The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
December 7, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 9-15

 

THURSDAY, NOVEMBER 14, 2002

Quitting Smoking May Be All in the Genes

Health Scout News
Thursday, November 14, 2002

THURSDAY, Nov. 14 (HealthScoutNews) -- If you're a smoker with a specific genetic variant, you may be more susceptible to cigarette cravings and relapse when you try to quit smoking.

That's the finding of a study in the November issue of Pharmacogenetics.

The study also found the antidepressant bupropion may lessen the effects of this genetic variation, especially in women.

Researchers at the Tobacco Use Research Center of the University of Pennsylvania School of Medicine examined 426 smokers taking part in a clinical trial of bupropion for smoking cessation.

The smokers stopped smoking and were given either bupropion or a placebo along with seven sessions of behavioral group counseling. The participants' smoking status, cigarette cravings and side effects were recorded weekly. Their smoking status was checked again at the end of the treatment session, and six months later.

The study found that smokers with a decreased activity variant of the CYP2B6 gene reported greater increases in cigarette cravings after they quit and were about 1.5 times more likely to start smoking again during the treatment phase of the study.

Previous research found the enzyme produced by the CYP2B6 gene affects both nictoine metabolism and bupropion metabolism.

The study also found preliminary evidence that bupropion may help smokers, especially women, to counter the effects of the decreased activity variant of the CYP2B6 gene.

The study found that 54 percent of the women with the variant who were treated with bupropion were still non-smokers at the end of the treatment, compared to 19 percent of the women with the variant who received a placebo.

More information

The U.S. Centers for Disease Control and Prevention (news - web sites) has a resource page on how to quit.

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Obesity Alone Can Damage Arteries, Study Shows

Reuters Health
Merritt McKinney
Thursday, November 14, 2002

NEW YORK (Reuters Health) - New research suggests that obesity itself damages blood vessels, even in the absence of high blood pressure and other known risk factors for artery disease.

In a study of middle-aged Italian women, obesity was directly related to thickening of the carotid arteries, the large vessels in the neck that deliver blood to the brain. Such thickening increases the risk of stroke and is an early sign of disease in other arteries, including those that supply the heart.

According to the study's lead author, Dr. Paolo Rubba at Federico II University in Naples, Italy, it has been thought "that obesity in itself is not dangerous for the arteries." This study, however, Rubba told Reuters Health, shows that obesity, particularly extra weight around the abdomen, is associated with blood vessel damage regardless of whether or not a person has high blood pressure. The study was done in women, but Rubba said the same "should also be true for men."

Rubba's team used ultrasound to measure the thickness of carotid arteries in 310 middle-aged women living in southern Italy. The researchers compared two measures of obesity--body mass index (BMI), which measures general obesity, and waist-to-hip ratio, which measures abdominal obesity--to the thickness of the carotid arteries.

Carotid artery thickness increased with obesity, Rubba and his colleagues report in the advance online edition of Stroke: Journal of the American Heart Association (news - web sites). Based on BMI, obese women had the thickest carotid arteries, followed by overweight women and then lean women. Similarly, women with the highest waist-to-hip ratios had the thickest carotid arteries.

Other risk factors for artery disease--such as high blood pressure and high cholesterol--often accompany obesity, but obesity was still directly related to artery thickness even after researchers accounted for these and other risk factors.

The study shows that "obesity should be treated in its own right for cardiovascular prevention," Rubba said. Treating high blood pressure alone, but not obesity, may be insufficient, he said.

In the report, Rubba and his colleagues point out that thickening of the carotid wall is an early sign of more widespread artery disease and can increase the risk of heart attack and other cardiovascular problems.

"It could be useful," they suggest, "to include carotid ultrasound assessment in screening evaluations of obese subjects to identify those at especially high cardiovascular risk who may require more aggressive therapy."

SOURCE: Stroke 2002;10.1161/01.STR.0000038989.90931.BE.

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Home Water Safety

Health Scout News
Thursday, November 14, 2002

(HealthScoutNews) -- According to the American Academy of Pediatrics, small children can drown in as little as one inch of water.

Here are some safety tips:

  • Empty all buckets and bathtubs after each use.
  • Keep your kids out of the bathroom unless you're with them. Instruct others to keep the bathroom door closed.
  • Never leave your child alone in the bathtub or in the care of another child.
  • Use a firm, lockable cover on a hot tub or spa.

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'Opt-Out' HIV Tests Could Reach More Pregnant Women

Reuters Health
Megan Rausher
Thursday, November 14, 2002

NEW YORK (Reuters Health) - Two different approaches can help ensure that most pregnant women get an HIV (news - web sites) test, a step that can reduce the risk of transmitting the virus from mother to child during or after birth, researchers from the US Centers for Disease Control and Prevention (news - web sites) (CDC) reported Thursday. Unfortunately, most states and Canadian provinces currently use a third, less effective approach to prenatal HIV testing.

"Up until now, the approach most areas have taken is 'voluntary opt-in,' where a women has to specifically say that she wants HIV testing," CDC's Dr. Harold Jaffe told Reuters Health in an interview. "Our report indicates that two other approaches increase testing rates. One is 'voluntary opt-out' in which women are essentially told that HIV testing is the standard here and if you don't want it, we won't do it, but otherwise we will."

The other is mandatory testing, adopted by New York and Connecticut. "This approach says that, if you are not tested during pregnancy, we as the state can test your infant with or without your permission," Jaffe said.

Both of these approaches have resulted in a big increase in voluntary prenatal HIV testing rates, Jaffe said. "Unfortunately, right now, most areas have opt-in approaches and the testing rates for that strategy are not very high."

It seems the voluntary "opt-out" approach results in prenatal HIV testing rates of between 85% and 98%, according to a report in the CDC's Morbidity and Mortality Weekly Report. Likewise, mandatory newborn HIV testing in New York and Connecticut has yielded similarly high rates, in the range of 81% to 93%.

