needed another operation, FDA said.

Consequently, FDA restricted the pump's permanent implantation to the most desperate patients, and ordered Thoratec to continue studying the device's long-term safety and effectiveness.

On the Net:

Food and Drug Administration: http://www.fda.gov/

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Cholesterol-Cutting Drugs May Help MS Patients

By Patricia Reaney

Reuters
Wednesday, November 6, 2002

LONDON (Reuters) - Cholesterol-lowering drugs usually prescribed to prevent heart disease and stroke may also help patients suffering from multiple sclerosis (MS), researchers said on Wednesday.

When they tested a leading cholesterol drug in mice with an MS-like condition, it reversed the paralysis caused by the illness and prevented relapses. The findings mirror results published last month that found that statins cut MS-linked activity in human cells in the laboratory.

Scientists at the University of California, San Francisco (UCSF) and Stanford University Medical Center believe that if the drug performs as well in human trials it could be a safe, easy-to-take therapy for the progressive auto-immune disease.

"We need to have clinical trials to validate efficacy," said Scott Zamvil, an assistant professor of neurology at UCSF.

"We have shown here for the first time that statins alter the immune response in a potentially favorable manner," he added in an interview.

The scientists used a drug called atorvastatin, which is produced by drug giant Pfizer, Inc. under the brand name Lipitor (news - web sites). It belongs to a class of drugs known as statins. Side effects of statins include muscle soreness and weakness.

MS, which afflicts about a million people worldwide, occurs when cells in the body attack and destroy the myelin sheath that protects the nerve cells in the brain and spinal cord.

The scientists, who reported the results in the science journal Nature, are hoping to conduct human trials of the drug on patients with early signs of MS.

After an initial attack of MS--which causes fatigue, numbness in the limbs and balance and visual problems--many patients do not receive treatment because there is no effective therapy and drugs for more advanced MS have side effects.

"The current forms of therapy are partially effective. They are given by injection and they are associated with side effects. The statins are well tolerated and have fewer potential side effects," Zamvil said.

Laboratory studies have shown that statins, which are swallowed, inhibit molecules in the body that are active during the early stages of MS. The drugs may also stop molecules from killing nerve cells, which can occur in the later stages of MS, suggesting they could be used in combination with other treatments for the illness.

Statins may also be useful in treating other autoimmune diseases such as rheumatoid arthritis and type 1, or early-onset, diabetes, according to the researchers.

Merck's Zocor is another leading statin. Zamvil and his colleagues found that atorvastatin prevented or reversed paralysis in the mice and interrupted an inflammatory process.

The study was funded by the National Institutes of Health (news - web sites) and the National Multiple Sclerosis Society and two private foundations. Zamvil received an Atorvastatin Research Award from Pfizer Inc. this year.

Hartmut Wekerle, of the Max Planck Institute of Neurobiology in Germany, described the new research as intriguing and said it raises hope of an oral treatment for MS and other diseases.

But he stressed that only clinical trials will determine whether they produce the same effects in humans.

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Study: Garlic May Prevent Cancer

By Paul Recer

AP Science Writer
T
he Associated Press

Wednesday, November 6, 2002

WASHINGTON (AP) - Men in China have the lowest rate of prostate cancer (news - web sites) in the world, and a diet rich in garlic, shallots and onions may be one of the reasons.

Researchers at the National Cancer Institute (news - web sites) report in a new study that a diet with lots of vegetables from the allium food group — which includes garlic, shallots and onions — reduces the risk of prostate cancer by about half. And the common Chinese diet includes hearty servings of these vegetables.

The study, appearing this week in the Journal of the National Cancer Institute, is based on interviews with 238 men with prostate cancer and 471 men who were free of the disease.

Men in the study, all residents of Shanghai, China, were asked how frequently they ate 122 food items.

The results showed that those who ate more than a third of an ounce a day from the allium food group were about 50 percent less likely to have prostate cancer than those who ate less of the foods.

"We checked on many food items and the allium food group stood out (as protective against prostate cancer)," said Ann W. Hsing, an NCI epidemiologist and the first author of the study. "But the conclusions need to be replicated in another study." She said the study was conducted in Shanghai because China has the lowest rate of prostate cancer in the world.

Scallions seemed to be the most protective. According to the study, men who ate about a tenth of an ounce or more a day of scallions reduced their prostate cancer risk by about 70 percent. For garlic consumption of the same amount, the prostate cancer risk was reduced by about 53 percent.

Hsing said that the typical Chinese diet is much more heavily seasoned with garlic, scallions and onions than is the traditional American diet. But even so, the amount of allium vegetables consumed is measured only in fractional ounces. For instance, the study suggests that an effective level of prostate cancer protection can be achieved with about one clove of garlic a day.

"The reduced risk of prostate cancer associated with allium vegetables was independent of body size, intake of other foods and total calorie intake," the study authors reported.

Hsing said the study reinforces earlier studies that have linked high vegetable consumption to a reduced risk of prostate cancer. For instance, earlier studies have found that that eating tomatoes and tomato products can lower risk of prostate cancer. Italy, where tomato sauce and garlic are favorites, has one of the lowest rates of prostate cancer in Europe, said Hsing.

Janet Stanford, a cancer epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, said the study by Hsing and her co-authors continues to support the general finding that "eating vegetables is a good thing."

Stanford said her group, in an earlier study, linked broccoli, cauliflower and related vegetables to a reduced prostate cancer risk, while a high fat diet increased the risk.

"This shows that your mother was right," said Stanford. "Eat more vegetables."

The Shanghai study was conducted by researchers at the National Cancer Institute, one of the National Institutes of Health (news - web sites), and at the Shanghai Cancer Institute in China.

On the Net:

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

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New Types of Vessel Problems Following Shingles

By Alison McCook

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - In some adults experiencing shingles, the virus responsible will replicate itself and accumulate in the blood vessels of the brain, leading to stroke.

Consequently, patients who suffer stroke as a result of the varicella zoster virus need to receive antiviral medication to treat the infection. Although most doctors may be aware of the standard symptoms of strokes caused by this virus, a new study describes two cases in which patients first developed the warning signs of stroke months after they developed shingles, a much longer time interval than usual.

These findings suggest that even when patients develop problems in their blood vessels months after having shingles, doctors need to "think about varicella zoster virus," lead author Dr. Donald H. Gilden told Reuters Health.

Varicella zoster virus also causes chickenpox in children. Consequently, all adults who developed chickenpox as a child carry the virus in their nerve cells. The virus remains dormant unless it is reactivated decades later, causing shingles, a painful rash that typically strikes after the age of 60.

In some adults who develop shingles, the virus will accumulate in the arteries of the brain, possibly reducing blood flow to the brain and putting people at risk of stroke.

In the November 7th issue of The New England Journal of Medicine (news - web sites), Gilden and his colleagues present the histories of two patients who developed an unusual type of blood vessel problem following a bout of shingles, highlighting the need for doctors to keep an open mind when treating similar patients.

In both cases, the patients showed early signs of stroke--such as numbness in limbs and loss of vision--around 6 months after they developed shingles, a much longer time interval than normally observed. Gilden told Reuters Health in an interview that when the patients' spinal fluid was tested for the presence of DNA from the varicella virus, none was present. However, additional tests revealed that the spinal fluid did contain antibodies designed to target the virus, indicating the virus was present and the patients needed antiviral medications.

In addition, Gilden explained that one patient developed shingles around the buttocks, but also experienced signs of stroke, indicating that the virus was also acting on blood vessels in the brain. The researcher said he suspected that the virus had reactivated in two places in the body at once, in order to cause symptoms in two widely separated places.

Both patients received infusions of antiviral medication, and both recovered shortly after, the report indicates.

Based on these findings, Gilden said he hopes that doctors realize that virally induced stroke can occur even months after the virus appears, and the presence of viral DNA in spinal fluid is not necessary to determine if the patient is carrying the virus. He added that these unusual cases demonstrate that a stroke can still stem from the virus even if shingles appear in a body region far from the brain.

Source: The New England Journal of Medicine 2002;347:1500-1503.

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Drug Doesn't Cut Heart Patient Risk

By Lindsey Tanner

AP Medical Writer
The Associated Press

Wednesday, November 6, 2002

CHICAGO (AP) - A promising anti-clotting drug does not improve hospitalized heart attack patients' chances of surviving a year when it is added to the standard treatment, a study found.

The disappointing results came in a follow-up international study of 16,588 patients who received intravenous doses of a standard clot-busting medicine with or without the newer drug, abciximab, or ReoPro.

ReoPro, known as a "super aspirin," helps keep blood particles called platelets from sticking together and forming a clot that can cause a heart attack. The older drug, reteplase, attacks different substances in blood clots.

ReoPro's primary use is for patients undergoing angioplasty, a technique that opens clogged blood vessels. In a study reported last year and funded by ReoPro's U.S. marketers Centocor and Eli Lilly, researchers tried using it in a different way, combining it with a reduced dose of reteplase in patients who had just suffered a heart attack. The combination treatment lowered patients' 30-day risk of a repeat heart attack by 30 percent.

But in the follow-up study, the death rates after a year were identical — nearly 700 patients in both groups died, or about 8 percent in each.

The findings were published in Wednesday's Journal of the American Medical Association (news - web sites).

The researchers said the reasons for the findings are unclear.

Dr. A. Michael Lincoff of Cleveland Clinic, who helped conduct the study, said ReoPro may still be a useful drug because it can reduce the short-term risk of repeat heart attacks and has other heart benefits.

On the Net:

JAMA: http://jama.ama-assn.org

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Testosterone Replacement Therapy Under Scrutiny

By Dana Frisch

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - The Institute of Medicine (news - web sites) and the National Institute on Aging (NIA) will form a multi-disciplinary task force to evaluate the benefits and risks of testosterone replacement therapy (TRT) in older men, the two US agencies announced Wednesday.

The year-long investigation will also consider the ethical questions associated with testosterone replacement in order to make a recommendation about whether clinical trials testing the hormone in older men should be done.

Dr. Stanley Slater, deputy director of the NIA's Geriatrics and Clinical Gerontology Program, told Reuters Health that sales data from pharmaceutical companies show a "dramatic increase" in the number of older men on TRT.

Many symptoms among older men could be attributed to testosterone deficiency, but they may also be due to other effects of aging. "This needs to be disentangled," Slater said.

For example, some have blamed impotence on low testosterone levels. However, evidence shows that in most cases, it is the result of circulatory problems.

Men with extreme hormone deficiency do benefit from testosterone supplements. Research suggests that testosterone therapy improves their libido and helps them maintain strong muscles and bones.

But side effects of testosterone therapy for healthy men are not yet known. Studies suggest it can increase red blood cell production, thickening the blood and increasing a man's risk of stroke. Its role, if any, in prostate cancer (news - web sites) risk is not yet known.

"The risks of TRT that are known are really less of a concern than the things that are unknown, such as the possible effect on the prostate," said Slater. "You can only really know if you conduct a large-scale clinical trial."

Some men on supplementation report feeling "younger" and "more energetic," though no large studies have examined such claims. Evidence for other possible benefits, such as sharpened memory and improved muscle and bone strength, remains inconclusive according to the NIA.

Testosterone plays a key role in puberty in males, and is responsible for many of the physical changes associated with sexual maturation including body and penile growth and the ability to produce sperm. The hormone is made in the testes, though females also produce small amounts.

Testosterone production peaks in adolescence and early adulthood and declines thereafter. Testosterone levels vary widely, the NIA notes, and even though production of the hormone may drop 20% to 30% as men age, their levels may still be well within normal limits.

The task force will include physicians with many different specialties including epidemiology, endocrinology, urology and oncology, and will prepare a report based on the scientific evidence to date. Over the next year, the committee will conduct four meetings and one workshop.

"The real message is that this is an area where we don't know nearly as much as we should," said Slater. "Men who are thinking about taking it who don't have profoundly low levels...might well want to consider this absence of knowledge about long-term risks and benefits as they consider embarking on a course of therapy."

For more information see www.nia.nih.gov/

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Amount of Exercise Said Key in Cutting Cholesterol

By Amy Norton

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - When it comes to lowering cholesterol, it seems the amount of exercise a person logs is more important than the intensity, researchers report.

Their study of previously sedentary, overweight adults found that more exercise was better than less, with high amounts of intense activity--the equivalent of jogging about 18 miles a week--showing the strongest effects on participants' cholesterol levels.

Fortunately, the study authors say, this doesn't mean people need to run miles each day to see a cholesterol dip. Participants who exercised at all came out of the study with better cholesterol profiles than those who remained inactive, lead author Dr. William E. Kraus pointed out in an interview with Reuters Health.

What the findings do mean, according to Kraus, is that, at least as far as cholesterol is concerned, it may be the amount of exercise that's really important. Among study participants who exercised relatively less, his team found no clear cholesterol differences between those who exercised intensely and those who engaged in moderate activity--although both groups had more healthful cholesterol levels than those who stayed sedentary.

What's more, active participants saw these cholesterol benefits while losing only a little weight. This shows that exercise can create heart-healthy changes "inside the body" even when the benefits are not yet evident on the outside, according to Kraus, a cardiologist at Duke University Medical Center in Durham, North Carolina.

"People should not get discouraged if they're not losing weight," he said, noting that factors like increased muscle may keep exercisers from seeing much of a difference on their bathroom scales right away.

Kraus and his colleagues report their findings in the November 7th issue of The New England Journal of Medicine (news - web sites).

Exercise has long been promoted for its cardiovascular benefits, one of which is thought to be more healthful cholesterol levels. But studies have yielded inconsistent findings on whether exercise, on its own, really does boost "good" HDL cholesterol and lower "bad" LDL cholesterol. One question has centered on the amount and intensity of exercise needed to affect cholesterol and other cardiovascular factors.

In the current study, 111 middle-aged adults with elevated cholesterol were randomly assigned to an inactive "control" group or one of three exercise groups. One group, the "high-amount/high-intensity" group, logged the calorie-burning equivalent of jogging 17 or 18 miles a week. The two lower-amount groups completed the equivalent of jogging (high-intensity) or walking (moderate-intensity) about 11 miles per week. All of the exercisers used machines such as treadmills and stationary bikes.

After about 8 months of regular exercise, the high-amount/high-intensity group showed increases in heart-friendly HDL cholesterol, as well as the greatest improvements in components of LDL cholesterol. The HDL boost was seen only in this group.

The implication, Kraus said, is that "any exercise is better than none, more is better than less, and inactivity is bad."

He also noted that lesser amounts of regular activity may bring cholesterol benefits like those seen with high amounts of intense exercise, but just may take longer to do so.

The fact that substantial weight loss was not required for the benefits in this study is also important, according to an editorial accompanying the report.

"The study...provides a ray of hope for those who find it easier to exercise than to lose weight," writes Dr. Alan R. Tall of Columbia University in New York.

Still, Kraus and his colleagues are looking at whether losing weight enhances the positive effects of exercise on cholesterol.

Source: The New England Journal of Medicine 2002;347:1483-1492.

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Just a Spoon Full of Sugar

HealthScoutNews
Wednesday, November 6, 2002

(HealthScoutNews) -- When your child needs pain medication, you need to know how much and when to administer it.

 The University of California, Davis, Health System offers these tips:

  • Know your child's weight so you can accurately choose the right dose of acetaminophen or ibuprofen.
  • If pain still persists, you can give a second drug with your physician's advice.
  • Don't give drops to a baby who's lying down; this can cause choking.
  • If your children are sleeping when it's time for the next dose, don't rouse them. When they wake on their own, you can judge whether they need another dose.
  • Don't give aspirin to infants or children. It can cause Reye's syndrome, a rare but sometimes fatal disease.

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New York Medicaid Moves to Mandatory Generics

By Karen Pallarito
Reuters Health

Wednesday, November 6, 2002

NEW YORK (Reuters Health) - New prescriptions for brand-name drugs that have generic equivalents will require prior authorization under a requirement of New York State's Medicaid program set to take effect this month.

Physicians who want to prescribe a brand-name drug for which a generic is available must call a designated hotline and justify the exception to obtain Medicaid coverage. The generic drug mandate, effective November 17, implements a law passed by the New York State Legislature in January.

Only brands that have an "A-rated" generic version--considered by the US Food and Drug Administration (news - web sites) to be therapeutically equivalent--are subject to the mandate.

State Health Commissioner Dr. Antonia Novello also has exempted nine specific brands from prior authorization. The list includes three anti-anticonvulsant drugs for controlling epileptic seizures and three immunosuppressive medications for preventing rejection of transplanted organs. Also exempted are the blood-thinner Coumadin, the anti-psychotic Clozaril and the heart failure treatment Lanoxin.

"To be on this list, a brand drug must provide a superior outcome or result over the available generic drug," explained Claire Pospisil, a state health department spokeswoman.

Even without the mandate, New York's Medicaid program has a generic substitution rate of 88.7%, "the highest in the nation for any state that doesn't have mandatory generics," according to Craig Burridge, executive director of the Pharmacists Society of the State of New York.

That compares with a national average generic substitution rate for cash-paying patients of 54%, Burridge said. For privately insured individuals receiving drug benefits through a pharmacy benefits manager, the rate is less than half of that, at 25%, he said. By mail order, it's 28%.

"The state was hoping that the number would go up to about 95%...in order to save about $16 million," Burridge told Reuters Health. But considering the commissioner's list of exempted brands, he said, the society believes the mandate will boost the generic substitution rate to 90%, saving just $8 million for the state.

The state is actually projecting savings of $10 million in the fiscal year ending March 31, 2003, and $20 million in the following fiscal year, Pospisil said.

The Medical Society of the State of New York is philosophically opposed to limits like those imposed by the mandatory generics program. "We do not think that the government should make clinical decisions...as to what is best for the patient," said Lynda Adams, a spokeswoman for the group, which represents 27,000 New York physicians.

Nevertheless, she said, the medical society is trying to work within the system. The group is working with state officials on ways to make the prior authorization requirement less burdensome. It wants the state to strike a provision requiring doctors to seek permission to prescribe a brand-name drug for a patient every six months, she said.

Recent trends in New York State Medicaid dispensing patterns suggest utilization is a big driver of prescription drug costs. Total prescriptions dispensed rose 18.15% in 2001 to 44.57 million, said Burridge, citing fresh data provided by state Medicaid officials.