Voluntary "opt-in," on the other hand, was associated with a wide range of testing rates, between 25% and 83%. Of note, the report indicates that states that switched from an opt-in approach to either an opt-out or mandatory testing approach increased their prenatal HIV testing rates.

"The data suggest that jurisdictions that use an opt-in approach and that have low prenatal HIV-testing rates should reevaluate their approach," the authors note.

Past studies have shown that taking HIV-fighting drugs in pregnancy, having a Caesarean section and avoiding breast-feeding can dramatically reduce the chances that an HIV-infected woman will pass the virus on to her child.

SOURCE: Morbidity and Mortality Weekly Report 2002;51:1013-1016.

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The Good Doctor

Health Scout News
Thursday, November 14, 2002

(HealthScoutNews) -- Do you have a new baby at home and want to find the best care available for your child?

John Hopkins University suggests you ask these questions before you select a doctor:

  • What is a typical wait in the office?
  • How far in advance do you have to book an appointment?
  • Who handles emergencies?
  • Who answers the phone?
  • What are the office hours?
  • What's the office staff like?
  • What's the cost of an office visit?
  • What's the schedule for well-baby check-ups?
  • How is insurance handled?
  • Do you have to pay at each visit?
  • When can you call with questions and concerns?

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First Human Trial of 'Global' HIV Vaccine Launched

Reuters Health
Alan Mozes
Thursday, November 14, 2002

NEW YORK (Reuters Health) - American researchers have reached what they hope is a milestone in AIDS (news - web sites) research, with the launch of the first human trial of a single AIDS vaccine designed to simultaneously prevent infection with the three most common forms of HIV (news - web sites).

The first trial phase of the so-called "global vaccine" was launched yesterday by the National Institutes of Health (news - web sites) (NIH) in Bethesda, Maryland, under the supervision of the Vaccine Research Center (VRC).

The trial vaccine incorporates modified parts of four different HIV genes. The genes are drawn from HIV subtype B--the most prevalent form of HIV in North America and Western Europe--as well as from subtypes A and C, which are the most common types in Africa and Asia.

Together the three types--or clades--of HIV account for about 90% of infections worldwide.

"The idea behind having this global vaccine candidate is to broaden the coverage of the vaccine," said Dr. Gary Nabel, director of the VRC. "It's giving a broader shield. And it has special relevance in the developing world, but it's also something that doesn't hurt here in North America--where we have clade B--because we don't lose anything."

Nabel pointed out that early lab tests with animals have already shown that immune response to any single type of HIV was not diminished by combining such protection against all three major HIV types. And he noted that the history of vaccine development supports the notion that such a combo vaccine can work.

"If you look at the polio (news - web sites) vaccine, it actually contains three different strains of the disease to cover the three different most prominent strains, so there's an important precedent for that concept," he told Reuters Health.

"When we talk about developing a vaccine for AIDS, I think the one lesson we've learned with time is that this is a virus that doesn't sit still," Nabel noted. "The virus is constantly mutating, and seems to be adapting to different populations. So the idea behind having this global vaccine is that we are trying to...have a better chance of resisting the newer viruses that develop."

The trial's first phase will involve 50 healthy, HIV-negative volunteers between the ages of 18 and 40 who will receive multiple inoculations with either the test vaccine or a saline solution placebo over the course of one year.

Nabel and his colleagues expressed confidence that whether or not the vaccine proves effective over time, the vaccine itself is completely safe for use in a public trial.

"You would not get the infection from this vaccine, that's very clear," said Nabel. "It couldn't happen. We've completely modified the genes with multiple mutations to protect from any kind of activity. So that's something I can be quite definitive about.

"But," he added, "everyone who comes into this trial gets counseling about avoiding risk, because there's no proof yet that this vaccine will protect them. So they are still susceptible to natural infection."

Even if all goes well throughout the clinical trial process, Nabel noted, the vaccine will not become available to the public until at least five years from now.

Sven Bocklandt--the first volunteer to receive an injection--emphasized his hopes for the vaccine's prospects, rather than any risks it might pose.

"AIDS is a disease which personally affects me," Bocklandt--a 28-year-old NIH research fellow unconnected to the VRC project--told Reuters Health. "It's threatening my life and all the people I care about pretty much... And the only way you can eradicate it is through a vaccine. That is the only solution to the AIDS crisis. But you cannot develop a vaccine unless you test it in people and see how they respond to it. That's the bottom-line for me. So that's why I'm doing this."

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When It Comes to AIDS, Parental Honesty Has Its Limits

HealthScoutNews
Randy Dotinga
HealthScoutNews Reporter
Thursday, November 14, 2002

THURSDAY, Nov. 14 (HealthScoutNews) -- A new study of parents infected with the AIDS (news - web sites) virus suggests that disclosing the illness to their children can harm family life by creating disruption and spawning inappropriate behavior.

The authors of the study, published in the new edition of AIDS, aren't suggesting that parents hide their condition from their children.

"But without appreciation of the long process involved when disclosing, parents are likely to be unprepared for the consequences of disclosure," says study co-author Martha B. Lee, a researcher at the University of California, Los Angeles.

While heterosexual transmission of the AIDS virus in the United States remains fairly rare, parents can be found in all the major risk groups, including gay men and intravenous drug users. Thanks to the development of powerful drugs called protease inhibitors, thousands of people with AIDS are living indefinitely without obvious symptoms.

"One of the greatest challenges for a parent living with HIV (news - web sites) is whether, how and when to disclose their HIV status to their children," Lee says. While there are an increasing number of HIV-positive parents and doctors often advise them to disclose their illness to their children, there are few studies into how and what they tell their children.