Between 2000 and 2001, the average price per prescription rose from $63.92 to $67.38 for brands and from $19.54 to $22.19 for generics.

Meanwhile, the number of over-the-counter (OTC) medicines dispensed, which Medicaid covers with a physician's request, rose from 6.4 million to 8.7 million, an increase of about 2.3 million. "That's actually good," Burridge said, "because OTCs are a fraction of the prescription drug costs."

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Snowboarding Safety

HealthScoutNews
Wednesday, November 6, 2002

(HealthScoutNews) -- If snowboarding's your thing, you need to protect yourself against common but often preventable injuries.

The Medical College of Wisconsin suggests these tips:

  • Get in shape before hitting the slopes.
  • Use the right equipment. Beginners should go for all-purpose snowboards.
  • Learn from a trained instructor in good weather.
  • Wear wrist guards or keep your hands clenched in a fist position.
  • Consider using ski poles, especially if you're a beginner.
  • Wear a helmet. The back of the head is a frequent impact area.
  • Snowboard on uncrowded slopes that have packed snow.

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Pressure on the Job Thwarts Exercise Plans: Study

By Charnicia E. Huggins
Reuters Health

Wednesday, November 6, 2002

NEW YORK (Reuters Health) - New study findings back up what most stressed-out workers already know: intense job demands often prevent people from exercising.

"Since we spend much of our waking lives at work, the workplace provides a convenient forum for health behavior change interventions," lead study author Dr. Nicola Payne of Middlesex University in the UK told Reuters Health. "Employers need to recognize exercise as a priority and actively encourage it."

Payne and her colleagues investigated the influence of working life on exercise behaviors in a study of more than 200 employees of a UK computer company. The study participants first completed a questionnaire about their intentions to exercise during the following week and were questioned one week later about whether their behavior matched those intentions.

Overall, nearly three out of every four employees said they intended to exercise at some point during the following week, the investigators report in the October issue of the Journal of Occupational Health Psychology.

At follow-up, however, one out of every five workers said that they did not exercise as they had intended to and those who did worked out for about 60 minutes less than they had planned, study findings indicate.

The only factors that differed between workers who exercised as they intended and those who did not were work demands and self-confidence, the report indicates.

Fifty-four employees were classified as having high-strain jobs, based on their work demands and their level of control over their job. These workers not only reported lower self-confidence in their ability to make and stick to a decision to exercise, but also exercised less frequently than did their colleagues.

"People in high-strain jobs...may not have the time for exercise (unable) or they may be too fatigued to exercise (unwilling) because they need more time to recover after the working day," Payne explained.


Thus, the findings suggest that "we need to focus on increasing people's confidence in their ability to exercise, even when they are faced with barriers such as having a demanding job," Payne said. "We also need to focus on helping people to implement their intentions to exercise."

Source: Journal of Occupational Health Psychology 2002;7:342-353.

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Inflammation Increases Chance of Stroke

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews
Wednesday, November 6, 2002

WEDNESDAY, Nov. 6 (HealthScoutNews) -- Men with high blood pressure and inflammation are more than four times more likely than other men to suffer a stroke at some point in their lives, says a new Swedish study.

The researchers also found that inflammatory proteins in the blood play a major role in strokes, even 10 years after they are first detected. Testing for such proteins could help physicians prepare for strokes and act to prevent them, says lead author Dr. Gunnar Engstrom, of the Malmo University Hospital in Malmo, Sweden.

"It is possible to detect these proteins by a simple blood test. This has been done for many years, and is still done at our hospital," Engstrom says.

On average, every 3.3 minutes a person dies of stroke in the United States, according to the American Stroke Association.

Until recently, inflammatory proteins weren't associated with heart disease and strokes. Then two years ago, two European studies in The New England Journal of Medicine (news - web sites) linked these proteins to heart attacks. However, this new study is much more extensive and argues that the proteins are almost as important as high blood pressure in determining strokes.

The study, published in the current online issue of Stroke, evaluated stroke risk, blood pressure and levels of the inflammatory proteins in 6,071 healthy Swedish men aged 28 to 61. Researchers tracked the men for an average of 18.7 years.

One-quarter of those in the study had high systolic blood pressure, making them 2.5 times more likely to have a stroke than men with normal blood pressure. However, those with both high blood pressure and inflammatory proteins in their blood -- about 10 percent of the group -- were 4.3 times more likely to have a stroke, Engstrom says.

"We know that smoking increase inflammation. There is maybe a hereditary component, too," he says. "It is possible that inflammation increases the risk of stroke through several different pathways."

An important question Engstrom plans to explore in future studies is whether inflammation actually triggers high blood pressure. It's a question shared by other doctors and researchers.

"If worsening blood pressure elevation over a period of years could be prevented or attenuated by anti-inflammatory treatments, a new window on primary prevention could be opened," says Dr. Keith W. Muir, a neurologist with the South Glasgow University Hospital in Scotland.

Because only 3 percent to 4 percent of those in the group had strokes during the study, Muir wonders whether a preventative treatment is worthwhile.

"Is an additional 1 in 25-to-30 chance of a stroke over a 20-year period justification for intensive drug treatment in a healthy middle-aged man?" Muir asks in an editorial that will run in next month's issue of Stroke.

Studies such as this one help doctors begin to answer that question, he says.

What To Do

To learn more about strokes, visit the National Stroke Association, or the Internet Stroke Center, run by the Washington University School of Medicine in St. Louis.

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Babies Look to Eyes for Information: Study

By Alison McCook

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - New research provides evidence to support the theory that babies use the direction of an adult's eyes to tell them what to look at.

Previous studies have investigated this question, but none had conclusively determined whether a baby who follows an adult's gaze is imitating the direction of the adult's turned head or their eyes, lead author Dr. Rechele Brooks of the University of Washington in Seattle told Reuters Health.

Now, in the current study, Brooks and co-author Dr. Andrew N. Meltzoff found that 12-month-old babies were more likely to look in the direction of an object if an adult looked at it with open eyes than if the adult's head was turned in that direction, but the eyes were closed. The babies who were at least 14 months old also heeded an object more if an adult was looking in the direction of the object and wearing a headband, rather than a blindfold.

These results indicate that babies rely on eyes, and not the head, to direct their attention, Brooks explained.

"Babies are looking at and following your eyes when you turn to look at something," Brooks noted. "They're actually monitoring that your eyes are open."

Brooks and Meltzoff obtained their findings from a series of experiments in which they sat across from an infant, with a table in between them, and two identical, colorful objects placed on either side of the baby. The investigators tried the experiment with 96 infants who were either 12, 14 or 18 months old. Each infant sat on a parent's lap.

During the experiments, the investigator first played with the infant and one of the toys. The investigator then made eye contact with the baby, then looked with either open or closed eyes in the direction of one of the toys.

In a second series of experiments, the investigator repeated the same experiment, but this time compared how long babies looked at the object when the investigator wore a blindfold or headband.

The researchers found that babies were more likely to look at the object when the investigators turned to the object with open eyes than when their eyes were closed or blocked by a blindfold. In addition, babies were more likely to point or babble while looking at the object if the adult across from them was looking at it with open eyes. Brooks and Meltzoff report their findings in the upcoming issue of Developmental Psychology.

In an interview with Reuters Health, Brooks explained that during the early months of life, babies can either play with a toy or an adult, and have trouble understanding how to join an adult and play with the same toy. Over time, however, she said she believes the babies expand their social skills and become able to connect the adult to the toy by what the adult is looking at. "I think (babies) are gradually just expanding what they know about eyes in a social way," Brooks explained.

She added that eyes are a smart thing to focus on, because they are often more specific about what to look at than the direction in which a head is turned. Eyes can also tell babies about what the adult is feeling while looking at the object.

This study did not address what happens to babies who don't learn to follow an adult's eyes, Brooks noted. However, the researcher speculated that parents with 12-month-old babies who are not connecting an adult's gaze to an object may want to exaggerate their attention, perhaps pointing to and reaching for an object to let babies know what to look at.

Source: Developmental Psychology 2002;38 (in press).

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Aging Brain Doesn't Lose Language Skills

HealthScoutNews
Wednesday, November 6, 2002

WEDNESDAY, Nov. 6 (HealthScoutNews) -- Normal age-related declines in brain activity don't hinder language processing.

That's the claim of a study being presented today at the Society for Neurosciences meeting in Orlando, Fla.

American researchers used functional magnetic imaging (fMRI) to study the brains of 50 people aged 23 to 78 years old.

They found that despite the natural decline in brain activity caused by aging, particularly in the language areas of the left frontal lobe, some forms of language processing may actually be done more efficiently in older people.

That contrasts with other studies that find older people have decreased performance and efficiency in other areas of brain function such as memory, attention and response speed compared to younger people.

This new study's findings are consistent with theories that suggest some types of brain function don't decline as people grow older.

The people in the study did a pronunciation task. They read pairs of words and had to decide whether each word pair was a synonym. For example, boat and ship. While doing the task, their brain activity was monitored using fMRI and compared to results recorded when they did a prior control task.

More information

Here's where to find more about the aging brain.

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Leg Exercises May Help Heart Failure Breathlessness

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - Heart failure patients may be able to lessen their breathing problems with exercises that strengthen the leg muscles, preliminary research suggests.

The study of 25 men and women with heart failure found that those who trained their leg muscles with supervised, low-intensity exercises saw improvements in breathlessness--a common and physically limiting symptom of heart failure.

According to the study authors, their findings indicate the importance of skeletal muscle, as opposed to the heart and lungs, in the breathing symptoms of heart failure.

Dr. Donna M. Mancini and her colleagues at Columbia Presbyterian Medical Center in New York report the findings in the November 6th issue of the Journal of the American College of Cardiology.

Chronic heart failure occurs when the heart can no longer pump blood efficiently enough to meet the body's needs, usually due to an underlying cardiac condition like coronary artery disease. Shortness of breath, fatigue and swelling around the feet and ankles are among the symptoms. Modest exercise, under a doctor's supervision, is one of the ways heart failure is managed.

In this study, Mancini's team tested the hypothesis that isolated leg exercises--using light weights and resistance bands--can improve breathing problems in heart failure patients. The researchers point out that such exercise may change muscle metabolism in a way that lessens patients' feelings of breathlessness.

They found that after 3 months of regular, supervised training sessions, the 17 patients assigned to the exercise group boosted strength and endurance in their leg muscles. And both their perceived breathlessness and ratings of their quality of life improved.

According to Mancini and her colleagues, this suggests that therapies aimed at improving muscle function "may improve the quality of life and exercise performance" in heart failure patients.

Source: Journal of the American College of Cardiology 2002;40:1602-1608.

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Peanut Allergies, Thought Outgrown, Can Return

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews
Wednesday, November 6, 2002

WEDNESDAY, Nov. 6 (HealthScoutNews) -- Peanut allergies that seem to disappear in young children can return years later in some, raising concerns that the same may hold true for other food irritants.

An estimated one in 150 Americans are allergic to peanuts, some so acutely that even the most minimal contact with peanut proteins can trigger severe and possibly fatal reactions. Yet doctors recently have learned that as many as 20 percent of kids allergic to the peanuts as toddlers grow tolerant to them by the time they enter school -- and it has been assumed that once the allergy resolves, it never returns.

However, immune system specialists at Mount Sinai School of Medicine in New York City have found three children in whom peanut allergies gone underground resurfaced. All of the patients were boys and ranged in age from 6 to 10 when their allergy returned. Each had first suffered reactions to peanuts when they were between 1 and 1.5 years old.

"No one had ever reported that anyone who outgrew an allergy grew back into it again," says Dr. Scott Sicherer, a pediatrician at Mount Sinai's Jaffe Food Allergy Institute who saw the patients. "The remarkable thing was they not only had symptoms but they developed increased sensitization," or blood signs of sensitivity to peanut proteins.

Sicherer and his colleagues report the cases in a research letter in tomorrow's issue of The New England Journal of Medicine (news - web sites).

The boys were among 44 children participating in a program to chart the course of peanut allergies. Their reactions followed by about a year a doctor-monitored "challenge" with small amounts of peanut foods to see how well they tolerated them. Those, including the three boys, who didn't react to the foods were told they could safely eat peanuts at home.

Sicherer says allergists should be cautious about advising their patients with dormant peanut allergies to dive headfirst into peanut-rich foods. The rebound phenomenon probably doesn't apply with other foods frequently implicated in allergies, such as milk, eggs, wheat and soy, he says. Whether it's a factor with former allergies to fish and tree nuts isn't clear.

Anne Munoz-Furlong, founder and chief executive officer of the Food Allergy and Anaphylaxis Network, calls the latest discovery "surprising."

"What it reminds us is that when we're talking about peanut allergy we have to start from scratch and assume nothing," Munoz-Furlong says. "We always have to be ready that it might come back."

Food allergies account for 30,000 emergency room visits and between 150 and 200 deaths a year in the United States. Many of those are believed to be the result of peanuts, Munoz-Furlong says.

What To Do

For more on food allergies, try the Food Allergy and Anaphylaxis Network or the U.S. Food and Drug Administration.

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Govt. Policies Show Weak Effect on Teen Sex: Study

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - Certain government policies on sex education and family planning may have little effect--good or bad--on teenage girls' sexual behavior, a new US study suggests.

Researchers found no association between state-mandated sex education in the public schools and the rate of sexual activity or contraceptive use among teen girls.

In addition, the cost of abortion--swayed by policies such as whether a state allows Medicaid to pay for "therapeutic" abortions--was not related to girls' sexual behavior. Nor was the availability of family planning services related to girls' odds of being sexually active, according to findings published in the November issue of the American Journal of Public Health, journal of the American Public Health Association (news - web sites).

There was evidence that girls in areas with greater family planning services were more likely to use birth control. However, the study authors report, a girl's neighborhood environment appeared to be a stronger influence over sexual behavior than any government policy they studied.

"Neighborhood context seems to be a more important determinant of adolescent female sexual behavior than the direct incentives created through government policies," write Dr. Susan L. Averett, of Lafayette College in Easton, Pennsylvania, and her colleagues.

Among neighborhood characteristics, Averett's team found, higher household incomes were associated with lower odds that a girl would be sexually active and with greater use of birth control. And there was some evidence that girls in neighborhoods with a high proportion of black Americans were less likely to be sexually active.

The researchers arrived at their conclusions after studying findings from a 1995 US survey that included nearly 1,300 unmarried females ages 15 to 19. They compared the survey responses with data on various government programs or mandates related to sexual behavior, such as state requirements that schools provide education on sex, AIDS (news - web sites) or proper condom use.

According to Averett's team, mandates on sex education were unrelated to sexual activity or contraceptive use. This, they write, suggests that concerns that sex ed encourages kids to have sex are "misplaced."

On the other hand, the authors add, the finding also suggests that "broad state mandates with regard to classroom content are not an effective means by which to encourage the adoption of 'safe sex' practices."

The availability of family planning services, which receive federal funding, was not related to the odds of teenage girls' being sexually active, but it was tied to greater contraceptive use. The cost of abortion in a woman's neighborhood showed no relationship to birth control use or sexual activity--in contrast to the hypothesis that, as the cost of abortion falls, teenagers may become more sexually active or more lax about birth control.

"Although we found some evidence that contraceptive use is influenced by the availability of family planning services," the study authors write, "none of our other policy variables were in any way related to observed sexual behavior."

According to the researchers, government policies that "mold communities and neighborhoods" could have greater influence over teens' sexual behavior than policies aimed at changing the cost of family planning or abortion.

Source: American Journal of Public Health 2002;92:1773-1778.

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GOP Control of Congress Could Reshape Health Agenda

By Julie Rovner

Reuters Health
Wednesday, November 6, 2002

WASHINGTON (Reuters Health) - Republicans recaptured control of the US Senate in the mid-term elections Tuesday, and increased their single-digit majority in the House. The gains bucked historical trends in which the President's party generally loses votes in Congress halfway through his first term.

The changes could have a major impact on top-tier health issues, including prescription drug coverage for the elderly and ways to help the nation's more than 40 million uninsured residents.

The Democrat-controlled Senate this year refused to go along with a House-passed approach to Medicare drug coverage. That bill, favored by the drug industry, would have created a benefit to be run by private insurers rather than Medicare itself. The Senate, while failing to agree on a Medicare benefit, did pass a drug bill the House refused to consider. That measure, which brand-name drugmakers opposed, would have made it easier for generic copies of brand-name drugs to get to market.

The Pharmaceutical Research and Manufacturers of America--which poured millions of dollars into some of the tightest House and Senate races through an advertising campaign run by the United Seniors Association--immediately declared victory over candidates that it said were trying to "demonize" the industry in order to win votes. "Americans see the real risks and dangers involved in further politicization of this issue," said PhRMA President Alan Holmer. "Voters do not want to jeopardize the miracle of life-saving innovation in modern medicines."

The change in party control in the Senate makes it more likely the chamber will consider a Medicare drug bill like the one that passed the House. The new chairman of the powerful Finance Committee, Charles Grassley of Iowa, was one of the sponsors of a "tripartisan" bill that roughly followed the House approach.

Another major change in outlook will come at the Senate Health, Education, Labor and Pension Committee, where conservative Judd Gregg (R-NH) will take over the chairmanship from liberal Edward Kennedy (D-MA). Gregg will be the most conservative member to chair the panel since Orrin Hatch (R-UT) headed it in the early 1980s. Republican chairs in the 1990s included moderates Nancy Landon Kassebaum of Kansas and James Jeffords (news - web sites) of Vermont, whose switch to Independent gave Democrats control of the chamber in 2001.

Among the Republican initiatives the new Congress is likely to consider is creation of "association health plans" that would allow small businesses to band together in insurance buying pools that would be exempt from state insurance laws. The House has passed bills to create AHPs several times in the past 6 years, but the Senate has never followed suit. Two new Republican senators, however, Elizabeth Dole (news - web sites) of North Carolina and James Talent of Missouri, made creation of AHPs centerpieces of their campaigns.

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Oral Vaccine Halts Cancer in Animals

By Kathleen Doheny
HealthScoutNews Reporter
H
ealthScoutNews

Wednesday, November 6, 2002

WEDNESDAY, Nov. 6 (HealthScoutNews) -- An oral vaccine stopped cancerous tumor growth in animals by choking off the blood supply to the tumors, a research team from California and Germany reports.

The work was done on mice, so the researchers caution that clinical use could be several years away. But the finding, reported in the advance online edition of the December issue of Nature Medicine, is lauded as groundbreaking by a prominent researcher in the field.

Ralph A. Reisfeld, a professor of immunology at The Scripps Research Institute in California, and his team first targeted a protein produced in new blood vessels, called vascular endothelial growth factor receptor 2, or VEGF receptor 2. This protein is one of several "activators" of new blood vessel growth, a process called angiogenesis. New blood vessel growth is critical, experts now agree, for cancerous tumors to grow and spread.

The researchers gave the animals genetically engineered bacteria that also contained a gene to express the VEGF receptor 2 protein. When the immune system activated to fight off the mild infection from the bacteria, it also killed the protein that spurs new blood vessel growth to the tumors. The vaccine worked against melanoma, colon cancer and lung cancer in the animals.

"The immune response triggered by the vaccine destroys the blood vessels that nourish the tumor," says Dr. Andreas G. Niethammer, a co-author on the paper who is also at Scripps Research Institute. The other authors are from the La Jolla Institute for Molecular Medicine in San Diego and the Universitaets-Hautklinik in Wuerzburg, Germany.

The concept of giving a DNA vaccine with weakened bacteria is not new, Reisfeld says. "The new thing is, we have killer cells attacking the blood vessels within the tumor." The killer cells, the researchers also found, have a very good memory.

"The mice were vaccinated and allowed to sit for 10 months (a lengthy period in a mouse's lifespan), and then they were challenged with tumor cells. They dramatically suppressed the growth of these tumor cells," Reisfeld adds.

The animals did have a delay in wound healing as a side effect, the researchers report, but there was no effect on the mice's fertility or neuromuscular performance.

Most DNA vaccines under study now are designed to attack the tumor directly, not the blood supply to it, Reisfeld and Niethammer say.

The problem with that approach is that tumor cells are constantly mutating, says Dr. Judah Folkman, a professor of surgery and cell biology at Harvard Medical School (news - web sites) and Children's Hospital in Boston and a pioneer in angiogenesis research.

He lauds the new research as "breaking new ground," particularly since the killer cells have a memory. "They've changed the target," he says, from the tumor to the endothelial cells that line the blood vessels and promote new blood vessel growth. "They are targeting the supply line," he notes.

Another plus of the new vaccine, Folkman says, is that it can be administered orally, rather than intravenously as most other immunotherapy cancer treatments are given.

"It looks promising as far as a potential treatment," agrees Dr. Mai. N. Brooks, an associate professor of surgical oncology at the UCLA David Geffen School of Medicine who was formerly a researcher in Folkman's laboratory.

"There is a long road between what works for mice and what works for men and women," she adds. "But this seems to be a unique approach to anti-angiogenesis. The idea of a vaccine that will confer long-lasting immunity is beautiful."

"We let the body do most of the work," Reisfeld explains. Eventually, the hope is that such a vaccine would work against a variety of cancers, he says. However, the vaccine must still be tested for toxicity and undergo clinical trials in humans. Reisfeld estimates it will take at least four to seven years before the vaccine might be routinely available.

What To Do

For more information on angiogenesis and cancer, see the U.S. National Cancer Institute or the American Cancer Society.

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Virus DNA May Predict Head and Neck Cancer Outcome

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - Head and neck cancer patients with a high level of Epstein-Barr virus (EBV) DNA after radiation treatment face a higher risk of cancer recurrence and death than those with lower levels of the virus DNA, researchers in Hong Kong report.

It is possible, according to the report, that monitoring levels of EBV DNA may help predict a person's survival or signal the need for more treatment.

In the study, Dr. Anthony T. C. Chan and colleagues looked at the relationship between EBV infection and nasopharyngeal cancer, a malignancy that arises in the area at the back of the nose and upper throat. Worldwide, the cancer is rare, but it is relatively common in certain regions such as Southeast Asia.

EBV, on the other hand, is prevalent throughout the world, and it is estimated that most people will be infected at some point in their lives. EBV can cause the "kissing disease" mononucleosis, but it usually produces no symptoms and lives in a life-long dormant state in certain body cells.

The virus has, however, been linked to some serious health conditions, including nasopharyngeal cancer--although, since EBV is so common and the cancer so infrequent, experts believe other factors are certainly involved.

In the current study, reported in the November 6th issue of the Journal of the National Cancer Institute (news - web sites), the investigators measured EBV DNA levels in 170 people undergoing radiation treatment for nasopharyngeal cancer that had not spread to other parts of the body.

Although 99% of the patients achieved "complete clinical remission" after treatment, those with higher levels of EBV DNA were more likely to relapse. The researchers found that people whose EBV DNA was high before treatment were more than twice as likely to suffer a recurrence of their cancer as those with low viral DNA levels. People whose EBV DNA levels were high after treatment were nearly 12 times as likely to have a recurrence as those with lower levels.

"We observed that a level of post-treatment EBV DNA greater than 500 copies per milliliter was highly statistically significantly associated with the poorest outcome," Chan and colleagues write.

"Such a subgroup of patients may benefit from further treatment after radiotherapy, which can be monitored by sequential measurement of EBV DNA," they add.

Source: Journal of the National Cancer Institute 2002;94:1614-1619.

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Hormone Could be Key to Weight Reduction

HealthScoutNews
Wednesday, November 6, 2002

WEDNESDAY, Nov. 6 (HealthScoutNews) -- An appetite-suppressing hormone found naturally in the body may help scientists find ways to fight obesity.

That's the thrust of a new study presented today at the Society for Neuroscience's annual meeting in Orlando, Fla.

Oregon Health and Science University researchers collaborated with British researchers to examine the effects of peripheral hormone peptide YY (PYY 3-36) -- which is secreted in the gut -- on a bundle of brain neurons involved in weight regulation.

The brain neurons are called pro-opiomelanocortin (POMC) neurons. They're contained in a cluster called the arcuate nucleus, located in the hypothalamus.

In experiments with mice, the Oregon scientists found that when PYY 3-36 was introduced to the arcuate nucleus, food intake in the mice decreased by about 35 percent.

Previous research had shown that PYY 3-36 concentrations in the blood increase after a person eats a meal. That increase in blood concentrations of PYY 3-36 may indicate that this hormone is one of the natural signaling systems the human body uses to indicate it has had enough to eat.

While this study provides more information about how the body regulates food intake, the OHSU scientists say much more research is needed to develop a drug that can combat severe obesity.

While the OHSU team studied mice, their British collaborators studied the effect of PYY 3-36 on POMC neurons in 12 non-obese humans. Some received intravenous PYY 3-36 for 90 minutes while those in a control group received saline infusions for the same amount of time.

Two hours after the infusions, the study subjects were offered a free-choice buffet meal and the researchers measured their food intake. The people who received the PYY 3-36 said they felt less hungry and ate about one-third fewer calories than the people in the control group.

That appetite reduction lasted about 12 hours.

More information

The U.S. National Heart, Lung, and Blood Institute has advice on how you can aim for a healthy weight.

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'Good' Cholesterol Helps Very Old Keep Their Smarts

Reuters Health
Wednesday, November 6, 2002

NEW YORK (Reuters Health) - While it's well known that high levels of "good" cholesterol reduce a person's risk of heart disease, experts now report that maintaining high levels of high-density lipoprotein (HDL) may also help the very old stay sharp.

"Among the many effects of plasma HDL, it recently became apparent that it protects from decreased cognitive function associated with Alzheimer's disease (news - web sites) and other forms of dementia," write lead author Dr. Nir Barzilai and colleagues at the Albert Einstein College of Medicine in New York City.

What's more, the authors point out that people living well into their 90s and beyond age 100 tend to have higher levels of HDL. Children of centenarians also have relatively high HDL levels.

In the current study, Barzilai's team sought to determine whether high HDL levels might be linked to mental ability in the very old.

They evaluated HDL levels and mental abilities of 139 men and women between 95 and 107 years old, and report their findings in the October issue of The Journal of Gerontology.

Blood levels of HDL "correlated significantly" with how well a person performed on a test of mental abilities, the authors report.

Good cholesterol may help keep the blood vessels functioning properly, reduce inflammation and help support brain cell function in other ways, they note.

"Our findings help to emphasize the beneficial and protective effects of increased plasma HDL," Barzilai said in a prepared statement. "It is clear from the data we collected that increased HDL levels play an important role in maintaining superior cognition in longevity."

Source: The Journal of Gerontology 2002;57A.

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TUESDAY, NOVEMBER 5, 2002

Something's Fishy About Smelly Seafood

HealthScoutNews
Tuesday, November 5, 2002

(HealthScoutNews) -- An overly stinky fish market can be a sign that you should buy your sushi elsewhere. But the lack of strong odors doesn't necessarily mean the vendor is using safe food-handling tips.

Based on the U.S. Food and Drug Administration (news - web sites)'s food code, there other things to watch for:

  • Employees should be in clean clothing and wearing hair coverings.
  • They shouldn't be smoking, eating, or playing with their hair. Nor should employees have runny noses, open wounds or other obvious medical problems.
  • They should be using disposable gloves when handling the food -- and changing them after they handle raw seafood.
  • Fish should be displayed belly-down on a thick bed of fresh, not melting, ice.
  • The employees should be able to answer questions about the different products, the age of the fish and why theirs is fresh.

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Study: Garlic May Prevent Cancer

By Paul Recer

AP Science Writer
The Associated Press

Tuesday, November 5, 2002

WASHINGTON (AP) - Men in China have the lowest rate of prostate cancer (news - web sites) in the world, and a diet rich in garlic, shallots and onions may be one of the reasons.

Researchers at the National Cancer Institute (news - web sites) report in a new study that a diet with lots of vegetables from the allium food group — which includes garlic, shallots and onions — reduces the risk of prostate cancer by about half. And the common Chinese diet includes hearty servings of these vegetables.

The study, appearing this week in the Journal of the National Cancer Institute, is based on interviews with 238 men with prostate cancer and 471 men who were free of the disease.

Men in the study, all residents of Shanghai, China, were asked how frequently they ate 122 food items.

The results showed that those who ate more than a third of an ounce a day from the allium food group were about 50 percent less likely to have prostate cancer than those who ate less of the foods.

"We checked on many food items and the allium food group stood out (as protective against prostate cancer)," said Ann W. Hsing, an NCI epidemiologist and the first author of the study. "But the conclusions need to be replicated in another study." She said the study was conducted in Shanghai because China has the lowest rate of prostate cancer in the world.

Scallions seemed to be the most protective. According to the study, men who ate about a tenth of an ounce or more a day of scallions reduced their prostate cancer risk by about 70 percent. For garlic consumption of the same amount, the prostate cancer risk was reduced by about 53 percent.

Hsing said that the typical Chinese diet is much more heavily seasoned with garlic, scallions and onions than is the traditional American diet. But even so, the amount of allium vegetables consumed is measured only in fractional ounces. For instance, the study suggests that an effective level of prostate cancer protection can be achieved with about one clove of garlic a day.

"The reduced risk of prostate cancer associated with allium vegetables was independent of body size, intake of other foods and total calorie intake," the study authors reported.

Hsing said the study reinforces earlier studies that have linked high vegetable consumption to a reduced risk of prostate cancer. For instance, earlier studies have found that that eating tomatoes and tomato products can lower risk of prostate cancer. Italy, where tomato sauce and garlic are favorites, has one of the lowest rates of prostate cancer in Europe, said Hsing.

Janet Stanford, a cancer epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, said the study by Hsing and her co-authors continues to support the general finding that "eating vegetables is a good thing."

Stanford said her group, in an earlier study, linked broccoli, cauliflower and related vegetables to a reduced prostate cancer risk, while a high fat diet increased the risk.

"This shows that your mother was right," said Stanford. "Eat more vegetables."

The Shanghai study was conducted by researchers at the National Cancer Institute, one of the National Institutes of Health (news - web sites), and at the Shanghai Cancer Institute in China.

On the Net:

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

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Ear Pressure

HealthScoutNews
Tuesday, November 5, 2002

(HealthScoutNews) --Do you have ear problems when you fly? According to the American Academy of Otolaryngology--Head and Neck Surgery, you should yawn and swallow often enough to keep pace with the plane's ascent and descent.

If your ears still get blocked, here's what you can do:

  • Step 1: Pinch your nostrils shut.
  • Step 2: Take a mouthful of air.
  • Step 3: Using your cheek and throat muscles, force the air into the back of your nose as if you were trying to blow your thumb and fingers off your nostrils.

When you hear a loud pop in your ears, you've done it. You may have to repeat this a few times during descent.

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Genital Herpes May Increase Cervical Cancer Risk

By Alison McCook

Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Researchers have long known that women infected with the human papillomavirus (HPV) are more likely than others to develop cervical cancer, and new findings suggest that that risk may increase when women have both HPV and genital herpes.

Dr. Jennifer S. Smith and her colleagues from the International Agency for Research on Cancer in Lyon, France, found that women with HPV and genital herpes appeared between 2 and 3 times as likely to develop invasive cervical cancer as women who had HPV alone.

These findings indicate that the virus that causes genital herpes "might increase the risk that women with HPV progress to cancer," Smith told Reuters Health.

All of the women included in the study were infected with herpes simplex virus type 2 (HSV-2), the main cause of genital herpes. This form of herpes is a lifelong infection that is closely linked to unsafe sex practices. In contrast, infection with HSV-1 tends to cause cold sores around the mouth, although it can infect the genitals as well.

The investigators developed their findings by retesting samples from studies conducted in seven countries that investigated the link between HPV infection and cervical cancer. In total, Smith's team tested blood samples for the presence of HSV-2 antibodies in 1,263 women diagnosed with cervical cancer, and 1,117 similarly-aged women who were cervical cancer-free. The women were from Thailand, the Philippines, Morocco, Peru, Brazil, Columbia and Spain.

Smith and her team discovered that around 44% of women diagnosed with cervical cancer also had signs of infection with HSV-2, while only 26% of cancer-free women also carried such antibodies in their blood. The overwhelming majority (more than 90%) of cervical cancer patients had cervical tissue that tested positive for HPV, while the virus was detected in only 15% of healthy women, the authors note in the November 6th issue of the Journal of the National Cancer Institute (news - web sites).

In an interview with Reuters Health, Smith said that most women who become infected with HPV do not develop cervical cancer, so researchers have been investigating for some time whether additional factors may help explain why some women develop cancer while others don't.

Based on the current study findings, Smith suggested that HSV-2 may simply act as one out of many influences that increase cervical cancer risk in women with HPV. Additional risk factors include long-term use of oral contraceptives, smoking, and having many children. Recent findings have also suggested that chlamydia infection may attenuate the risk of cervical cancer in women with HPV.

"Herpes is one co-factor, among other co-factors in increasing the risk of invasive cancer," Smith said.

Just how HSV might increase that risk remains unclear, she noted. Ulcers caused by HSV-2 may help HPV sneak into the layer of tissue in the cervix where cancer arises, Smith said. HSV-2 can also cause inflammation, which can lead to DNA damage and, ultimately, cancer.

Unfortunately, not all women who should be screened for cervical cancer are, Smith added. In populations where not everyone is tested, the researcher suggested that health officials focus on women who may have an increased risk of the disease--such as those with both HPV and HSV-2.

Source: Journal of the National Cancer Institute 2002;94:1604-1613.

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Collecting Fat

HealthScoutNews
Tuesday, November 5, 2002

TUESDAY, Nov. 5 (HealthScoutNews) -- A new Dutch study offers a better understanding of the factors that control the buildup of fat in our bodies.

The researchers found that a part of our autonomic nervous system may be involved in the complex mechanisms that create fatty tissue. The study appears in the current issue of the Journal of Clinical Investigation.

The Dutch researchers looked at the role of the parasympathetic nervous system (PSNS). It controls our bodies during what are called "rest and digest" situations. That's when our bodies are relaxed and digestion is increased.

In this study with rats, the researchers found that PSNS does seem to play a role in creation of fatty tissues.

More information

Here's a site that explains how fat cells work.

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Doctors Test Post-Bypass Memory Drugs

By Lauran Neergaard

AP Medical Writer

The Associated Press
Tuesday, November 5, 2002

WASHINGTON (AP) - Call it brain fog, that loss of memory and thinking ability that strikes tens of thousands of patients after open-heart surgery, and sometimes other big operations, every year.

Now doctors are studying if giving patients certain drugs just before a heart bypass could prevent this mental decline by essentially protecting the patients' brain cells from the rigors of surgery.

The clinical trials mark a turning point: For decades, doctors didn't know what to make of patient complaints that in getting their hearts fixed, something hurt their brains.

Today, few doubt it's a real problem that affects not just heart patients but those undergoing other major surgeries, too, such as hip or knee replacements. Often, patients recover. But one study found 42 percent of heart-bypass patients suffer significant drops in mental sharpness that can last not just months but years. Other research suggests 10 percent of hip-replacement patients suffer similar mental decline.

In some ways this "postoperative cognitive dysfunction" is a byproduct of the modern operating room. As surgery — particularly the half-million heart bypasses performed every year — has become increasingly successful, aftershocks such as a muddled brain draw more concern.

"It's a big quality of life issue," says Dr. James Cottrell, president of the American Society of Anesthesiologists.

No one knows yet what's to blame. It may be that only certain people are at high risk, such as those whose brain blood vessels are starting to clog and something about surgery speeds up the disease.

For now, suspects range from the heart-lung machine that circulates bypass patients' blood — it can dislodge tiny bits of fat, blood clots or air bubbles that flow to the brain — to the inflammation and post-surgery fever that are a risk after any major operation.

Surgery's stresses spark inflammation and other reactions that "in some ways is the body's way of healing itself," explains Dr. Mark Newman, anesthesiology chairman at Duke University and a leading expert on post-surgery mental decline. "But the question is if it goes beyond a certain level, do you end up with problems?"

That's where much of the prevention research centers: If surgery even temporarily blocks oxygen in part of the brain or sparks severe inflammation, the body reacts with a chemical cascade that injures or kills brain cells.

Newman and other scientists are studying if injecting patients with one of three different medications before a bypass could block that chain reaction and spare brain cells:

_Two small studies suggest lidocaine, normally used for irregular heartbeat, can prevent bypass patients' brain fog. Duke now is testing 250 bypass patients, half given lidocaine and half not, to see who has better brain function a year after surgery. Newman says lidocaine might work by blocking a pathway that lets toxic doses of calcium flood into oxygen-deprived brain cells.