Researchers at UCLA recruited 301 HIV-positive parents who lived in New York City and received welfare. The researchers interviewed them and their 395 children periodically for five years.

Three out of four parents disclosed their illness to older children, defined as 12 years of age and older, while only 40 percent did so with younger children.

"The older kids may have more knowledge and understanding about HIV," Lee says. "Therefore, the child's maturity may influence the parent's decision to disclose. Another possibility is that parents are concerned about their children encountering HIV-related stigma, and the older kids are expected to be able to deal with stigma better than the young kids."

Another expert who has studied parents who are HIV-positive says they often make decisions based on their perceptions of how their children can handle the disclosure. They consider whether the children "are strong and happy and can handle tough news, or are distressed and need to be protected from it," says Laurie Bauman, a professor of pediatrics at Yeshiva University's Albert Einstein College of Medicine in New York City.

The new study found that mothers were more likely to reveal their HIV infection to their children than men.

"Women may be more verbal and apt to share feelings and what's going on with them," Lee says. "Also, we think that the mothers may be seeking support from their children."

There was no difference in disclosure rates between ethnic groups.

However, the researchers did find the children of parents who disclosed their illness were more likely to engage in "problem behaviors," including unprotected sex, alcohol and drug use, and criminal activity.

Parents and their doctors must work together to determine if disclosure is best for an individual family, Lee says. Also, they must consider the downside of keeping the truth to themselves.

"If parents are discouraged from disclosing, an implicit message is communicated that HIV is stigmatizing and must be hidden," Lee says.

Bauman says secrecy has other costs.

"Secrets in general are considered undesirable in a family because they create distance," she says. "Children pick up that there are secrets, and they'll project on them things that aren't really true. Young children, particularly, will imagine that things are much worse than they are."

What To Do

To learn more about HIV/AIDS and treatments, visit the U.S. Centers for Disease Control and Prevention or the National Institute of Allergy and Infectious Diseases.

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Treating Anemia May Resolve Restless Legs Syndrome 

Reuters Health 
Paula Moyer
Thursday, November 14, 2002

MIAMI (Reuters Health) - Patients with restless legs syndrome may want to find out if iron deficiency is causing their symptoms, particularly if medication does not solve the problem, according to Dr. Birgit Frauscher.

She and colleagues from the University of Innsbruck in Austria followed the case of a man with long-standing restless legs syndrome. The man was found to have low levels of iron in his blood. When he was given blood transfusions after a surgery, his symptoms disappeared.

"Cases of restless legs syndrome which do not respond to medication may be due to iron insufficiency," Dr. Birgit Hogl told Reuters Health. In most cases, an iron supplement would be the appropriate treatment, she said, noting that in this case the patient was very ill and required blood transfusions before he could undergo surgery for cancer.

Frauscher, a neurology resident, was the principal investigator and presented the findings here at the Movement Disorders Society's Seventh International Congress of Parkinson's Disease (news - web sites) and Movement Disorders. Hogl, the chief of the sleep disorders clinic at the University of Innsbruck, collaborated with her.

Restless legs syndrome, also known as RLS, is a common condition marked by a discomfort in the legs and an irresistible urge to move them. RLS is typically worse at night and at rest, and is therefore considered a sleep disorder. Although no medication is approved in the United States for treatment of RLS, physicians often prescribe certain drugs that are used to treat Parkinson's disease, because it is thought that, like Parkinson's, RLS is caused by an inadequate amount of dopamine in the brain.

Physicians have known for some time that in certain patients inadequate iron may be the underlying cause of RLS. This may be particularly true for patients who develop the condition in association with other serious medical problems, such as kidney failure, or patients who become anemic while undergoing chemotherapy.

In this case, a 70-year-old male patient with a 6-year history of RLS had experienced severe worsening of his symptoms for 2 months. When he was examined, he was found to have cirrhosis of the liver and stomach cancer. When he was seen at the sleep disorders clinic, a 3-night study showed that he had severe insomnia.

Hogl and colleagues also conducted an RLS test known as "SIT" (suggested immobilization test), in which the patient is told not to move. The SIT results showed that the man's legs jerked involuntarily when he tried to remain still, a characteristic RLS symptom. When the patient was given levodopa, pergolide and ropinirole, medications often used to treat RLS, he experienced no relief.

The physicians then reviewed the patient's chart and conducted several laboratory tests. They found a slightly decreased iron blood level and also found that the patient's iron levels were lowest when the RLS symptoms were the most severe.

After the patient underwent surgery to receive a liver shunt and to remove a portion of his stomach, he received blood transfusions. His RLS disappeared, and he remains symptom free.

Hogl said that, although the patient had other serious health problems, the RLS was very disruptive. She urged family members to make sure that individuals with RLS get help. "RLS has a serious effect on the patient's quality of life," she said. "This particular patient was so plagued with insomnia due to the RLS that he had developed suicidal thoughts."

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Aneurysm Screening Saves Lives

HealthScoutNews
Ed Edelson
HealthScoutNews Reporter
Thursday, November 14, 2002

THURSDAY, Nov. 14 (HealthScoutNews) -- A program to screen older men for the weakness in the body's main artery called an aortic aneurysm saves lives, a British study finds.

In just four years, one life was saved for every 710 apparently healthy men over 65 who had an ultrasound examination to detect the problem, says a report in this week's issue of The Lancet.

On the surface, the report of a study including more than 67,000 men would appear to settle a long-running debate about the value of screening for aortic aneurysms and doing corrective surgery when one is found. In 1996, the U.S. Preventive Services Task Force said there was "insufficient evidence to recommend for or against routine screening of asymptomatic adults."

However, cost complicates the picture. Medicare does not pay for the screening test, which can cost several hundred dollars in the United States. "The question is, what is the cost-benefit ratio and how does it fit in with the other things we do,'" says Dr. Richard A. Stein, a professor of medicine at Weill Cornell Medical Center in New York City and a spokesman for the American Heart Association (news - web sites).