_Certain levels of magnesium seem to block that toxicity, too, as well as lessen cell damage from inflammation. So, using federal money, Duke is enrolling 400 bypass patients into a study to see if magnesium might block brain fog.

_Initial testing of an experimental drug called pexelizumab, thought to block an inflammation-causing immune system protein, showed bypass patients who received the drug had slightly less mental decline. Duke and several other hospitals are participating in a 3,000-patient study of pexelizumab, sponsored by the drug makers Alexion Pharmaceuticals and Procter & Gamble.

Some companies also are testing if filters put onto heart-lung machines can help by keeping debris from flowing to the brain.

Until those studies are done, Newman advises patients worried about coming surgery to ask their anesthesiologists about one step believed to lower brain risk — rewarming their cooled-down bodies more slowly than usual after the operation is done.

The key is intense temperature monitoring that tells when the brain, which warms faster than other organs, reaches 98.6 degrees, Newman explains. At that point, doctors should stop warming and let other organs gradually reach normal temperature on their own.

Editor’s Note:  Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Adolescent Drug Use Creates Long-Term Imbalance

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 5, 2002

TUESDAY, Nov. 5 (HealthScoutNews) -- Drug use during adolescence, including such commonly prescribed drugs as Ritalin (news - web sites), may upset brain chemistry more than any other time in a person's life, new research says.

 The findings should help scientists better understand why addictions generally begin during adolescence, and what the long-term risks result.

"This is a major public health question," says the lead researcher, Dr. Michelle Ehrlich, a neurology professor at Thomas Jefferson University in Philadelphia. "The adolescent brain appears to be more sensitive to certain effects of these psycho-stimulant drugs. We need to see whether this sensitivity leads to permanent brain changes and behavior changes."

In the study, which just appeared in the Journal of Neuroscience, the researcher gave cocaine and amphetamine to groups of adult, adolescent and baby mice every day for a week. Then they compared the chemistry in two sections of the mice brains against that of a control group. Because mice have many of the same brain functions as humans, scientists believe the results should shed light on our brains, Ehrlich says.

After taking the drugs, all the mice had elevated levels of an addiction-marking protein in the part of the brain that controls movement and hyperactivity. But adolescent mice also had high levels of the protein in the part of the brain that controls the "reward" mechanism.

Because of that chemical imbalance, adolescents may depend on drugs to stimulate their reward mechanism, leading to addictive behavior, Ehrlich says. Meanwhile, other studies have shown that the protein, called Delta FosB, stimulates other chemical responses in the brain months after drug use has stopped, which may contribute to drug cravings.

"The implications are that there is an increased adaptation in the younger brain than in the older brain to these psycho-stimulants," Ehrlich says.

But Ehrlich isn't worried only about the effects of illegal drugs. The same long-term changes in brain chemistry may also occur after adolescents take prescribed amphetamine.

"Amphetamine is one of the most commonly used drugs for attention deficit disorder. Ritalin is one of the most well-known ones," Ehrlich says. "I prescribe these drugs. I work with children on these drugs. I'm not saying we shouldn't use them, but we should know about their long-term effects."

In some cases, the risks of prescribing amphetamine drugs are worthwhile, says Dr. Eric Nestler, chairman of the psychiatry department at the University of Texas Southwestern Medical Center. But Nestler, who was one of the first researchers to discover Delta FosB, says such drugs are prescribed too often, when the risks aren't worthwhile.

"There has to be a concern," he says. "Kids with attention deficit disorder are really impaired. A drug like Ritalin works well with those conditions, and to deny it to a kid who really need it is a disservice. The problem comes when the diagnosis of attention deficit disorder is made too frequently."

So far, though, no one has studied whether Ritalin and other prescribed drugs raise the level of Delta FosB like cocaine and amphetamine, Nestler says. "That would be an interesting study," he says.

Nestler says he is surprised that Erlich's team didn't see higher Delta FosB levels in both parts of the adult mouse brain. In his research, he found that both adolescent and adult mice have elevated levels, although he thinks he used a more sensitive method of detecting Delta FosB.

Still, if Ehrlich's research shows that adolescents have a higher level of Delta FosB than do adults, it reveals key evidence about the addiction process, he says.

"This is the first finding to suggest that the adolescent brain is more sensitive. That is very interesting," Nestler says.

What To Do

To learn more about these drugs, visit this site at the California State University at San Marcos. Or for more information about how amphetamine is prescribed to treat attention deficit/hyperactivity disorder, try the National Center for Birth Defects and Developmental Disabilities.

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Too Much Screen Time Can Make Computer Users Sick

Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - The more time an office worker toils in front of a computer, the more likely he or she is to suffer a host of physical, mental and sleep-related ills, Japanese researchers report.

While video display terminal (VDT) use has become commonplace in many types of jobs, there is little information on how long a person can safely use a computer each day. To investigate, Dr. Tetsuya Nakazawa of Chiba University and colleagues surveyed over 25,000 office workers who responded to three questionnaires between 1995 and 1997.

Participants answered questions about the amount of time they spent in front of a VDT, their sleep habits, and physical and mental ailments including headache, low back pain, eyestrain, depression and anxiety. Their findings are published in the October issue of the American Journal of Industrial Medicine.

"In our study, we found a significant relationship between duration of daily VDT use and physical symptoms," even after adjusting for other factors that could influence the results, the authors write.

Office workers stuck in front of a computer most commonly complained of headache, eyestrain, joint pain and stiff shoulders.

Mental symptoms such as lethargy, anxiety and "reluctance to go to work," as well as sleep-related problems including insomnia and fatigue, were most common among workers who spent more than 5 hours a day glued to their computer screen.

"This result suggested that the effect of duration of daily VDT use on these scores has a threshold effect, and the prevention of mental disorder and sleep disorder requires the restriction of VDT use to less than 5 hours per day," the researchers write.

While the type of computer work the study participants performed varied considerably, as did the size of the computer used and the work environment, "it should be emphasized that even under such working conditions, our results were extremely consistent over a 3-year period," Nakazawa and colleagues note.

The researchers call for more research into the relationship between computer use and physical, mental and sleep symptoms.

Source: American Journal of Industrial Medicine 2002;42:421-426.

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Leg Exercise Helps Heart Patients Breathe Easier

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews

Tuesday, November 5, 2002

TUESDAY, Nov. 5 (HealthScoutNews) -- Some light exercise can help people with failing hearts literally breathe easier. Three months of carefully controlled exercise sessions on treadmills or stationary bikes reduced the labored breathing called dyspnea that often afflicts people with moderate heart failure, says a report in tomorrow's issue of the Journal of the American College of Cardiology.

One purpose of the study was to show that people with heart failure can be helped by light exercise, even if their condition makes them feel shortness of breath during mild exertion, says Dr. Donna Mancini, an associate professor of medicine at Columbia-Presbyterian Medical Center in New York City.

Twenty-five patients were enlisted in the trial, and 17 of them agreed to do light exercise over the three-month period. The other eight attended classes on relaxation and guided imagery techniques, with no exercise training, to serve as a control group.

"We were able to show that in the training group there was less shortness of breath during exercise than before the training program, while in the control group there were no changes," Mancini says.

The exercise program concentrated on improving function of the muscles of the legs for a reason, she says. It has been thought that better breathing would come only from better heart muscle function, but the study shows that improving muscle function "can improve the symptoms of heart failure. Otherwise you could say that the reason they are less short of breath is that their respiratory muscles are also being trained," she explains.

While Mancini says the study indicates that "even a low level of exercise is beneficial in improving symptoms," she also warns that anyone with heart failure should approach exercise with caution and should start training only after talking with a physician.

"You should probably have an exercise prescription, x number of repetitions of y kinds of exercise," she says. "The duration and setting of a workout on a treadmill or stationary bicycle should be specified."

The benefits of exercise probably come from improvements in muscle metabolism that changes the activity of receptors that set off signals triggering shortness of breath, Mancini says. However, it's also possible the training just makes people feel better overall, so that the symptoms of breathlessness become less bothersome to them. Either way, she says, "exercise helps these people feel better."

It's possible that there was a psychological element in the improvement, says Dr. Stanley Rubin of the Greater Los Angeles Health Care System, who was asked to comment on the study by the American College of Cardiology. "The active group clearly had more health-care giver interaction than the placebo group," Rubin says. "Because the outcomes are modestly beneficial, it is difficult to know for certain that the observed effect is solely due to the physical conditioning."

Nevertheless, he says, "therapy directed to the physical conditioning of the heart failure patient may be beneficial in improvement of symptoms."

What To Do

A primer on heart failure is offered by the American Heart Association, which also has a page on exercise. You can also learn about the disorder from the National Heart, Lung, and Blood Institute.

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Drug Side Effects Can Be Deadly in Children Under 2

By Natalie Engler

Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Medications used to treat either a mother or child played a role in nearly 6,000 serious side effects, including 769 deaths, in children under 2 years of age in the US between 1997 and 2000, according to an analysis of cases reported to the Food and Drug Administration (news - web sites).

Medications given to pregnant or breast-feeding women may have caused a large proportion of adverse events, and just four drugs were the principal suspect in more than one third of all the reported deaths.

"The results of this study underscore the need for additional testing in the youngest pediatric patients and for greater vigilance in the use of higher risk drugs and in medication for pregnant and lactating women," the researchers report in the November issue of the journal Pediatrics. However, they note that the reports do not prove that the medication was the actual cause of the side effect or death.

Overall, the investigators identified 1,902 drugs, chemicals, biological products, vaccines, over-the-counter medications, vitamins, minerals, dietary supplements and other substances in the reports, but just 17 drugs were indicated in more than half of the serious side effects or deaths in children given medication directly.

The vast majority of deaths (84%) happened before the infant's first birthday.

In the study, Thomas J. Moore of George Washington University in Washington DC and his colleagues analyzed over 7,000 reports of adverse drug reactions in children under age 2 received by the US Food and Drug Administration from November 1997 through December 2000. Overall, 5,976 reports were new and unique cases that had not been reported previously.

They found that in 1,432 cases, or 24%, the drug or product had been given to the mother either during pregnancy, labor or while breast-feeding. The most common adverse effects in these cases were birth defects or disability in the child.

The top 10 list of drugs suspected as a cause of serious and deadly reactions when administered directly to children included treatments for respiratory syncytial virus, antibiotics and over-the-counter analgesics, such as acetaminophen and ibuprofen. Infection with RSV is common, and most people are infected by age 2 and experience cold-like symptoms that eventually improve without treatment. But in some infants and in adults with weakened immune systems or lung disease, the virus can cause pneumonia and other potentially life-threatening complications. RSV infection is the leading cause of hospital admissions in young children.

"Drugs have many important benefits. But this should make parents aware that all drugs--even familiar ones such as acetaminophen and ibuprofen--can sometimes have serious adverse effects," Moore said in an interview with Reuters Health.

This is the first time such data has been made available to pediatricians, said Moore.

Moore cautioned that the findings do not mean infants should stop receiving drugs when necessary. "The information in this study contributes to a much larger balance of risks and benefits that must be weighed in the decision whether to use a particular drug in a particular patient," he said.

He added that, while he has no data that compares the number of adverse reactions to the total number of infants given each medication, "serious adverse reactions to acetaminophen are rare."

Acetaminophen was suspect in just 1.6% of all serious adverse reactions to drugs administered directly.

Moore stressed that "these reports do not prove that the suspect drug directly caused the reported adverse event. Instead they should be considered a warning flag to encourage us to examine those drugs more carefully."

He added that they also underscore the need for more pediatric testing to more accurately measure drugs' risks and benefits.

Source: Pediatrics 2002;110:e53.

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Testosterone Boosts Memory In Older Men

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 5, 2002

TUESDAY, Nov. 5 (HealthScoutNews) -- The hormone that makes men male may also play a big role in keeping them sharp into old age.

Older men who had high levels of testosterone freely circulating in their blood performed better on memory and cognitive tests than men with lower testosterone levels, a new study found.

"What it's suggesting is that higher testosterone may preserve memory and other specific aspects of cognition," says Susan Resnick, study co-author and an investigator in the National Institute on Aging's Laboratory of Personality and Cognition. "Still, this is not a causal relationship. It's an association. It's too early to tell men to take testosterone to improve memory."

Using data from the Baltimore Longitudinal Study of Aging, the longest-running examination of human aging, researchers over a 10-year period analyzed the free, or unbound, testosterone circulating in the bloodstreams of 407 men who were between 50 and 91 years old. The free testosterone levels were then correlated with the men's performances on a series of memory and cognitive tests.

Why was free testosterone the focus of the study?

Most testosterone made by the body becomes bound to a protein called sex hormone binding globulin (SHBG), Resnick says. However, about 2 percent circulates freely through the blood.

Free testosterone can pass through the blood-brain barrier, while bound testosterone cannot, Resnick adds. "The free testosterone is what can get into the brain and have an effect of behavior and cognition," she explains.

Researchers found the higher the level of free testosterone, the better men performed on the memory and cognitive tasks. Among the tests given:

·         The men were shown images of complex geometric shapes and asked to choose the mirror image of each from among several possibilities. This test measured "spatial rotational ability," or how well the men were able to visualize rotating objects on a page, Resnick says.

  • They were asked to name as many words as they could think of beginning with a certain letter. They were also asked to name all the synonyms they could think of for a particular word.
  • They were shown a "shopping list" and then had to recall as many items on the list as they could.
  • They were shown a geometric image and then had to recall the image and draw it.

"The biggest and most consistent effects were on the two memory tests," Resnick says.

The study appears in the November issue of the Journal of Clinical Endocrinology & Metabolism.

Dr. Abraham Kryger, medical director of the Monterey Preventive Medical Clinic in California, says he wasn't surprised by the findings.

"It's common knowledge among endocrinologists that higher levels of free testosterone improve memory and cognition," Kryger says.

Testosterone is produced in the testes, the male reproductive glands that also produce sperm. It's essential in the development and maintenance of many male characteristics, including the penis and testes, facial and body hair, muscle mass and strength, deepening of the voice and sex drive.

As men age, their testes tend to produce less testosterone than they did during adolescence and early adulthood, when testosterone production peaks. Blood levels of SHBG also increase with age, meaning older men may also have a higher percentage of bound testosterone.

Men with low levels of free testosterone in their blood can be prescribed testosterone replacement, which comes in injectable, patch or gel form, Kryger says.

Symptoms of low testosterone include fatigue, development of breasts, loss of sex drive and problems with erections, he says.

If men suspect they could have low testosterone levels, they should see a doctor. Men need to make sure the doctor checks their level of free testosterone, not just total testosterone, he says.

Testosterone is an anabolic steroid with the potential for abuse. Body builders and athletes who abuse testosterone take from 100 to 1,000 times the amount that a man prescribed testosterone replacement would take, Kryger says.

Resnick cautions men against rushing out and demanding testosterone replacement from their doctors. Some studies suggest supplements might trigger excessive red blood cell production, causing a thickening of the blood and increasing the chance of stroke, she says.

If you already have adequate levels of testosterone, taking too much can cause a suppression of your body's own production of it, she adds.

"We still have much to learn," Resnick says. "Until we know much more about the fundamental effects of sex hormones on the aging brain and other parts of the body, testosterone supplementation is not a prudent choice for older men seeking to improve their memory and cognitive performance."

What To Do

Read more about testosterone's role in the body at The Hormone Foundation. For more on the natural decline of testosterone, read this.

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Anabolic Steroid May Restore Muscle in the Very Ill

By Jacqueline Stenson

Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Anabolic steroids can help seriously ill patients regain lost weight and improve their health, new research suggests.

The oral steroid oxandrolone boosted muscle mass in patients with chronic obstructive pulmonary disease (COPD) and those with severe burns, all of whom had lost weight because of the toll their conditions take on the body, researchers reported Tuesday at a meeting of the American College of Chest Physicians (ACCP) in San Diego, California.

Anabolic steroids have a bad reputation because of their abuse by athletes. But when used in a medical setting for limited periods of time, they can safely boost muscle mass and help very ill patients improve, said Dr. Barry Make, director of the emphysema center at National Jewish Medical and Research Center in Denver, Colorado.

In a four-month study of 142 COPD patients, Make and colleagues found that those taking the highest of two doses of oxandrolone gained an average of 5.3 pounds of lean muscle mass, whereas those taking inactive placebo pills lost a pound of muscle. In addition, the steroid group lost 1.5 pounds of fat while the placebo group gained 1.2 pounds. The lower dose of the drug also helped, but not as much as the higher dose.

COPD includes disorders such as emphysema and chronic bronchitis in which lung function declines over time. About a quarter of patients with COPD lose weight involuntarily, which can worsen their condition. Muscle wasting makes it harder to breathe and get around, and it has been shown to hasten death.

"This drug not only puts on weight, it puts on muscle," Make told Reuters Health. That's important because other research has found that COPD patients who regain lost muscle have better health outcomes, he said. In another, one-month study involving 40 critically ill patients with severe burns, those given oxandrolone attained significantly higher visceral protein stores--a measure of the body's nutritional status--than patients given placebo.

"Visceral protein is the protein that restores organ function," explained study author Dr. Bruce Friedman, critical care director of the burn center at Doctors Hospital in Augusta, Georgia. "It is a measure of how well the patient is doing inside the body, and it is a marker of the nutritional status of the patient. The patients who sustain the better nutritional status are those who will heal faster."

Preliminary follow-up data indicate that the burn patients also are gaining weight, he said. "These patients do gain lean body mass."

A concern with anabolic steroids is that they can damage the liver. But while some patients in the COPD study had temporarily elevated levels of liver enzymes, none sustained permanent liver damage. Long-term side effects aren't a major concern because doctors generally would administer the steroids only until the patient gained sufficient weight, according to Make.

Doctors also use oxandrolone to treat certain other conditions, including muscle wasting in AIDS (news - web sites) patients, Friedman noted.

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Staff Changes Could Save Lives in ICUs

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 5, 2002

TUESDAY, Nov. 5 (HealthScoutNews) -- Here's a study where the conclusion seems obvious from the start: Tens of thousands of lives could be saved every year if America's intensive care units were fully staffed with doctors trained in critical care medicine.

However, with only 10 percent of such patients getting that kind of care, reaching that goal will not be easy, say the researchers. Most of them are members of a specialty whose name is unfamiliar and whose history is short: intensivist, a critical care specialist.

"There is fairly overwhelming evidence that full-time interventionists should man intensive care units (ICU)," says Dr. Derek C. Angus, an associate professor of critical care medicine and health policy management at the University of Pittsburgh. He is the lead author of the study, which appears in tomorrow's Journal of the American Medical Association (news - web sites). "The problem is that it is not clear how you can do it. There is no easy way to staff every facility in America with full-time intensivists." The first board examination in critical care medicine was given as recently as 1987, he notes.

So why do the study?

"To gather data supporting the value of intensivists and put it into the published literature so that it can be input in an ongoing debate about our health-care system," says Dr. Todd Dorman, an associate professor of anesthesia and critical care medicine at the Johns Hopkins Bloomberg School of Public Health and another member of the study team.

Or as Angus puts it, the idea is to point out that "it is unacceptable not to worry about how you provide coverage in intensive care units."

One statistic shows the need to worry about that coverage, says Maurene Harvey, the first intensive care nurse to be president of the Society of Critical Care Medicine. "Twenty percent of Americans die in intensive care units. We don't let nurses work in the ICU unless they are trained in critical care medicine, but we do let physicians without that training work there," she says.

The generally accepted estimate until now has been that full intensivist staffing of ICUs would save 54,000 lives a year, Harvey says. However, the new study raises that figure considerably, to 162,000 lives. That number is understandable given the fact that there are 6,000 ICUs in the United States caring for 55,000 patients every day, Harvey adds.

To arrive at the number of lives that could be saved, the researchers combed the medical literature and came up with 26 studies of ICU staffing strategies and the resulting effect on patients. They found that high-intensity staffing was associated with a lower ICU death rate in 14 of 15 studies, with an overall 39 percent lower risk of death. Intensive staffing also reduced the length of stay in 14 of 18 studies, which would translate into billions of dollars of savings.

While individual institutions may be motivated to make changes because of this study, "this is an organizational issue in health care," Dorman says. "This is an issue that is not related to the doctor-patient relationship. It will be up to hospitals and schools of medicine and health-care institutions to be partners in changing organizational structures."

A number of strategies have to be considered, Angus says. One would be "to make more rational use of the ICU," sorting out those patients who need critical care from those who might not. Another would be to trim costs by using "physician extenders," trained personnel other than doctors.

They are available, says Harvey, and include physician's assistants and nurse practitioners trained in critical care medicine. "You have to organize a team," she says.

"Before we spend more money, we should at least make sure we organize and deliver the services we provide as rationally as possible," Angus says.

What To Do

You can get an overview of the field from the Society of Critical Care Medicine. You can also read this article about how intensivists are making a difference at some hospitals in Wisconsin.

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Depression May Up Risk of Preterm Birth: Study

Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Pregnant women who suffer from feelings of depression may be at risk of delivering their babies too early, according to researchers.

In a study of more than 1,000 low-income African-American women attending four medical clinics in Baltimore, Maryland, investigators found a greater risk of delivering a baby before 37 weeks gestation among women who were depressed. Nearly 13% of women with depressive symptoms delivered early, compared with 8% of women who did not have symptoms.

It is not clear how depression might raise preterm birth risk, but some studies have suggested that depression affects immune system function in a way that could raise the risk of infection and preterm birth. More research is needed into potential mechanisms, Dr. Suezanne T. Orr from East Carolina University in Greenville, North Carolina, and colleagues report in the November issue of the American Journal of Epidemiology.

Nonetheless, "our results document an association between elevated levels of maternal depressive symptoms and spontaneous preterm birth," they write.

The study included women 18 and older who filled out a questionnaire to assess their depressive symptoms. Specifically, the women were asked about feelings of sadness and hopelessness, sleep and appetite changes, and episodes of crying. Researchers scored the questionnaires from 0 to 60, with a score of 16 or above indicating an elevated level of depressive symptoms.

In other findings, just over 25% of women started prenatal care during their first trimester and 75% had started care by the end of their second trimester. Slightly more than one quarter of women smoked cigarettes, about 7% reported using alcohol during pregnancy and about 9% used drugs.

The researchers note that women face the highest risk of a first episode of depression between age 20 and 40, prime childbearing years for most women. Overall, one in five women will suffer from at least one bout with clinical depression in her lifetime.

Spontaneous preterm birth, which raises the risk of infant death and illness, affects twice as many African-American women as white women, the report indicates.

"Treatment of elevated levels of depressive symptoms among pregnant women, especially economically disadvantaged African-American women, could result in a reduction of spontaneous preterm births in this population," Orr and colleagues conclude.

Source: American Journal of Epidemiology 2002;156:797-802.

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Acetaminophen Can Hurt Stomach in High Doses

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 5, 2002

TUESDAY, Nov. 5 (HealthScoutNews) -- Acetaminophen is often a first line of treatment for arthritis because it is believed to have fewer side effects than other painkillers, but a new study may change that assumption. Canadian researchers recently discovered that in high doses, acetaminophen is just as likely to cause gastrointestinal (GI) problems, such as upset stomach and ulcers, as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Results of the study appear in the November issue of Arthritis and Rheumatism.

"Physicians need to know that if they are increasing the dose of acetaminophen rather than switching to another medication because they think they will see less GI events, they should look at other options," says one of the study's authors, Dr. Elham Rahme, an assistant professor of medicine at the Research Institute of McGill University Health Centre in Montreal. And, she adds, patients shouldn't increase their dose of acetaminophen without first consulting their doctor.

Arthritis affects as many as one in three American adults, according to the Arthritis Foundation, and acetaminophen -- the active ingredient in Tylenol, among others -- is often recommended to manage the pain associated with this disorder.

Rahme and her colleagues studied data from almost 50,000 arthritis patients over age 65. Just over 21,000 were taking acetaminophen and nearly 27,000 were taking NSAIDs. About 6 percent of the NSAID group was taking both NSAIDs and acetaminophen.

The researchers split the acetaminophen group into six categories, based on dosage, from less than 650 milligrams per day to greater than 3,250 milligrams daily. The NSAID group was split into three -- a high dose, low dose and those taking both types of medications. All of the patients were followed for a period of one prescription up to 30 days.

Overall, the NSAID group had slightly more gastrointestinal side effects than the acetaminophen group -- 16.3 percent versus 13.8 percent. However, as the dose of acetaminophen went up, so did the rate of side effects.

"We saw that there really is a difference," Rahme says. "At the low dose of acetaminophen, GI events are much lower than in the NSAID group, but when you go to 2,600 milligrams a day and higher, there were similar rates of GI events."

Rahme says the rate of stomach and intestinal troubles nearly doubles between the low dose of acetaminophen and the high dose group. And the high dose isn't exceptionally high, either -- the researchers started to see side effects at about the equivalent of eight regular strength or about five extra strength acetaminophen tablets a day.

In the group that took both NSAIDs and acetaminophen, there were 10 percent more GI problems reported than in those who took NSAIDs only.

Rahme says there are some limitations to the study. For example, there may be a slight bias toward having GI problems because the patients included were older and often on more than one medication. Many had already been on either acetaminophen or NSAID therapy. Rahme says the researchers tried to control for these variables and still saw more GI problems in patients on high doses of acetaminophen.

Dr. John Klippel, medical director of the Arthritis Foundation, wasn't surprised by the results of this study, but says that acetaminophen will likely remain the first line of treatment for many patients because it's cost-effective and still considered quite safe in low doses.

However, he adds, "Consumers need to be aware that high doses of acetaminophen -- eight to 10 tablets a day -- may be associated with an increased risk of GI side effects, which may be comparable to NSAIDs."

He also cautions that consumers should check the label of any over-the-counter medication they are taking to be sure they're not getting extra doses of acetaminophen. "Acetaminophen is probably the most widely used analgesic in the world, and it's contained in a lot of cold and headache preparations. " Klippel says.

What To Do

For more information on acetaminophen, visit the National Library of Medicine.

Here are some tips from the Arthritis Foundation on managing pain.

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Study Looks at Heart Drug, Color Blindness Link

Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Up to 30% of elderly patients who take digoxin, a form of the drug digitalis used to treat heart failure and other heart problems, may experience at least some degree of red-green color confusion as a side effect, new study findings from the UK show.

The effect seems to occur even in patients with normal levels of the drug in their blood, suggesting that doctors cannot test for the color deficiency to help determine if a patient is experiencing digoxin toxicity.

According to the report published in the British Journal of Ophthalmology, digoxin toxicity remains a "common medical problem, particularly in the elderly, where it is often difficult to diagnose." The condition is most often associated with headache, nausea, fatigue and confusion.

Previously, experts had speculated that color blindness in these patients could be an indication that their dosage of digoxin was too high.

To investigate, Dr. J. G. Lawrenson of City University in London, UK, and colleagues evaluated the theory among a group of 30 elderly patients who were receiving digoxin treatment.

"Slight to moderate red-green (visual) impairment was found in approximately 20% to 30% of patients (taking digoxin)," the authors write. About 20% of patients also had difficulty distinguishing between shades of blue. None of the patients noticed any impairment in their vision prior to the tests.

"There was no correlation between color vision impairment and (blood) digoxin level," the authors note.

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.

"In summary, elderly patients receiving maintenance digoxin therapy showed a high incidence of color vision impairment," Lawrenson and colleagues write.

"As a result, color vision testing in this population would have limited value for the detection of drug toxicity," they conclude.

Source: British Journal of Ophthalmology 2002;86:1259-1261.

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Fiber Overload Won't Stop Recurring Colon Polyps

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews

Tuesday, November 5, 2002

TUESDAY, Nov. 5 (HealthScoutNews) -- Don't toss your All-Bran yet, but new research shows that fiber intake did not affect the recurrence rate of colon polyps.

All the participants entering the trial were already consuming higher-than-average amounts of fiber, however, which may have skewed the results.

"Because they were already consuming fiber, they may already have been protected," says Elizabeth Jacobs, lead author of the study appearing in tomorrow's issue of the Journal of the National Cancer Institute (news - web sites).

Colon cancer, the second biggest cancer killer in the United States, starts with tiny polyps in the colon. Plenty of evidence suggests that the cancer is at least partially caused by environmental factors. And anecdotal evidence suggests that high-fiber diets may protect against the cancer.

This research examined data from the Wheat Bran Fiber (WBF) trial, which looked at about 1,500 men and women in the Phoenix area, all of whom had had at least one colorectal adenoma removed within the past three months. Adenomas or adenomatous polyps are abnormal growths in the colon that are generally thought to be precursors to cancer.

The participants had been randomly assigned to receive a cereal fiber supplement of either two grams per day or 13.5 grams a day. After three years, there appeared to be no difference in recurrence rates between the two groups.

The participants were then divided into four groups according to how much fiber they were eating when they joined the trial. Here, again, baseline fiber intake did not affect adenoma recurrence between the groups or within the groups. Nor did the source of dietary fiber (fruits; breads, cereals and crackers; and vegetables) at baseline seem to have any effect on polyp recurrence.

It's difficult to draw any firm conclusions from the results because the men and women studied were already consuming more fiber than your average American (17.5 grams per day vs. 14.8 grams per day).

"This only represents three years and since the participants already may have eaten more fiber, all we know is that three years of supplementation did not work," Jacobs says.

"In the world of polyps, three years is probably not long enough, biologically, to expect any real results," says Dr. Irwin Grosman, chief of gastroenterology at Long Island College Hospital in Brooklyn, N.Y.

The ideal study, Jacobs adds, would look at what people eat through their entire lives, because it takes at least 10 to 20 years for colorectal cancer to develop. Such a study, however, is unlikely to occur. Another important area for research is to determine where intake is most important: for prevention or to slow down growth rates of the polyps.

Still, Jacobs says, none of this means you should stop eating fiber, especially given that it seems to have beneficial effects on other aspects of health, such as heart disease and diabetes.

What To Do

For more on colorectal cancer, visit the National Cancer Institute or the American Cancer Society.

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Study Looks at Long-Term Hormone Use, Alzheimer's

By Suzanne Rostler

Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Long-term use of hormone replacement therapy (HRT) may protect women from Alzheimer's disease (news - web sites), researchers said Tuesday. However, the new study shares some of the pitfalls of past research that suggested a host of health benefits for such hormones.

Those past studies--and the safety of HRT in general--are currently in question after the largest, well-designed study to date found that the treatment's risks may outweigh its benefits among postmenopausal women.

The current study found that women who used HRT in the past were less likely to be diagnosed with Alzheimer's than their peers who had never taken HRT. In fact, the risk was reduced nearly threefold among current users who reported taking hormones for more than a decade, reaching a level comparable to that seen in elderly men. However, the women were not randomly assigned to take the hormones--the "gold standard" when it comes to determining a treatment's efficacy.

After age 85, women are more likely to be diagnosed with Alzheimer's than men, possibly as a result of a sharp drop in estrogen levels, Dr. Peter P. Zandi from Johns Hopkins University in Baltimore, Maryland and colleagues note in the November 6th issue of The Journal of the American Medical Association (news - web sites).

"Our findings suggest that if women were to use long-term postmenopausal HRT, their excess risk of Alzheimer's disease over that of men in late old age might disappear," they write.

This July, a major National Institutes of Health (news - web sites) study assessing the long-term health effects of combination HRT was stopped early because of a slightly increased risk of breast cancer (news - web sites), stroke, heart attacks and clots in the lung among study participants.

However, those women enrolled in the study, called the Women's Health Initiative, also had fewer hip fractures and a lower risk of colon cancer. Even so, the study was stopped, and American women were advised to reassess their own risk picture. In that study, women were randomly assigned to take hormones or an inactive placebo, skirting the "healthy user" effect that complicated past research. Studies have found that women who choose to take such hormones may have a healthier lifestyle in general--which could be responsible for the health benefits attributed to the hormones.

The current study found no Alzheimer's prevention benefit for current HRT users who had taken hormones for less than a decade, indicating that there may be a crucial window of time following menopause during which HRT may reduce the risk of Alzheimer's disease.

"We do know that Alzheimer's disease is playing havoc with the integrity of the brain for decades before dementia can be diagnosed, so the presumed effect is in the earlier stages of the illness, before there are any symptoms," Dr. John C.S. Breitner, a study author, told Reuters Health.

It is still unclear how hormones might be protective, he added.

The study is based on information from nearly 2,000 women with an average age of 74 and more than 1,300 men with an average age of 73. Researchers interviewed the study participants about their medical history, diets, and lifestyle habits, including women's hormone use.

Three years later, nearly 3% of men and nearly 5% of women had been diagnosed with Alzheimer's disease, the report indicates.

Women who had used HRT in the past had a 41% lower risk of the disease compared with their peers who had not used HRT. Among current users, only those who reported that they had taken HRT for more than 10 years were protected. Women who had taken HRT for more than 10 years were 2.5 times less likely to have Alzheimer's disease compared with women who never used HRT, the investigators found.

There was no relationship between Alzheimer's disease and the use of multivitamins or calcium supplements, indicating that the lower risk was not the result of other healthy lifestyle habits, the authors note.

While more research is needed before doctors can recommend HRT for the prevention of Alzheimer's disease, many women will continue to take hormones to relieve menopausal symptoms, according to an accompanying editorial.

"The possibility of a critical period of use suggests that treatment...might offer some protection against Alzheimer disease," write the editorialists, Dr. Susan M. Resnick from the National Institute on Aging in Baltimore, Maryland, and Dr. Victor W. Henderson of the University of Arkansas for Medical Sciences in Little Rock.

Resnick is a co-researcher on studies funded by the drug company Wyeth-Ayerst and has served as an unpaid consultant to the company. Henderson has received support from Wyeth-Ayerst, as well as Eli Lilly and Organon.

Although the NIH has halted some trials of HRT since the Women's Health Initiative results were released, others are continuing after participants were informed of the potential health risks of HRT.

Source: The Journal of the American Medical Association 2002;288:2123-2129, 2170-2171.

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Only 9 of U.S. Toddlers Get Immunized on Time

By Alison McCook
Reuters Health

Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Only 9% of children in the US get all the vaccines they need at the right time by the time they turn 2 years of age, according to researchers from the US Centers for Disease Control and Prevention (news - web sites) (CDC).

After reviewing national data on immunization rates, Elizabeth T. Luman and her colleagues discovered that the vast majority of 2-year-olds did not receive at least one vaccine at the age recommended by health officials.

"Vaccinations received too early may result in less than optimal protection," Luman told Reuters Health. "When vaccinations are given late, children remain unprotected for a period of time. This can result in disease for the individual child, as well as the increased possibility of disease outbreaks in the country."

Luman and her team obtained their findings from a National Immunization Survey conducted in 2000 that includes information on when 16,211 children between the ages of 24 and 35 months received vaccines. Currently, US health officials suggest that children receive around 15 vaccines before they reach 19 months of age. Reporting in the November issue of Pediatrics, Luman and her team found that only 24% of the infants surveyed had received the recommended vaccines to prevent Hemophilus influenzae type b (Hib), and only 27% had been vaccinated against diphtheria, tetanus, and pertussis (DTP) at the correct times.

In an interview with Reuters Health, Luman explained that young children need a large number of vaccines during their first years of life, and it may be difficult for their guardians to keep track of when the children need which vaccines.

She added that many of the vaccines that are recommended confer protection against diseases that are relatively rare in this country, and, as such, parents may not understand how important it is to immunize their children against diseases that they never see.

However, she and her colleagues note that while the incidence of Haemophilus influenzae type b is low, children who are not vaccinated against the disease can still become ill and die from it.

One method for helping guardians remember to vaccinate their children involves "reminder systems," Luman noted, with health professionals providing information about which vaccines are due when. Guardians can also keep track of the shots their child needs by visiting the CDC Web site, Luman said.

"If we fail to ensure that our children receive the recommended vaccinations at the appropriate times, the potential for disease outbreaks--all the more devastating because of their preventability--is great," Luman said.

Source: Pediatrics 2002;110:935-939.

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Study: Some Herbal Meds Interfere with Cancer Drug

By Charnicia E. Huggins
Reuters Health

Tuesday, November 5, 2002

NEW YORK (Reuters Health) - An herbal dietary supplement that some men use to treat prostate cancer (news - web sites) may interfere with the anti-cancer activity of the chemotherapy drug paclitaxel, making it less effective, researchers report.