At the moment, Stein says, he would recommend the test only for persons with known risk factors for heart disease, such as high blood pressure or atherosclerosis. "I am not yet ready to advise an asymptomatic 65-year-old man," he says.

However, a second study on the screening procedure, appearing in this week's issue of the British Medical Journal, finds it is cost-effective as well as lifesaving. Researchers looked at the same group of men and found it would cost about $45,000 for each year saved on a person's life and that figure would fall substantially after only a few years.

An aortic aneurysm is a weak spot in the major artery running to the heart. If it bursts, it usually is fatal. The British Multicentre Aneurysm Screening Study enlisted 67,000 men aged 65 to 74, an age group at highest risk. Half were invited to have an ultrasound examination -- 27,147 accepted the invitation -- and the other half were told to do nothing.

Over four years, 1,333 aneurysms were detected in the screened group. Surgery was done to replace the weak spot in the aorta with plastic tubing when it reached a certain size. There were 65 aneurysm-related deaths in the screened group and 113 in the unscreened group, says Alan Scott, leader of the study. "Screening reduced mortality by 50 percent over four years, and it was more effective the longer you followed it," he says.

Every man should have an ultrasound test to detect an aortic aneurysm at the age of 65, Scott says. "If it is normal, it indicates you are protected against rupture for 10 years," he says.

"In view of the much higher frequency of the condition among men, and the absence of effect of screening on the incidence of ruptured aneurysms in it would be logical to screen only men," he says.

The cost of the program is low in the British nationalized health-care system -- 23 pounds (about $37) per screening, 53 pounds ($85) per person including treatment, Scott says. "But the cost depends on the system," he adds.

"This kind of screening for life-threatening conditions is the future of medicine," Stein says, but cost must be considered in setting up such programs because there is a large number of screening tests for different conditions.

"We have to begin to push the level of yield higher," he says. "Can we begin to characterize patients over a certain age by the presence of risk factors? We have to see if we can stage people in terms of risk and determine when it is fiscally appropriate [for] Medicare to pay for a test."

"But when I am 65, I will go in and have the test," he says.

What To Do

You can learn more about aortic aneurysms from the American Heart Association or the National Library of Medicine.

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Study: Skiers and Snowboarders Need Helmets

Reuters Health
Thursday, November 14, 2002

NEW YORK (Reuters Health) - Skiers and snowboarders should wear helmets to protect themselves from traumatic brain injuries, according to a new report.

Head injuries account for only a small number of total injuries among skiers and snowboarders, yet they are the number one cause of death and serious injury for people engaged in these sports, according to lead study author Dr. A. Stewart Levy of Saint Anthony Central Hospital in Denver, Colorado, and his colleagues.

"Because most traumatic brain injuries treated at our facility resulted from a direct impact mechanism, we believe that the use of helmets can reduce the incidence and severity of head injuries occurring on the ski slopes," they write.

Their conclusion is based on an analysis of data on head injuries that occurred on ski slopes from 1982 to 1998. The data were collected from a Colorado trauma center located near several ski resorts.

Overall, 1,214 skiers and snowboarders were admitted to the trauma center during the study period, and nearly 30% of them had traumatic head injuries, Levy's team reports in the October issue of The Journal of Trauma: Injury, Infection, and Critical Care.

In nearly half (47%) of the cases, the injury was due to a skier or snowboarder's collision with a tree or other stationary object. Forty percent of the patients were injured in a simple or major fall, while the rest were hurt in collisions with other skiers.

Skier-tree collisions were the most common cause of injury and were also responsible for the most severe injuries, the report indicates.

In fact, roughly 7% of the skiers and snowboarders injured in skier-tree collisions died, in comparison to less than 2% of those injured in simple falls. In total, 14 skiers and snowboarders died during the study period.

Men were more than twice as likely to suffer a head injury than women, and skiers and snowboarders younger than 35 had three times the head injury risk of those 35 and older.

Still, injuries were more severe among the older patients, who generally fared worse than their younger peers, the researchers note.

Finally, snowboarders were three times more likely to experience head injuries than skiers.

Only one patient was wearing a helmet at the time of injury, the report indicates. That patient did not require a hospital stay and fully recovered after being treated for a mild concussion.

According to a recent report by the US Consumer Product Safety Commission (news - web sites) (CPSC), helmet use could prevent or reduce the severity of 44% of head injuries sustained by adult skiers and snowboarders. Based on that finding, the safety experts recommend that skiers and snowboarders wear helmets.

"We agree with the conclusion of the CPSC report and feel certain that there is significant potential to reduce the incidence and severity of head injuries on the ski slopes through more widespread use of ski helmets," Levy and his team conclude.

SOURCE: The Journal of Trauma 2002;53:695-704.

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No Amount of Alcohol Safe for Expectant Moms

HealthScoutNews
Thursday, November 14

THURSDAY, Nov. 14 (HealthScoutNews) -- The dangers of heavy drinking during pregnancy are well documented. Now, there's new research that suggests moderate drinking during pregnancy may also pose a danger to a fetus in the womb.

The problems caused by moderate drinking may be more subtle -- long-term cognitive impairments that don't become apparent until the child reaches adolescence and then become progressively worse as the child grows older, says an American study.

It appears in the November issue of the journal Alcoholism: Clinical and Experimental Research.

The study looked at the physiological and behavioral problems in the mature offspring of female rats given alcohol during pregnancy. The mother rats' blood alcohol levels reached levels equal to less than half the level of legal intoxication in humans.

The study authors say their findings indicate that even low to moderate levels of drinking during pregnancy cause long-lasting learning problems for offspring.

They say the findings should be a warning to pregnant women and the doctors who care for them.

More information

Learn more about the dangers of drinking during pregnancy.

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Experimental Alzheimer's Vaccine Causes Brain Bleed

Reuters Health
November 14, 2002

NEW YORK (Reuters Health) - New research in mice shows that an experimental therapy can flush out abnormal brain deposits linked to Alzheimer's disease (news - web sites), but the treatment also leads to bleeding in the brain.

Neurological deposits called plaques--made of substances called amyloid-beta proteins--are hallmarks of Alzheimer's disease. One experimental approach for treating Alzheimer's is to vaccinate against protein bits called amyloid-beta peptides. Several research teams have shown that, in mice, vaccination can lower levels of the Alzheimer's-linked peptide, clear plaques from the brain and improve mental function.

Working with mice, Dr. Mathias Jucker of the University of Basel in Switzerland and colleagues confirmed the benefits of immunization. Mice vaccinated against the peptides did experience a reduction in plaques. Unfortunately, the animals also had an increase in brain hemorrhaging, the researchers report in the November 15th issue of the journal Science.

Compared to mice that did not receive the vaccine, treated mice were twice as likely to have brain hemorrhages, and the bleeding was more severe.

The researchers note that the formation of amyloid deposits in blood vessels in the brain weakens the walls of blood vessels. Jucker and his colleagues speculate that the vaccine used in the research may increase the risk of bleeding by further weakening these vessels.

The findings do not mean that vaccination is not a feasible approach for treating Alzheimer's, but they do suggest how the treatment may be improved, according to the report. The authors point out that more than 10% of all people aged 60 and older and 80% of people with Alzheimer's disease have diseased blood vessels in the brain. It may be possible to improve amyloid-beta vaccination by screening patients for artery disease beforehand, they suggest.

SOURCE: Science 2002;298:1379-1380.

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Sepsis Vaccine Shows Promise

HealthScoutNews
By Kathleen Doheny
HealthScoutNews Reporter
Thursday, November 14, 2002

THURSDAY, Nov. 14 (HealthScoutNews) -- A vaccine to protect against sepsis, a potentially life-threatening disease that's on the rise in the United States, has performed well in animal studies.

That's the encouraging news from scientists at the Scripps Research Institute in La Jolla, Calif., who report their findings in the current issue of the international edition of the journal Angewandte Chemie.

Sepsis, also known as septic shock and systemic inflammatory response syndrome, is a severe illness caused by overwhelming infection of the bloodstream by toxin-producing bacteria. "It occurs in two of every 100 hospital admissions, and is caused by bacterial infection that can originate anywhere in the body," according to the National Institutes of Health (news - web sites).

It begins with an infection. The immune system is then activated and that sets off a cascade of events, such as uncontrolled inflammation and activation of the blood coagulation system. Next, there can be multiple organ failures, from which many sepsis patients eventually die.

Doctors have been successful at reducing the percentage of people who die from sepsis, which is generally treated with antibiotics to quell the infection. However, overall deaths are up as the incidence of sepsis has more than quadrupled in the United States in the past two decades.

In the past, other researchers have tried to protect against sepsis by infusing antibodies to target endotoxins. These are dangerous chemical components of certain bacteria that can cause the immune system to overreact and release lethal amounts of inflammatory chemicals, such as tumor necrosis factor alpha, or TNF-alpha. However, the results haven't been encouraging.

The new Scripps vaccine takes a more active approach. It aims to neutralize the endotoxins and prevent the overreaction of the immune system. The researchers vaccinated mice after giving them a sub-lethal dose of lipid A, a component of endotoxins, says Paul Wentworth Jr., an associate professor of chemistry at Scripps and a co-author of the study.

The vaccine produced a nearly 95 percent reduction in the production of TNF-alpha, a good indication that the vaccine controlled the body's response to infection.

"Normally the body makes TNF-alpha," Wentworth says. However, in the case of sepsis, its production can spiral out of control. "The TNF-alpha is a marker for the body's over-response to the bacterial endotoxins," he says.

"We think the vaccine is working in two ways," Wentworth adds. "It is binding to the lipid A and neutralizing its activity. And it could also be generating antibodies that catalyze the destruction of lipid A molecules."

Wentworth says the study, while promising, is preliminary. If continuing studies show positive results, he says the researchers hope that human trials could begin in the next five years or so. It would likely take a decade before the vaccine is on the market, he says.

Another expert calls the Scripps research and approach interesting.

"This [vaccine] is targeted to the reaction [by the immune system to the bacteria]," says Dr. Phil Dellinger, director of critical care medicine at Cooper Health System in Camden, N.J., and an expert on sepsis. One downside, he says, is that it would not work for "gram-positive infections," which he says are now more common causes of sepsis.

Wentworth says the Scripps team is working on a vaccine that would work against gram-positive infections as well.

What To Do

For more information on sepsis, visit the National Library of Medicine or this Eli Lilly and Co. site.

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Secondhand Smoke May Cost $70 Per Person in US

Reuters Health
Alison McCook
Thursday, November 14, 2002

PHILADELPHIA (Reuters Health) - Wanna light up? Better ask your neighbors if they can afford it first. An estimate of the expenses associated with death and illness reveals that secondhand smoke may cost people in some US regions, if not the entire country, $70 a year.

The findings are based on an analysis of the costs associated with environmental exposure to tobacco for residents from Marion County, Indiana, according to Dr. Terrell W. Zollinger of Indiana University in Bloomington.

Among Marion County's population of around 800,000, Zollinger and his colleagues estimated that the cost of diseases and deaths that resulted from secondhand smoke reached $56.2 million in the year 2000 alone.

Of that total, $30.8 million stemmed from expenses linked to the premature deaths and illnesses in children exposed to secondhand smoke.

These findings demonstrate in very real terms how a person's choice to smoke is one that can impact an entire community, Zollinger said.