The supplement, PC-SPES, includes extracts from eight different herbs, and consequently, hundreds of different compounds.

"If a patient were taking PC-SPES concurrently with paclitaxel, the paclitaxel may have less anti-tumor effect," study author Dr. Peter S. Nelson of the Fred Hutchinson Cancer Research Center in Seattle, Washington told Reuters Health.

He and his colleagues compared the effects of the herbal remedy and the prescription drug in laboratory and mouse studies and found that both PC-SPES and paclitaxel reduced the size of cancer tumors. Their findings are published in the November 6th issue of the Journal of the National Cancer Institute (news - web sites).

Paclitaxel, however, had the greatest anti-tumor effect, the report indicates.

Tumor size was also reduced when the two medicines were combined; however, the result was comparable to those seen when paclitaxel was used independently. In fact, the herbal therapy seemed to make paclitaxel less effective.

PC-SPES appears to hinder the growth of cancer cells by inhibiting the assembly of certain cell structures called microtubules. "We believe there is a chemical or compound within this complex mixture that has this activity," Nelson said.

However, paclitaxel works by doing the opposite: inhibiting the disassembly of these same microtubular structures.

"Our results suggest that PC-SPES and paclitaxel may have conflicting effects if administered together in the clinical setting," the authors write.

"The studies reported here provide a cautionary note emphasizing the potential hazards of combining complex poorly defined botanical compounds with conventional medical therapies," they add.

Men with prostate cancer who use PC-SPES or any other herbal or complementary medicine should therefore inform their doctors of such use, Nelson said. "Most (complementary medicines) will likely have no or minimal interactions with known drugs; others may have significant interactions."

Men who are more interested in preventing prostate cancer than treating it, however, should make sure that their diet includes plenty of garlic, scallions, chives and other vegetables in the allium family, according to the findings of a second study.

Previous research has also linked the intake of allium vegetables to a lower risk of stomach, colon and esophagus cancer. These vegetables are rich in the antioxidants known as flavonols and other compounds that have been found to inhibit tumor growth in laboratory studies.

To investigate whether the vegetables are similarly effective against prostate cancer, a team of American and Chinese researchers interviewed 238 men with prostate cancer and 471 men without the disease about their intake of 122 different foods.

They found that men who reported eating more than 10 grams a day of allium vegetables--roughly equal to two cloves of garlic--were half as likely to have prostate cancer as those who ate about 2 grams or less of the vegetables, Dr. Ann W. Hsing of the National Cancer Institute in Bethesda, Maryland and colleagues report in the same issue of the journal.

When the vegetables were pitted against each other, the investigators found that garlic and scallions seemed to have the greatest anti-cancer effects.

For example, men whose garlic-eating habits put them in the highest of three garlic intake categories were about 50% less likely to be diagnosed with prostate cancer, while those who reported eating the most scallions were 70% less likely to be diagnosed with the disease, the report indicates.

Yet the protective effect of the vegetables was reportedly most evident among men with early-stage cancer, rather than those in advanced stages of the disease.

Men who reported a high intake of garlic and other allium vegetables were also less likely to have high-fat, high-calorie diets, and were more likely to eat green leafy vegetables and other healthy foods. However, the findings remained true when other foods were taken into consideration, the researchers note.

"I think our results underscore the importance of having a healthy lifestyle," Hsing, the study's lead author, told Reuters Health.

"It's important to have a balanced diet and to eat enough vegetables, including allium vegetables," she added.

Source: Journal of the National Cancer Institute 2002;94;1641-1647, 1648-1651.

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Asthma Rates in Kids May Be Higher Than Estimated

By Jacqueline Stenson
Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Asthma may afflict many more children than is currently estimated, according to a survey of Philadelphia schoolchildren.

"One out of four children told us they knew they had asthma," said lead researcher Dr. Salvatore Mangione. "And as many as one out of three have symptoms suggestive of asthma. These are pretty high figures."

By comparison, national statistics indicate that about 1 in 10 US children has asthma, said Mangione, an associate professor of medicine at Jefferson Medical College in Philadelphia, Pennsylvania.

Studies of kids in New York City and other urban areas also have suggested that asthma is more common than expected, he noted.

In the new study of 5,764 students attending 5th and 6th grade in 57 Philadelphia public schools, kids watched five video scenes of youngsters with various asthma symptoms. Then they were asked if they had any of those symptoms and if they had ever been told they had asthma.

About 25% of the kids indicated they had asthma, said Mangione, who reported the findings Monday at a meeting of the American College of Chest Physicians in San Diego, California.

Yet based on symptoms the children reported, the disease appeared to be even more prevalent. Over the prior year, 29% of students said they had experienced wheezing at rest, 32% said they had wheezing during exercise and 30% said they had been awakened by coughing.

In addition, 20% of children said they had experienced three or more asthma symptoms in the last year, indicating high odds of having asthma, yet half of the kids were unaware that they might have the disease.

Doctors did not actually examine the students to confirm the presence of asthma, but the video survey has been shown to be a good predictor of the disease, Mangione said.

Given that asthma may affect as many as one third of students, schools--particularly those in inner cities--should consider screening children for the illness, Mangione suggested.

Asthma is the most common chronic disease of childhood and the major medical reason that students miss school, he said.

The disease is particularly common among poor, inner-city youngsters, though the exact reason is unclear. Smoking in the home, exposure to cockroach allergen and obesity are factors that are known to predispose a child to asthma, and all are common among inner-city youth, Mangione added.

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Pregnancy Complication, Baby's Enzyme Lack Linked

By Merritt McKinney
Reuters Health

Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Babies whose mothers developed a rare complication that causes too much fat to accumulate in liver cells during pregnancy are at increased risk of having a genetic mutation that causes a potentially fatal enzyme deficiency, according to a new study.

Based on the findings, the study's authors recommend that all babies whose mothers had the complication, known as acute fatty liver of pregnancy (AFLP), be screened for the genetic condition.

The deficiency is "rare but very serious," the study's lead author, Dr. Jamal A. Ibdah of Wake Forest University School of Medicine in Winston-Salem, North Carolina, told Reuters Health in an interview. Recognizing the association between AFLP and the enzyme deficiency can be "lifesaving," he said.

Ibdah explained that "the baby can be treated with a simple modification in the diet."

AFLP, which may develop during the third trimester of pregnancy, causes excess fat to build up in liver cells. The condition, which can be deadly for both mother and infant, can cause jaundice, nausea, vomiting and pain. Recently AFLP has been linked to a late-pregnancy complication called HELLP syndrome (for hemolysis, elevated liver enzymes and low platelets).

There have been several recent reports of an enzyme deficiency in infants whose mothers had AFLP, HELLP or both during pregnancy. Deficiency of this enzyme, called long-chain 3-hydroxyacyl coenzyme A dehydrogenase (LCHAD), prevents babies from properly processing certain fats. If diagnosed early enough, the deficiency is treatable with a low-fat diet that contains fats that are easier for the infants to process.

A mutation called E474Q can cause LCHAD deficiency, so Ibdah and his colleagues looked for the mutation in 108 blood samples taken from women who had AFLP or HELLP or from their children or partners.

Ibdah's team detected the E474Q mutation in 19% of the families of women who developed AFLP during pregnancy. In contrast, none of the children whose mothers had HELLP carried the mutation.

"Our results justify screening newborns prospectively for the E474Q mutation at birth in all pregnancies complicated by AFLP," the researchers conclude in a report in the November 6th issue of The Journal of the American Medical Association (news - web sites).

In the interview, Ibdah noted that several states already require this screening, along with other tests, in all newborns. He added that the screening can benefit mothers, too. If a woman becomes pregnant after having a child with the enzyme deficiency, doctors can perform a prenatal diagnosis to see if her fetus has the condition. This early detection would allow doctors to closely monitor the woman during pregnancy, he said.

Source: The Journal of the American Medical Association 2002;288:2163-2166.

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Breast and Womb Cancer Have No Genetic Link-Study

Reuters
Tuesday, November 5, 2002

LONDON (Reuters) - Women with a family history of breast cancer (news - web sites) do not have a higher risk of developing cancer of the lining of the womb, American scientists said on Tuesday.

Although several risk factors for both illnesses are the same, there is no genetic link between breast and endometrial cancer, they concluded.

"A family history of breast cancer does not seem to be an important endometrial cancer risk factor, although a personal history of breast cancer does increase the risk," said Dr Neely Kazerouni of the US Centers for Disease Control in Atlanta, Georgia.

According to research published in the Journal of Medical Genetics, a woman who has suffered from breast cancer has about a 30% increased risk of developing endometrial cancer.

But having a close family relative with breast cancer does not have an impact on a woman's susceptibility to endometrial cancer.

Kazerouni and his colleagues studied the medical histories of 37,500 women who participated in a US national breast screening program that started in 1979.

During a 14-year follow-up period, 648 women in the study developed cancer of the lining of the womb but the scientists said there was no evidence that having a close relative with breast cancer predisposed them to the disease.

Endometrial cancer usually occurs in older women. Obesity, diabetes, early puberty and late menopause and having few or no children are risk factors for the illness.

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Gene May Influence Tamoxifen's Effectiveness

By Merritt McKinney

Reuters Health
Tuesday, November 5, 2002

NEW YORK (Reuters Health) - Breast cancer (news - web sites) patients who have inherited a "slow version" of a certain gene may not fare as well on tamoxifen as other patients, the results of a new study suggest.

Assuming that the results are confirmed, doctors may one day be able to "make treatment decisions based on who is likely to respond well to tamoxifen treatment," said Susan Nowell, of the National Center for Toxicological Research in Jefferson, Arkansas.

Once researchers understand the mechanism of how the genetic variation affects a person's response, "this could lead to the design of individualized dosing strategies that could enhance the response to this drug," she told Reuters Health.

Tamoxifen, which has been shown to prevent and treat breast cancer that is sensitive to the effects of estrogen, attaches to the same receptor as the hormone estrogen. In the breast, tamoxifen acts as an "anti-estrogen" to fight cancer.

The cancer drug can prolong survival and prevent breast cancer from recurring, but some women on the drug do experience recurrences of cancer. A gene called SULT1A1 is involved in processing tamoxifen, so a team led by Nowell, who is also at the University of Arkansas for Medical Sciences in Little Rock, analyzed the activity of this gene in women with breast cancer. The study included 160 women who had received tamoxifen and another 177 women with breast cancer who had not.

Among women who did not receive the drug, the survival rate was similar regardless of whether a woman inherited a less-active version of SULT1A1.

But the gene did seem to have an effect on the survival of women taking tamoxifen, according to a report in the November 6th issue of the Journal of the National Cancer Institute (news - web sites).

Women who inherited two low-activity copies of the SULT1A1 gene--one from each parent--were three times less likely to survive as women who had two normal SULT1A1 genes or one low-activity and one normal activity gene. The lower survival odds persisted even when the researchers took into account factors that could influence survival, such as age, race and stage of tumor at diagnosis.

"Although this study needs to be replicated, our results suggest that there may be decreased efficacy of tamoxifen among approximately 13% of the population, based on SULT1A1 genotype," the authors state in the report.

The 5-year survival was 88% in patients with the high-activity form of the gene, compared to only 64% in patients with the low-activity form, Nowell told Reuters Health. Roughly 13% of women had two copies of the slow version of the gene, 43% had two copies of the normal gene, and 44% had one of each.

The findings suggest that "genetic variation in a common drug-metabolizing enzyme can have an influence on how well a patient responds to tamoxifen therapy," she said. Nowell and her colleagues are in the process of confirming the findings in a larger study.

Source: Journal of the National Cancer Institute 2002;94:1635-1640.

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Alcohol, Violence Bigger Danger Than Drugs in Clubs

By Patricia Reaney
Reuters

Tuesday, November 5, 2002

LONDON (Reuters) - Alcohol and violence pose more of an immediate health hazard than drugs for young adults who enjoy clubbing, researchers said on Tuesday.

Drugs such as Ecstasy, speed, cocaine and heroin are a serious problem in clubs, but assaults fueled by alcohol are the main reason clubbers seek hospital treatment.

"There is a perception that clubbing is all about drugs and wild debauchery, certainly the latter. It is still primarily about drink," said Dr. Chris Luke of Cork University Hospital in southern Ireland.

Despite the glamour, high tech atmosphere and designer drugs, the emergency room specialist said clubbing is really an old-fashioned activity with lots of alcohol and everything that goes with it. "The problems that require hospital attention are the ones that result from alcohol-fueled violence and pure alcohol intoxication compounded by drugs," he told Reuters.

"For every drug problem (treated in hospital) there are five or 10 alcohol problems," he added.

Booze, Bottles And Bouncers

Luke, who has worked in emergency rooms in England, Scotland, Ireland and Australia, said the problem is the same throughout the western world.

"Clubbing is the key arena or platform for youth culture. It brings together all the issues, sexual health, drugs, drinks and public order."

In Britain alone nearly 16 million people go clubbing at least once a year. Luke and his team studied the type of injuries clubbers were treated for in a large hospital in Liverpool, northern England.

Nearly 800 were treated during the 12-month study and alcohol was the most common contributing factor. Almost 60% of the injuries were due to assaults, 10% of which were caused by club security staff.

One in five clubbers had been attacked with glass bottles or containers. Accidents included falls from stages, windows and stairs.

"We see everything--broken backs, very badly bottled faces, very bad cuts to fingers and feet," said Luke who reported his finding in the Emergency Medicine Journal.

"It is increasingly common to see young girls, both victim and perpetrators, of violence involving glass and faces," he added.

Drugs problems in clubs tend to be self-limiting apart from the occasional tragedy such as an Ecstasy death. Clubbers are also more likely to have taken two or more drugs as well as alcohol, according to Luke.

"Ecstasy was a drug of the 90s and it is still a considerable problem but cocaine is the tidal wave we are seeing. Cocaine is associated with sudden death from heart attack and stroke but also with extraordinary violence," he said.

The researchers urged club owners to use unbreakable glass or plastic containers and to eliminate glass outside club venues to reduce injuries requiring hospital treatment.

They also advised club owners to limit overcrowding, curb promotions for cheap drinks and provide medical facilities on site at large venues.

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MONDAY, NOVEMBER 4, 2002

Bariatric Surgery Used on Obese Kids

By Lindsey Tanner

AP Medical Writer
The Associated Press

Monday, November 4, 2002

CHICAGO (AP) - Drastic surgery for obesity, once viewed as suitable only for adults, is emerging as an option for children, a new pediatrics report says.

Whether gastric bypass surgery, which shrinks the stomach from the size of a football to the size of an egg, might have long-term side effects for youngsters is unknown. But with childhood obesity reaching pandemic proportions, some families and their doctors see it as the only effective solution.

Researchers also haven't determined what age and weight a youngster should be before surgery, or whether the surgery, which can result in nutritional deficiencies in adults, could interfere with a child's use of bone-building calcium, said authors of a report in November's issue of Pediatrics.

Youngsters in one recent study who underwent gastric bypass were 15 to 17 years old, a time when peak bone mass is occurring, said the authors, Dr. Sue Y.S. Kimm of the University of Pittsburgh and researcher Eva Obarzanek of the National Heart, Lung and Blood Institute.

Because childhood obesity is so pervasive — about 15 percent of youngsters are severely overweight or obese — more research "is urgently needed," they said.

Doctors say demand is strong, bolstered in part by famous patients like pop singer Carnie Wilson, who dropped from about 300 pounds to 148 after an Internet-broadcast surgery in 1999, at age 31.

Most of the more than 100,000 people who are likely to have the surgery this year are adults, said Dr. Walter Pories, president of the American Society for Bariatric Surgery. He has no exact figures on how many children have undergone obesity surgery, but in an informal survey of 600 group members earlier this year, about 10 said they had done surgeries on children, all with positive results.

Some doctors cringe at the thought of subjecting youngsters to elective surgery that's so extreme.

"People change their habits. Doing something in the first 20 years that can affect you for the next 50 years ... ethically it's very hard to justify that," said Dr. Timothy Sentongo, a gastrointestinal specialist at Chicago's Children's Memorial Hospital.

For some children who have exercised and dieted to no avail, surgery is the only alternative, said Dr. Henry Buchwald, a University of Minnesota surgeon who has done obesity operations on 18 youngsters under age 18.

"Their life is turned around from being ridiculed at school to living a normal child's life," he said.

Ideally, patients should have achieved their maximum growth, said Buchwald, though his youngest was a 13-year-old who was about 150 pounds overweight.

Families should be told about surgery consequences, which may include malnutrition and gallstones.

"They're going to have to restrict their eating behavior or they'll just vomit and be uncomfortable," he said.

Ohio teenager Courtney Dunham says the risks were worth it. The high school senior says she has been teased since kindergarten, when a classmate said she triggered earthquakes (news - web sites) when she walked.

Before her Aug. 2 surgery, she weighed 329 pounds — at 5-feet-3-inches, nearly 200 pounds overweight. So far she's shed 40 pounds, with no side effects. Her goal is to fit into size 16 jeans.

"It was a pretty big step, but ... it was the right thing to do," she said.

Her family is prone to obesity and associated ailments like diabetes and heart disease, and Courtney knew she was pushing her luck.

The doctors assured her that her biggest concern — that surgery might rule out eventual motherhood — was unfounded. So shortly after her 18th birthday, she underwent a 2 1/2-hour gastric bypass, the most common type of bariatric surgery, in which a small stomach pouch is created by stitching the stomach's upper portion closed.

The intestine is redirected to attach to the pouch and to bypass a portion of the small intestine that normally absorbs nutrients. The operation results in weight loss by reducing food intake and nutrient absorption.

Courtney is now required to eat no more than a cup of food a few times daily, but must avoid sugar, which can cause symptoms including nausea, rapid heartbeat and stomach bleeding after the surgery.

Dr. Victor Garcia, who runs the program with Dr. Thomas Inge, has done similar operations on about six youngsters; four more are scheduled for surgery this month.

Not every obese youngster is a candidate, Garcia said.

"We have refused a number of patients for whom we felt the family would not be supportive," he said. "It's challenging because most parents are overweight along with the child."