"There's a lot of people who say, 'well, if somebody else wants to smoke, that's fine. It doesn't affect me.' Well guess what? It does affect you," Zollinger said.

In Marion County, Zollinger said that smoking is banned from government buildings and sports arenas, but bars and restaurants are free to permit smoking, and people always can become exposed to secondhand smoke in their home or with friends.

In an interview with Reuters Health, Zollinger explained that he and his colleagues based their estimates on calculations of the costs associated with illnesses that are linked to secondhand smoke. In children, research suggests that breathing in cigarette smoke can increase their risk of asthma and having a relatively low weight at birth. Secondhand smoke in adults has been linked to many ills ranging from asthma, lung and cervical cancers, and stroke.

However, those illnesses can also have other causes, the researcher noted. To determine what proportion of the price tag on each illness stems from secondhand smoke, Zollinger and his team applied so-called risk estimates. For example, around 33% of asthma deaths in adults are believed to stem from secondhand smoke, and 14% of office visits in children due to ear infections have been linked to exposure to tobacco. Consequently, 33% of the total cost associated with death from asthma in adults could be attributed to secondhand smoke, Zollinger said.

Estimating the costs associated with loss of life was difficult, Zollinger admitted. He said he and his colleagues relied on a figure established earlier by the federal government, which placed the value of a human life to be at less than $1 million. He explained that he weighed that value according to how many years a person had lost as a result of an early death, with the death of a child--who lost perhaps 70 years of life--costing more than the death of an older adult, who had already realized most of his or her life expectancy.

Zollinger noted that he expected the total cost of secondhand smoke would be much higher in larger counties, and suggested that other counties estimate the expenses associated with secondhand smoke, as well.

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Suicide: The Risk is Lifelong for Those Who've Tried It Once

HealthScoutNews
By Ed Edelson
HealthScoutNews Reporter
Thursday, November 14, 2002

THURSDAY, Nov. 14 (HealthScoutNews) -- People who have attempted suicide once remain at risk of another try for the rest of their life, a comprehensive new British study indicates.

The study, which covered 23 years, has implications for relatives and friends as well as psychotherapists of those who have tried to take their own lives.

"Basically, we are talking about the rest of their lives," says lead author Dr. Gary R. Jenkins, a consulting psychiatrist at East Ham Memorial Hospital in London. The report appears in the new issue of the British Medical Journal.

Jenkins and his colleagues studied the records of 140 people who attempted suicide between May 1977 and March 1980, looking specifically at the cause of death for the 25 who had died by July 2000.

"Examination of death certificates revealed three suicides and nine probable suicides (four were recorded as open verdict and five as accidental death)," they report.

Using these findings as a guideline, the researchers extrapolated the risk of additional suicide attempts for the next 23 years.

Their conclusion: the suicide rate for those who had attempted it once was 5.9 attempts per 1,000 people per year for the five years after the first try; 5.0 attempts per 1,000 people per year 15 to 20 years after the first try; and 6.8 attempts per 1,000 people for the final three years.

"The rate did not decline with time," the researchers report.

The overall suicide rate for the general population is about two attempts per 1,000 people per year.

"This confirms something we know about suicide, that the best predictor is a previous attempt," Jenkins says. "But there haven't been any studies of this length. This paper proves what we have thought clinically -- a previous attempt is a predictive factor even if it is more than two decades after the first act."

The findings demonstrate that "if a patient shows up in an emergency room and has made a suicidal attempt, the clinician needs to be aware that the risk of doing so again is very high, and the patient should not be let go without a psychiatric assessment or follow-up," Jenkins says.

John L. McIntosh, professor of psychiatry at Indiana University and a past president of the American Association of Suicidology, says the study also indicates that "people in this person's life should react and respond more quickly when there are difficulties."

"Friends and particularly family members will want to seek help for this person and make sure he or she gets to a mental health professional quickly," McIntosh says.

The British study is valuable because "it reinforces long-standing results from other studies that are not nearly as lengthy as this one," McIntosh says. "We didn't know that this risk continued with them this long. We are basically talking about the rest of their lives."

"Many would assume that the heightened risk will be gone after two or three years. This suggests that is not accurate," he adds.

What To Do

Comprehensive information about suicide is offered by the National Institute of Mental Health or the National Strategy for Suicide Prevention.

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Not Enough Older Americans Getting Flu Shot: CDC

Reuters Health
November 14, 2002

NEW YORK (Reuters Health) - Despite the fact that older adults face a higher risk of getting severely ill with the flu, less than two thirds of older Americans are getting their recommended flu shot, US health officials report.

According to national survey data for 2001, about 65% of adults aged 65 and older said they had been vaccinated against the flu during the previous year. That's down from 67% in 1999, report researchers at the US Centers for Disease Control and Prevention (news - web sites) (CDC) in Atlanta, Georgia.

Even fewer older Americans (60%) reported ever getting the pneumococcal vaccine--although that was an increase over 1999 levels, the researchers report in the November 15th issue of the CDC's Morbidity and Mortality Weekly Report.

The pneumococcal vaccine provides immunity against the Streptococcus pneumoniae bacteria that cause pneumonia and certain other infections. Together, pneumonia and the flu are leading causes of hospitalization and death among the elderly.

Health officials advise that older adults and others at heightened risk of complications be especially vigilant in getting a flu shot every year. Because the circulating flu strains are different every flu season, the vaccine makeup is changed each year. The pneumococcal vaccine generally needs to be given only once, according to the CDC.

Based on these latest findings, the CDC investigators write, more needs to be done to boost rates of flu and pneumococcal vaccination among older adults. They say doctors should offer pneumococcal vaccination throughout the year, and should continue to give flu shots even after the flu season is in full swing.

And, the researchers point out, health officials need to keep working on the racial gap seen in flu and pneumococcal vaccination. In the 2001 survey, black and Hispanic older adults were much less likely than whites to have gotten either vaccine.

In an illustration of how devastating the flu can be, a separate CDC report details an influenza outbreak in Madagascar this past summer blamed for hundreds of deaths. Because most illnesses occurred in remote areas of the island nation, the report notes, health authorities' awareness of and response to the outbreak was delayed.

Researchers also point out that health officials' ability to get the flu vaccine to remote areas was "extremely limited." This year's US vaccine is designed to protect against a flu strain similar to one that caused the deadly Madagascar outbreak, according to the CDC.

SOURCE: Morbidity and Mortality Weekly Report 2002;51:1016-1018, 1019-1024.

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Lungs Still Harmed Even When Smokers Cut Down

Reuters Health
November 14, 2002

NEW YORK (Reuters Health) - Smoking fewer cigarettes is not likely to help a person escape chronic obstructive pulmonary disease (COPD). Their best bet is to kick the habit altogether, according to researchers in Denmark.

COPD includes the lung disease emphysema and chronic bronchitis, and is marked by progressively worsening shortness of breath and coughing. The disease is currently the fourth leading cause of death in the world, after heart disease, cancer and stroke.

In the current study, Dr. N. S. Godtfredsen of Copenhagen University Hospital and colleagues followed the lung health of nearly 20,000 people for up to 14 years. The investigators compared heavy smokers (15 or more cigarettes a day) who reduced the number of cigarettes they smoked by at least half over the study period but didn't quit, with smokers who did quit, as well as people who were continuous heavy smokers.

"Quitting smoking early in the study period was associated with a reduction in the risk of hospital admission for COPD of approximately 40%," Godtfredsen and colleagues write in the November issue of the journal Thorax.

While quitting smoking has repeatedly been shown to be associated with improved lung function and slower lung deterioration compared to regular smokers, the results of the current study regarding smoking reduction "were not so clear cut," the researchers note.

The investigators found "no difference" in the risk of being hospitalized for COPD between people categorized as continuous smokers and those who reduced the number of cigarettes that they smoked.

"More research is needed, especially on the effects of smoking reduction, but the current results suggest that this is not a viable alternative or supplement to the existing strategies to reduce the harmful effects of tobacco," Godtfredsen's team concludes.

SOURCE: Thorax 2002;57:967-972.

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Too Many Baby Bottles Can Add Pounds in Kids

Reuters Health
Alison McCook
November 14, 2002

PHILADELPHIA (Reuters Health) - Toddlers and preschoolers who drink multiple bottles of milk or sweet liquids each day are more likely than others to be obese and to be anemic due to low levels of iron in their blood, according to new study findings.

Author Richard Kahn of Montefiore Medical Center in the Bronx, New York, said that previous investigations into the impact drinking from bottles can have on a child's health have focused mostly on the risk of tooth decay. But the current findings suggest the effects could extend further than the mouth, Kahn noted.

"We want to go beyond the view that (weaning off of a bottle) is just a matter of tooth decay prevention," Kahn said during a presentation here Wednesday during the 130th Annual Meeting of the American Public Health Association (news - web sites).

Kahn and his team interviewed the parents of 95 children between the ages of 18 and 56 months who were visiting a site of the federal nutrition program for poor US families known as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Most of the children were either Latino or African American.

The authors measured the levels of iron in the children's blood and calculated their body mass index (BMI), a measure of weight in relation to height used to gauge obesity.

Kahn and his team found that 64% of the children received at least three bottles of milk or sweet liquids each day, with some parents reporting that their children drink up to 10 bottles daily.

Many of the children were also either overweight or anemic due to low levels of iron in their blood, the authors report. More than one third of the children had BMIs that classified them as obese, and 21% were anemic.

Comparing bottle use to the rates of obesity and anemia, Kahn and his team discovered that children who drank many bottles each day were more likely than others to be obese or anemic.

Kahn explained that the calcium in milk can influence how well the body absorbs iron from the diet, as can a milk protein known as casein.

In terms of the link between bottle feeding and obesity, the researcher estimated that each milk-filled baby bottle contains 180 calories, and kids who drink many bottles each day are likely getting all the calories they need from their bottles. However, he noted that many parents do not realize that drinking bottles can destroy a child's appetite. As a consequence, either the child eats on top of drinking bottles--which can put him at risk of obesity--or the child struggles against the parent who is forcing food on him, leading to conflicts within the family.

The American Academy of Pediatrics currently recommends that parents try to pry bottles out of their children's mouths once they turn 16 months old. However, based on these findings, Kahn recommended that weaning begin in children as young as one year old.

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Life Expectancy Gap Due to Smoking, HIV, Diabetes

Reuters Health
Charnicia E. Huggins
November 14, 2002

NEW YORK (Reuters Health) - Blacks and the less educated in the US have life expectancies about 6 years shorter than their white and better-educated counterparts, respectively. Now a new report suggests that smoking-related diseases are largely to blame when it comes to cutting the life expectancy of people with lower levels of education.

And high blood pressure, HIV (news - web sites), diabetes and homicide appear to be the greatest contributors to the discrepancy in death rates among blacks versus whites, according to a team of California researchers.

"Previous studies have found that African Americans and those less educated have worse health outcomes for a diverse array of diseases, thus, it has been difficult to know where to focus our public health resources," lead study author Dr. Mitchell D. Wong, of the University of California at Los Angeles told Reuters Health.

"The study has important implications for redirecting public health efforts and the allocation of future research funding," he said.

Wong and his colleagues analyzed data from the 1986 to 1994 National Health Interview Survey and estimated death rates from various diseases, based on a life expectancy of 75 years.