Pediatrics: http://www.pediatrics.org

American Society for Bariatric Surgery: http://www.asbs.org

Cincinnati Children's Hospital:http://www.chmcc.org

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One-Fifth of Those over 40 at Risk of Heart Failure

Reuters Health
Monday, November 4, 2002

NEW YORK (Reuters Health) - In the United States, men and women over age 40 have a one-in-five chance of developing heart failure, new study findings indicate.

With the population aging and the likelihood that a person will survive a heart attack increasing, the condition will likely become even more common, according to Dr. Donald M. Lloyd-Jones, of the National Institutes of Health (news - web sites)'s Framingham Heart Study, and colleagues. They report their findings online in this week's rapid access publication of Circulation: Journal of the American Heart Association (news - web sites) for November 26.

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.

While much has been reported about the emerging epidemic of congestive heart failure, few studies have sought to gauge a person's lifetime risk of developing the disease, the authors note.

To investigate, the researchers followed the health outcomes of 8,229 healthy men and women from 1971 to 1996. A total of 583 people were diagnosed with heart failure during this period.

"At age 40 years, the lifetime risk for congestive heart failure was 21% for men and 20.3% for women," Lloyd-Jones and colleagues write.

Remaining lifetime risk did not change with advancing age, they add, except if a person had high blood pressure. For these people, their lifetime risk of heart failure doubled. But among people who had not suffered a heart attack, the congestive heart failure risk was lower, at 11.4% for men and 15.4% for women.

"The lifetime risk estimates presented here are useful for researchers and policymakers in predicting the population burden of congestive heart failure," the investigators report.

"Given that congestive heart failure is already the leading cause of hospitalization in the elderly, significant public health efforts should be aimed at reducing the incidence of congestive heart failure," the authors conclude.

Source: Circulation 2002;10.1161/01.CIR.0000039105.49749.6F.

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FBI Probes Heart Doctors' Surgeries

The Associated Press
Monday, November 4, 2002

REDDING, Calif. (AP) - The FBI (news - web sites) is investigating whether two heart surgeons performed hundreds of unnecessary procedures to boost their earnings.

Last week, 40 FBI agents went to Redding Medical Center requesting the records of heart operations performed by Dr. Chae Hyun Moon and Dr. Fidel Realyvasquez Jr. Neither physician has been charged with any crime, and both continue to practice.

In an affidavit filed in federal court, the FBI said the team of cardiologists may have performed unnecessary heart surgeries or complex and expensive diagnostic probes on hundreds of patients.

Calls to Moon and Realyvasquez were not immediately returned Sunday. Their lawyers say they are brilliant surgeons who will be vindicated.

Some people in this city of 85,000, largely populated by retirees, told the San Francisco Chronicle that the physicians were top-notch surgeons who saved lives.

"My husband would be dead if it wasn't for those doctors," Mary Volk said. "Dr. Moon tested him and found two blocked arteries and a blood clot. He could have died just walking across the parking lot."

Others weren't so sure.

"If my father had not agreed to surgery would he still be alive?" asked Jamie Shoemaker-Marcigan.

Shoemaker-Marcigan's father, 69-year-old Richard Shoemaker, died Aug. 28 while recovering from surgery performed by Realyvasquez.

"His lung specialist advised him against heart surgery, but he trusted the two heart doctors," she said. "They said surgery was the only way to go."

In the affidavit, FBI agents said they have interviewed doctors and other medical officials who have raised questions about the apparently high number of heart surgeries performed at Redding Medical Center.

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Occupation Linked to Risk of Hand, Wrist Arthritis

Reuters Health
Monday, November 4, 2002

NEW YORK (Reuters Health) - Certain jobs appear to increase a person's risk of developing arthritis of the hand and wrist, according to researchers at the National Institute for Occupational Safety and Health (NIOSH).

While there have been many previous studies investigating the connection between occupation and so-called "soft tissue" hand/wrist disorders, such as carpal tunnel syndrome, few have looked at the relationship between work exposures and arthritis of the wrist and hand, the researchers report.

To investigate, lead author Dr. Charles Dillon of the National Center for Health Statistics in Hyattsville, and co-authors Drs. Martin Petersen and Shiro Tanaka of NIOSH in Bethesda, Maryland evaluated survey information from a national sample of 30,000 working adults. The participants answered questions about their job, hand and wrist discomfort, and whether or not a healthcare provider had diagnosed them with arthritis.

The highest prevalence of hand/wrist arthritis was seen among technicians, machine operators, assemblers and farmers, as well as in the mining, agriculture and construction industries, the authors report in the October issue of the American Journal of Industrial Medicine.

People who worked at jobs that required repetitive bending and twisting of the hands and wrists had a 43% increased risk of developing arthritis, the investigators found.

"Among workers with hand arthritis, 7.4% had made major changes in their work, 7.6% missed work and 4.5% stopped working or changed jobs because of the problem," Dillon and colleagues write.

Although more definitive studies need to confirm or refute the current findings, the researchers note that the findings do have a "general public health significance" given that many people have hand/wrist arthritis that could potentially be prevented by reducing certain risk factors at the workplace.

Source: American Journal of Industrial Medicine 2002;42:318-327.

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Study Ties 250 Baby Deaths Yearly to Drug Reactions

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, November 4, 2002

MONDAY, Nov. 4 (HealthScoutNews) -- Nearly 250 infants and toddlers may die every year from bad reactions to drugs and treatments that no longer have to be tested in the youngest patients.

A new study appearing in the November issue of Pediatrics found that only 17 drugs and other therapies accounted for 54 percent of all serious and deadly adverse reaction reports to the U.S. Food and Drug Administration (news - web sites) (FDA).

However, a federal court recently overturned a 1998 FDA requirement that companies test products in children if they are often given to them. The U.S. District Court in Washington ruled the FDA didn't have the authority to impose the so-called "pediatric rule."

That court decision worries many pediatricians.

Dr. Carol J. Blaisdell, a University of Maryland pediatrician and a study co-author, says: "We pediatricians are very concerned about that and will hope that the Congress supports FDA authority" to force drug makers to test their products in children. "We do need to be looking at kids specifically, and we can't assume that drug is safe and effective" in a child simply because it works in adults. The absence of a pediatric rule "leaves doctors without a lot of ability to know if what we're doing is safe."

Blaisdell adds the reports in the study aren't proof that medication was responsible for the deaths.

"What we don't know from this analysis is all the clinical issues that went into those children's care," such as whether they were very ill, had multiple medical problems, or didn't receive an appropriate dose of the drug. Even so, Blaisdell says, the study relied on voluntarily reported events and likely far underestimates the risks of medications to young children.

Blaisdell and her colleagues culled through more than 7,100 reports to the FDA of adverse reactions to drug and biologic therapies between November 1997 and December 2000. Analyzing the cases, they found an average of 243 deaths a year linked to the substances, and a far higher number of serious but nonfatal complications. About 40 percent of the deaths occurred in the first month of life and 84 percent happened before the baby's first birthday.

Leading the group of the most commonly reported drugs was palivizumab, prescribed to prevent severe respiratory infections. It was implicated in nearly 28 percent of cases. "This is a drug used for prevention, not for treatment of an illness once it is started," Blaisdell says.

Second on the list was cisapride, a heartburn drug sold as Propulsid that was pulled from the market in 2000 after being tied to heart rhythm anomalies.

Ibuprofen, the active ingredient in painkillers such as Motrin and Advil, accounted for 33 reports of reactions, or 1.3 percent of the total.

A quarter of side effects were linked to mothers who exposed the baby to the substance during late pregnancy, delivery or through breast-feeding.

Susan Cruzan, an FDA spokeswoman, says the agency was "disappointed" in the court's decision to overturn the pediatric rule. "We still believe it's vitally important that drugs be studied in children," she says.

Some drug makers elect to study their products in children, and Cruzan says "about 40" now have warning labels with pediatric information. The FDA has also encouraged pharmaceutical firms to study their products in children by offering them a six-month patent extension for their trouble. The 2002 Best Pharmaceuticals for Children Act renewed that provision.

Thomas J. Moore, a health policy analyst at George Washington University in Washington, D.C., says it's too soon to tell if this year's law will improve drug safety in children. However, he says marrying studies to patents could result in only the most profitable drugs undergoing pediatric testing.

"The pediatric rule provided the ability for the FDA to identify those [substances] for which proper information about the drug in children was most needed," he says.

What To Do

For more information about drug safety in children, try the U.S. Food and Drug Administration or the Pediatric Pharmacy Advocacy Group.

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FDA Launches Study of Fatal Elk, Deer Disease

Reuters Health

Monday, November 4, 2002

NEW YORK (Reuters Health) - The US Food and Drug Administration (news - web sites) (FDA) will fund two studies to investigate whether chronic wasting disease (CWD), now spreading through the nation's deer and elk herds, poses any risk to human health, Health and Human Services (news - web sites) Secretary Tommy G. Thompson said Monday.

CWD, like "mad cow" disease in cattle, belongs to a family of illnesses known as transmissible spongiform encephalopathies (TSEs). While there is no evidence that CWD poses a risk to humans, dozens of people--almost all of them in the UK--have contracted a fatal TSE called variant Creutzfeldt-Jakob disease (news - web sites), apparently after eating meat from cattle infected with mad cow disease, or bovine spongiform encephalopathy (news - web sites).

The two new studies will seek to evaluate the risk to human health of eating CWD-contaminated meat or being in close contact with infected animals.

"We must determine whether CWD is a threat to our food supply and how best to stop the spread of this disease in our deer and elk herds," Thompson said in a prepared statement. "We will aggressively pursue innovative methods to expand research and direct assistance to states to fight the spread of CWD."

Colorado State University recently won an $8.4 million grant from the National Institutes of Health (news - web sites) to establish a center focusing on CWD. The center will investigate how deer and elk become infected with CWD and whether the illness can spread to other species. Scientists there will also work on a vaccine for the disease.

Researchers at the National Institute of Allergy and Infectious Disease's Rocky Mountain Laboratories in Hamilton, Montana, will study whether monkeys that eat meat contaminated with CWD prions, the abnormal proteins implicated in all TSEs, will develop CWD. Such primate studies are important in determining whether meat from a CWD-infected animal poses a risk to humans. Researchers at the labs have already begun investigating possible treatments for CWD.

The National Institutes of Health plans to spend roughly $24.3 million to study TSEs in fiscal 2002, and has asked for an 8.7% increase in TSE research funding for the following fiscal year, according to the HHS statement.

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Iron Deficiency May Contribute to Alzheimer Damage

By Merritt McKinney

Reuters Health

Monday, November 4, 2002

NEW YORK (Reuters Health) - New research suggests that a lack of iron may contribute to the decay of brain cells caused by Alzheimer's disease (news - web sites). In experiments with human and animal brain cells, reducing the production of the most common form of iron in cells, known as heme, led to degeneration similar to that caused by aging and Alzheimer's disease.

Although it is too soon to say that getting enough iron will ward off Alzheimer's, "there's no excuse" for anyone not getting enough iron and other vitamins, according to senior study author Dr. Bruce N. Ames of the Children's Hospital Oakland Research Institute in California.

Noting that many people do not consume enough of the essential vitamins and minerals, Ames told Reuters Health in an interview that a multivitamin that contains iron is "an insurance pill" in case the link between low heme and brain degeneration is confirmed, since iron and vitamin B6 are needed for heme production.

In the interview, Ames said that a lack of iron disrupts a person's metabolism by damaging mitochondria, which are the power plants of cells. If mitochondria become damaged, harmful substances called oxidants that can contribute to the aging process can accumulate in cells, Ames explained.

In experiments directed by first author Hani Atamna, the researchers found that interfering with the production of heme, the form of iron that is essential for normal cell function, caused cells to degenerate and become more likely to die. This type of degeneration was similar to what happens in the brain of a person with Alzheimer's. In addition, interfering with heme caused cells to make abnormal versions of proteins called APP, which accumulate to form the brain deposits that are a hallmark of Alzheimer's disease.

The investigators were tinkering with cells in the lab, but under normal circumstances, aging, exposure to certain metals including aluminum, and a deficiency in iron and vitamin B6 can all impair the production of heme. The study does not prove that a lack of heme is what causes Alzheimer's-related degeneration, but it does provide "a plausible mechanism," Ames said.

He cautioned that "a lot more work has to be done" to confirm the role of heme in brain degeneration. In the meantime, however, a multivitamin may serve as "an insurance pill," he said.

"We ought to get everybody up to snuff" on their vitamins and minerals, Ames said.

Source: Proceedings of the National Academy of Sciences (news - web sites) 2002;10.1073/pnas.192585799.

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Smoke Signals: Puffing Parents Send Mixed Messages

By Jacqueline Stenson

Reuters Health

Monday, November 4, 2002

NEW YORK (Reuters Health) - Parents who ask their children to light their cigarettes or empty their ashtrays are signaling to their kids that it's okay to smoke, even though they may preach otherwise, according to researchers.

While parents may think these tasks are merely harmless chores for a child, the reality is that youngsters asked to perform them are more likely to start smoking, said Dr. Rafael Laniado-Laborin, a lung specialist at Tijuana General Hospital in Mexico, and an associate professor at San Diego State University in California.

For instance, kids who are asked to light their parents' cigarettes are more than twice as likely to smoke as those who are not asked to do this task, study findings show.

Asking a child to light a cigarette and other parental "prompting" behaviors tell kids that it is acceptable to smoke and may even encourage them to do so, Laniado-Laborin told Reuters Health. "Kids who are prompted will smoke more frequently than other kids," he added.

The study involved questionnaires completed separately by 292 sets of parents and their children, all 7th and 8th graders in San Diego.

Fifty percent of students said their parents asked them to clean ashtrays, 60% said parents asked them to bring their cigarettes and 14% said parents asked them to light their cigarettes. About 3% of kids said their parents actually lit cigarettes in the child's mouth, according to findings released Monday at a meeting of the American College of Chest Physicians (ACCP) in San Diego.

However, parents generally reported that such behaviors did not occur so frequently. For instance, just 9% of parents said they asked their children to clean ashtrays and 28% said they asked them to bring their cigarettes.

"Parents do not accept that they are prompting kids to smoke," Laniado-Laborin said. "Parents in focus groups say it's not really prompting--it's a chore. The signals they're sending their kids are getting crossed."

"The discrepancy in the rates of these behaviors reported by parents and children indicates that parents who smoke seem to be ignorant of involving their children in their smoking habit," Dr. Udaya B.S. Prakash, ACCP president, said in a statement. "It is crucial that efforts be made to educate parents on how they may be unknowingly jeopardizing their children's health and indirectly encouraging them to smoke."

Hispanic boys who said their parents asked them to light cigarettes were the most likely to smoke, results showed. But youngsters who reported strong family ties were less likely to start smoking than those who tended to put their friends first.

Overall, 8% of Hispanic and 5% of non-Hispanic kids said they smoked in the month prior to the survey.

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USDA Checks Two More Meat Plants in Listeria Probe

By Randy Fabi

Reuters

Monday, November 4, 2002

WASHINGTON (Reuters) - The US Department of Agriculture (USDA) said on Monday it was investigating two more meat plants in connection with a deadly Listeria outbreak in eight northeastern states.

"There are at least two other establishments that we are doing the same kind of investigation," said Steve Cohen, spokesman for USDA's Food Safety and Inspection Service.

Cohen would not disclose the names of those companies.

USDA inspectors have already linked Pilgrim's Pride Corp. and, most recently, Jack Lambersky Poultry Co. Inc., to the Listeria outbreak, prompting the companies to recall a total of 27.6 million pounds of ready-to-eat turkey and chicken products.

The USDA, along with the Centers for Disease Control and Prevention (news - web sites) (CDC), is investigating a total of 120 Listeria cases, including 23 deaths, which first emerged in mid-July. CDC said 50 cases so far, which include seven deaths and three miscarriages, have been linked to the same strain.

Officials are investigating US meat companies based on information received from the victims.

"We are going in the order of priority based on information from the CDC," Cohen said. The two unnamed meat plants "are establishments whose products were also mentioned in interviews, but less frequently."

Cohen said the USDA tested both the plants and their food products. The results were sent to the CDC to be analyzed.

Jack Lambersky Poultry, which does business as J.L. Foods Co. Inc., on Saturday recalled about 200,000 pounds of poultry after its products were the first to be definitively linked to the outbreak.

The CDC said Pilgrim's Pride Wampler deli turkey was more than likely another source of the outbreak, after environmental samples tested positive to the same Listeria strain. The company last month launched the nation's largest meat recall, withdrawing nearly 27.4 million pounds of poultry.

Jack Lambersky, headquartered in New Jersey, and Texas-based Pilgrim's Pride have voluntarily closed the plants linked to the outbreak until the USDA completes its investigation.

Listeria can be deadly for the elderly, those with chronic diseases, young children and pregnant women.

The disease, which thrives in cool, damp places like home refrigerators, is destroyed when a product is cooked to at least 160 degrees Fahrenheit (71 degrees Celsius). But most consumers do not cook ready-to-eat products.

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Overweight Boys Reach Sexual Maturity Later

By Dana Frisch

Reuters Health

Monday, November 4, 2002

NEW YORK (Reuters Health) - Overweight boys are likely to finish puberty later than their leaner peers, the exact opposite of the weight-maturity relationship seen in girls, a new study shows.

Differences in biological development may explain the gender difference, study author Dr. Youfa Wang of the University of Illinois at Chicago notes in the November issue of Pediatrics. The growth spurt for girls begins and ends earlier than for boys, and in adolescence, boys gain fat-free mass, like muscle, whereas girls gain more fat than muscle, he writes.

For example, among boys, "early maturers may utilize more energy and nutrients for growth in height while leaving less excess energy for the development of adipose tissue (fat)."

The study concludes that sexual maturity should be taken into account when determining whether a child or adolescent is overweight. For example, a girl may be mischaracterized as overweight when she is in fact more mature.

A secondary finding of the study was that ethnic differences in obesity prevalence virtually disappear when sexual maturation is taken into account.

"This indicates that differences in sexual maturation and socioeconomic status are likely the major contributors of racial differences in fatness among American children and adolescents," Wang writes, although he notes that it may be possible that a common genetic factor influences both sexual maturation and obesity.

Dr. Daniel Hoffman, an assistant professor of nutritional sciences at Rutgers University in New Jersey, said that if this association is correct, "it could be very interesting because the whole ethnic influence on obesity is unclear." He told Reuters Health that ethnicity is not a physical characteristic, and how it might affect physical traits like obesity and sexual maturation is not well understood.

The study used a sample of about 1,500 boys and 1,500 girls aged 8 to 14 from data collected between 1988-1994 as part of the Third National Health and Nutrition Examination Survey.

The study included white, black and Mexican-American children and teens in roughly equal proportions. Almost 30% of boys and over 26% of girls were overweight, and slightly more than 10% of both boys and girls were obese.

Physicians assessed the children's sexual maturity based on stages of breast development in girls and genital development in boys, and characterized almost one third as "early maturers" in comparison to the study population average. Hoffman points out that adolescents who mature earlier are at greater risk of developing chronic diseases like diabetes and high cholesterol since they are entering their adult life earlier.

Wang found that boys who were "early maturers" were 40% less likely to be obese, whereas early maturing girls were over 10% more likely to be obese.

This is the first study to find an association between obesity and age of puberty in males. Hoffman said that earlier data on obesity showed that the association between obesity in males and sexual maturation was more variable than data on females, which clearly links being overweight with earlier sexual maturation.

Dr. Penny Gordon-Larsen, an assistant professor of nutrition at the University of North Carolina at Chapel Hill, said in an interview that very little data exists on males and sexual maturation because it is harder to determine in males than females. Females can report how old they were when they first menstruated, but in males the changes are more progressive.

Wang's study "represents a major step in understanding the link between sexual maturation in males and weight," said Gordon-Larsen. "The first study is very important but there is still a lot of work that needs to be done."

She notes that the findings have implications for classifying the number of children or adolescents who are overweight or obese. "It is very important that we understand this relationship," she said, in order to focus public health messages effectively.

Source: Pediatrics 2002;110:903-910.

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Evidence of How Food Might Shift Body Clock

By Alison McCook

Reuters Health

Monday, November 4, 2002

NEW YORK (Reuters Health) - The body has an internal clock that affects vital signs such as temperature and blood pressure and also influences when we sleep and wake.

While many experts argue that light has the strongest influence on how that clock is oriented, some evidence suggests that what and when we eat might play an equally, if not more important, role. Now, new study findings by Dr. Steven McKnight of the University of Texas Southwest Medical Center in Dallas and colleagues provide further evidence that food has a significant effect on our internal clock, or circadian rhythm.

Regardless of whether food or light has the upper hand, more and more evidence suggests that people who travel to a new time zone should adopt the meal schedule of the new place to help combat jet lag, McKnight told Reuters Health.

If an airline offers a large meal that matches the place you just left but not where you are going, the researcher suggested opting out, and trying to train your stomach to adopt to your destination's time zone. "Begin to have your feeding cycle on that new daylight schedule that you're going to be in," McKnight advised.

Previous experiments have shown that mice, which normally sleep during the day, can be taught to reverse their schedule if they are only fed during daylight hours. Genetic analyzes of these altered mice reveal that genes that were turned on when the mice slept during the day were now turned off--and vice versa--indicating that their body had undergone internal changes to adapt to the shift in schedule.

Recently, McKnight and his team discovered more details on how food can influence circadian rhythms. Food contributes a certain amount of fuel for the body processes, which gets stored in the form of a substance known as NADPH. When that fuel is used up, it becomes converted into NADP.

The researchers demonstrated that the Clock gene transcription factor, which controls how our body clock is set at certain times, may sense how much NADP is present in relation to the amounts of NADPH and act accordingly. In humans, for instance, in the morning the body contains little NADPH relative to NADP, since the night is spent using up fuel rather than adding it via meals. This particular ratio of NADP to NADPH may tell the transcription factor to behave in a certain fashion--in humans, it helps tell the body clock it is time to wake up.

Now, McKnight and his team discovered new findings that help link circadian rhythms to metabolism, which he presented Sunday at the Society for Neuroscience's annual meeting in Orlando, Florida.

At the meeting, McKnight demonstrated that mice that lack the Clock gene transcription factor are unable to switch to sleeping during the night when they are only fed during daylight hours. Mice tend to spend many of their waking hours running on a wheel, and those that lack this body clock regulator also are unable to take naps between their normal waves of activity, a characteristic habit in mice.

All in all, McKnight said he believes that all of the previous evidence demonstrates that food has a stronger influence on circadian rhythms than light. "When you ask whether food or light wins, food wins," he told Reuters Health.

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Study Finds Pill Curbs Hormone in Kidney Patients

By Deena Beasley

Reuters

Monday, November 4, 2002

LOS ANGELES (Reuters) - An experimental pill can stabilize levels of a calcium and phosphorus-regulating hormone that is overproduced by most kidney dialysis patients, researchers said on Sunday.

Over-secretion of parathyroid hormone, a complication for about 60% of kidney disease patients, raises the risk of bone fractures, bone disease and death, said Dr. Sharon Moe, assistant dean for research support at Indiana University School of Medicine in Indianapolis and a study investigator.

"We have been able to show sustained suppression of parathyroid hormone (PTH) without an increase in phosphorus and calcium in the blood, which is what sets this drug apart from existing therapies," Moe said.

The drug, known as AMG073, is being developed by Amgen Inc. and NPS Pharmaceuticals Inc. It is potentially the first in a new class of drugs called calcimimetics that bind to the calcium-sensing receptors on the surface of the parathyroid gland, making the receptors more sensitive to calcium in the blood and reducing output of the hormone.

The parathyroid glands regulate calcium in the body, including how much is stored in bones. Overproduction of the glands' hormone, or hyperparathyroidism, causes calcium in bones to dissolve into the blood stream, weakening the bones and making them more susceptible to fracture.

Amgen estimates that 800,000 Americans with chronic renal insufficiency, who will eventually require dialysis, develop secondary hyperparathyroidism and about 90% of the more than 300,000 kidney dialysis patients in the United States suffer from the condition.

An extension of a mid-stage trial showed that after a year of treatment in combination with existing drugs, half of patients on AMG073 had a 30% or more reduction in PTH, compared with 12% of placebo patients. After two years, 55% of AMG073 patients had at least a 30% reduction in PTH, the researcher said.

The results were presented at a meeting in Philadelphia of the American Society of Nephrology.

Over the two-year period, the drug also prevented calcium and phosphorus levels from increasing, according to Amgen. High levels of the minerals are associated with cardiovascular problems and even death.

"No one really knows why--but it looks like phosphorus changes the vascular smooth muscle to become like a bone cell. If you take a blood vessel cell, put it in a petri dish and feed it phosphorus, it will grow a little piece of bone," Moe said.

Currently, patients suffering from hyperparathyroidism are treated with a combination of vitamin D to reduce production of PTH and phosphorus binders to limit the absorption of dietary phosphorus. But the treatment can increase calcium phosphate levels, leading to cardiovascular complications.

Side effects of AMGO73, like nausea and gastrointestinal irritation, are comparatively mild, Moe said. She said there were concerns it could interfere with the body's ability to balance calcium blood levels, but studies have not shown that to be a problem.

The investigator said that, if eventually approved by regulators, AMG073 would probably be used as a primary therapy for lowering PTH levels, but if patients experience a drop in calcium levels they could be cycled back to the older drugs.

Amgen and NPS launched a pivotal-stage trial of the drug last December, but they have not released a timeline for when those results will be available, an Amgen spokeswoman said.

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SUNDAY, NOVEMBER 3, 2002

Antidepressants: Too Much of a Good Thing?

By Irene S. Levine
HealthScoutNews Reporter

HealthScoutNews

Sunday, November 3, 2002

SUNDAY, Nov. 3 (HealthScoutNews) -- Now that some of the stigma of mental illness has been stripped away, more Americans than ever before are reaching out for help with depression.

But the form that treatment takes is a matter of increasing debate in health-care circles.

The heart of the argument: Are antidepressants being over-prescribed or under-prescribed for those struggling with depression? The answer isn't as simple as you may think.

In a study published recently in the Journal of the American Medical Association (news - web sites), Columbia University psychiatrist Dr. Mark Olfson and his colleagues examined national trends in the outpatient treatment of depression between 1987 and 1997.

Olfson found the percentage of Americans being treated for depression more than doubled during the 10-year period. And the total number of people receiving treatment rose from 1.7 million to 6.3 million.

The researchers also found that patients were almost five times more likely to be treated with antidepressants than they were in 1987.

A number of factors account for the dramatic rise in the use of antidepressants.

Proponents say they are the fastest, most reliable method of delivering much needed relief to victims of a debilitating disease.

"The most robust and rapid response to treatment is obtained from antidepressant medications," says Dr. Barnett Meyers, a professor of psychiatry and clinical epidemiology at Cornell University's Weill Medical College in White Plains, N.Y.

And the newer generations of antidepressants -- called selective serotonin reuptake inhibitors and marketed under such brand names as Prozac, Zoloft and Paxil -- produce less troublesome side effects than older medications.

Further fueling the rise in the use of antidepressants: The proportion of pharmacy costs borne by health insurers increased over the 10-year period of Olfson's study, reducing out-of-pocket costs for consumers.

Depressed patients were also more likely to consult initially with their family physician or a psychiatrist, who would tend to prescribe medication, as opposed to psychologists or social workers who'd be more likely to provide psychotherapy, the study found.

That helps to explain, in part, the sharp decrease in the percentage of people receiving psychotherapy for depression. The researchers found that 60.2 percent of those treated for depression in 1997 received psychotherapy, down from 71.1 percent in 1987. And the average number of psychotherapy visits per patient, per year, also declined from 12.6 to 8.7 over the 10-year span.

The trend toward antidepressants as the treatment of choice is viewed with concern by some mental-health experts.

"The idea that depression is simply some sort of biological error that can be easily fixed by an antidepressant fundamentally shortchanges people," says Dr. James S. Gordon, a psychiatrist who directs the Center for Mind-Body Medicine in Washington, D.C.

"What's happening now appears to be more economical," Gordon adds. "There's a tremendous amount of advertising [by the drug companies]. Doctors are immediately reaching for the prescription pad without thinking of the complexity of the human being sitting in front of them."

Many experts also attribute the shift in treatment options to the rapid growth of managed-care plans and aggressive efforts to reduce health-care costs.

"The Olfson data, indicating that there has been a 50 percent reduction in the use of psychotherapy alone over the 10-year period, probably results from obstacles that insurance companies place as a barrier to obtaining this treatment," says Meyers. He adds that depression is often best treated using a combination of medication and psychotherapy.

"These economically driven barriers can be expected to decrease the number of mental-health practitioners with psychotherapy training, which will further limit access of patients to this treatment," Meyers says. "Research data demonstrating that mild clinical depression may respond robustly to psychotherapy, and that psychotherapy augments the benefits of antidepressants argue that this trend should be reversed."

Major depression affects more than 19 million Americans at any point in time. Current research suggests a combination of antidepressants and cognitive behavioral psychotherapy is the most effective treatment regimen for most forms of major depression. In cases of mild depression, some studies show that psychotherapy can be as effective as medication.

Although depression is a very treatable disease, the majority of depressed Americans receive no treatment at all, according to a 1999 U.S. Surgeon General's study titled, "Report on Mental Health." And a 2001 report by the National Institute of Mental Health concurred, stating that only 25 percent to 50 percent of individuals with anxiety and depressive disorders receive appropriate treatment.

Meyers says that studies from around the world show that when mistreated or left untreated, depression can have devastating consequences. For instance, major depression accounts for 20 percent to 35 percent of all suicides, according to the Surgeon General's report.

"Depression is one of the major public health problems of our country," Gordon says. "We need to look at what's making people depressed and address it in a comprehensive, holistic and individualized way."

"In that mode, drugs certainly have a part, but that's a smaller part than they are playing now," he adds.

What To Do

To learn more about depression, visit the National Institute of Mental Health or the American Psychiatric Association.

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SATURDAY, NOVEMBER 2, 2002

Gulf War Research Funds to Increase

By Ken Guggenheim

Associated Press Writer

The Associated Press

Saturday, November 2, 2002

WASHINGTON (AP) - The Department of Veterans Affairs (news - web sites)' plan to sharply increase funding for research into Gulf War (news - web sites) illnesses marks a turning point in how the government perceives the problem, the leader of a veterans group said Friday.

"We've had to fight tooth and nail to convince people that Gulf War illness was more than stress," said Steve Robinson of the National Gulf War Resource Center, an umbrella group of 60 veterans organizations.

The department announced this week it would make up to $20 million available for research in 2004. That figure is more than double the amount spent by the department in any previous year, it said. By comparison, the VA spent $8.4 million in 2001 and $3.7 million in 2002. No figures were available for 2003.

The announcement follows a VA advisory panel's report in June highlighting areas that needed more research, including a connection between the veterans' syndromes and neurological problems.

A VA spokesman, Jim Benson, said he doesn't view the funding as a change of direction for the department, noting that more than 200 research projects have already been funded by the VA and other agencies.

"It's hard to say we just got the message because we've been spending a lot of time, a lot of money and a lot of effort looking for a cause, and have been treating Gulf veterans the whole time," he said.

Tens of thousands of veterans of the Persian Gulf War have suffered from a variety of illnesses they believe were linked to their service. Symptoms have included chronic fatigue, diarrhea, migraines, dizziness and loss of balance.

Many scientists have blamed stress, but veterans believe it is more likely they were exposed to a toxin in the Gulf. In one example, they point to the 101,000 soldiers who the Pentagon (news - web sites) says were exposed to deadly gases when U.S. combat engineers blew up a weapons depot in Khamisiyah, in southern Iraq, in 1991.

Michael Kilpatrick, deputy director of the Pentagon's Deployment Health Support Directorate, said new research might show how the physical and emotional stress of a wartime deployment might make soldiers more vulnerable to dangers in the environment.

The research may have added importance with the United States considering military action against Iraq, which it accuses of developing chemical and biological weapons.

"For any of today or tomorrow's deployments, we are very focused on the protection of health of those deployed," Kilpatrick said. "We recognize that people are going to be in dangerous situations, we recognize that there are going to be tremendous opportunities for exposure to all kinds of chemical or biological (substances)."

On the Net:

Department of Veterans Affairs: http://www.va.gov

National Gulf War Research Center: http://www.ngwrc.org/

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Web Sites Promote Anorexia and Bulimia as a 'Lifestyle'

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Saturday, November 2, 2002

SATURDAY, Nov. 2 (HealthScoutNews) -- They go by names such as "Anorexic Beauty," "Emaciate Me" and "Salvation through Starvation."

They glorify snapshots of women with their rib cages and spinal columns protruding.

They also give such tips as how to hide an eating disorder from friends and family. Or how to trick doctors into believing you're gaining weight by stuffing your pockets with weights.

Dozens of sites that promote anorexia -- and the related illness bulimia -- as a lifestyle choice rather than a mental disorder are flourishing on the Internet.

And doctors and nutritionists are appalled.

"These sites are horrific," says Lauren Solotar, vice president of clinical services and operations at the May Institute in Walpole, Mass., which specializes in behavioral health care, education and rehabilitation.

"These are people who have a disorder who are rationalizing it. It is very dangerous," Solotar says.

Experts say the sites, some of which include message boards and chat rooms, probably wouldn't cause the average person to develop an eating disorder. But they could trigger the irrational fear of becoming fat in someone prone to it.

And the sites can certainly worsen an eating disorder in people who already have one by giving them the "how-to" tips on starvation, and by convincing them their warped perceptions of food and body image are shared by many.

"What everyone else --- friends and family -- are saying is abnormal or unhealthy, these Web sites are promoting and normalizing," says Molly Kimball, a nutritionist at the Ochsner Clinic Foundation in New Orleans. "The sites tell them they're being strong for making the decision not to eat."

An estimated 7 million women and 1 million men in the United States have an eating disorder, according to the National Association of Anorexia Nervosa (news - web sites) and Associated Disorders (ANAD).

Complications can include hair loss, weakened bones, gastrointestinal problems, kidney failure, heart attack -- even death.

Eighty-six percent of eating disorders occur before the victim turns 20. And unless the problem is caught early, which happens all too infrequently, the treatment, including therapy and medical monitoring, can be lengthy -- two years or more -- and costly -- $100,000 and up, ANAD says.

As anorexics become more and more obsessive about avoiding food, they often start to isolate themselves from friends and family. The Web forums provide them with an online community of other people with an eating disorder. They provide one another with support -- by telling them that starving themselves is OK.

Consider this posting on one site from a woman who called herself "Emma" and wanted to know what to do about dizzy spells prompted by not eating.

"Wicked site, it's really useful!! It's helped me loads with how to cope with hunger and how to be anorexic."

Or this posting from a woman who was giving tips on hiding an eating disorder from a spouse.

"I always do my binges on the days he's working. Then on the days he's not, I stick to salads, or super light meals when I'm around him so I don't have to purge. He thinks that I'm 'cured' and that I'm just eating healthy. He doesn't know that mia/ana is back in my life."

"Mia" is short for bulimia nervosa, the disease in which people binge on food and then force themselves to vomit. "Ana" is short for anorexia nervosa, or self-starvation.

As the anorexic grows thinner and thinner, family and friends will often try to intervene, Kimball says. They'll tell the person they look too skinny and encourage them to eat. The anorexic will often further retreat into secrecy, and many -- no one knows the exact number -- look to the message boards on the pro-anorexia Web sites for validation.

"These sites further alienate them from their friends and family," Kimball says.

Rather than help them recover, the people who run these sites are defiant about their illness. They claim their eating disorder is something they can "turn on and off." Or they simply have more willpower and determination than the rest of us to be thin.

"It is most definitely not a lifestyle choice," says Solotar, who specializes in eating disorders. "It is a very serious disorder that can lead to death. There are many medical and physical complications. There is a high mortality rate."

"The longer they have the belief system -- the intense focus on thinness and the phobia against gaining weight -- the more solidified it becomes and the more difficult it is to treat," Solotar says. "These are sick people and for some of them, the Web sites are making things worse."

So what can parents do to protect their teens from these sites?

Thwarting their impact isn't easy. But Kimball suggests that parents keep computers in the family room or kitchen, rather than a bedroom, so teens can't be secretive about their Web surfing habits.

What To Do

If you or someone you know needs help with anorexia or bulimia, visit the National Association of Anorexia Nervosa and Associated Disorders. There are also numerous sites that offer referrals for treatment and online support, including S.C.a.R.E.D.

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