Overall, people without a high school education were at risk of dying an average 9 years earlier than high school graduates, while blacks were at risk of dying almost 2 years earlier than their white counterparts, the investigators report in this week's issue of The New England Journal of Medicine (news - web sites).

These findings remained true when the researchers took into account the study participants' age, gender and race or educational level, the report indicates.

The diseases that most accounted for the educational disparity in death rates were heart disease, lung cancer, stroke, congestive heart failure, pneumonia and lung disease--all smoking-related diseases.

In fact, eliminating heart disease--which accounted for nearly 12% of the potential years of life lost--would lead to a nearly 10-month gain in life expectancy, study findings show. Similarly, eliminating lung disease--the second greatest contributor to the educational disparity--would add about 6 months to the life expectancy of less-educated individuals.

On the other hand, the discrepancy in death rates among blacks, in comparison to whites, was largely due to deaths from high blood pressure (hypertension)--which accounted for 15% of the disparity, followed by deaths from HIV, diabetes and homicide.

Eliminating the number one contributor to racial disparities--high blood pressure--would lead to an almost 3-month gain in life expectancy among blacks, and getting rid of HIV deaths would lead to a roughly 2-month gain in life expectancy, the report indicates.

In many studies on eliminating racial disparities, researchers have focused on heart attacks and cancer--the leading causes of death among African Americans and whites, and differences in treatment, according to Wong. The present study findings, however, "suggest that we need to pay more attention to hypertension, HIV and diabetes, as well as homicide," he said.

The study did not investigate whether health insurance, access to care or related factors might explain the disparities in death rates, but the fact that smoking-related diseases accounted for the top six contributors to the educational disparity in life expectancy suggests "that interventions to prevent smoking could have an enormous impact," the authors write.

"In addition, we know that African Americans are more likely to get hypertension, HIV and diabetes, and also tend to have more severe disease," Wong said. "Thus, it is important to find out what the impact would be of improved screening, prevention and treatment of these diseases on racial disparities in life expectancy."

SOURCE: The New England Journal of Medicine 2002;347:1585-1592.

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Full of Excuses? Deflecting Blame Not Always Wise

Reuters Health
Amy Norton
Thursday, November 14, 2002

NEW YORK (Reuters Health) - Excuses for bad behavior may abound in our but-it's-not-my-fault culture, but researchers say that shifting blame from one's self can often backfire.

Psychologists at the University of Florida found that under certain circumstances, excuses gain nothing more than ill feelings from others. Their study of college students showed that people who routinely avoid responsibility for mistakes and misdeeds risk being viewed as lacking character and being deceitful and self-absorbed.

And blaming others, giving a suspect excuse or using excuses that completely ignore one's own weaknesses may win a similar fate, according to the study findings, published in the current issue of the Journal of Social and Clinical Psychology.

It may seem logical that people would often have no patience for excuses, but excuses do serve a purpose. Indeed, the psychological-research field has frequently focused on the upside of excuse-making, according to the authors of the new study.

Deflecting blame helps "buffer the self from failures," explained lead author Beth A. Pontari, who is currently at Furman University in Greenville, South Carolina.

Blaming one's self for every mistake can take a toll, and it's a particular problem among people with depression. Making excuses, or "externalizing" blame for things that go wrong, can save people from feeling inappropriately bad about themselves.

"I don't think that, inherently, excuses are bad," Pontari told Reuters Health.

Instead, she and her colleagues identified instances when excuses become "problematic." Their study presented college students with descriptions of several scenarios in which the central character made excuses for his or her behavior. The researchers found that under certain conditions--such as when the character had a history of making excuses, or when an excuse like "I was stuck in traffic jam" could not be corroborated--participants did not look kindly on the excuse-maker.

Similarly dim views were cast on excuses that "perpetuated a weakness"--for example, when a worker blames a "quirky" computer for his or her on-the-job shortcomings. In contrast, the researchers report, "central characters fared better when they balanced their excuse"--by, for example, simply taking some responsibility.

So, according to Pontari, instead of merely blaming traffic for your late arrival at that meeting that cost your company that important client, try acknowledging that you should have left earlier.

"It's the balancing act that we have to do as human beings," she said.

SOURCE: Journal of Social and Clinical Psychology 2002;21:497-516.

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WEDNESDAY, NOVEMBER 13, 2002

Air Pollution, Medical Costs Linked

The Associated Press
Laura Meckler, Associated Press Writers
Wednesday, November 13, 2002

WASHINGTON (AP) - Older Americans in the most polluted parts of the country are significantly more likely to need medical treatment, particularly for lung ailments, according to a study that suggests reducing pollution could cut medical spending as well.

Earlier studies have established a link between air pollution and early death, but this is the first large-scale look at the impact on medical care itself, said Victor R. Fuchs, a Stanford University economist and lead author of the study being published Tuesday in the journal Health Affairs.

"With medical care spending exceeding $1 trillion per year, even a reduction of only a few percentage points would save society tens of billions of dollars annually," the study concluded. "Use of medical care is significantly higher in areas with more pollution."

The study found air pollution significantly increases Medicare recipients' medical care needs, even after controlling for region, population size, education, income, cigarette use and obesity. Because race plays such a large role in health, the study focused only on whites.

It examined 183 metropolitan areas with more than 100,000 people, using air pollution data from the Environmental Protection Agency (news - web sites), and averaged data from 1989-91.

Overall, it found air pollution was greatest in the West and lowest in Florida and Big Sky country. In general, it found hospital admissions were greatest in the Deep South and in southern states nearby: Arkansas, Oklahoma and Texas.

Specifically, the analysis found hospital admissions for respiratory problems were, on average, 19 percent higher in the 37 areas with the highest air pollution compared with the 37 areas with the least amount of pollution.

Similarly, outpatient care was 18 percent higher and hospital admissions were 10 percent higher.

Controlling for demographic and health factors, the researchers found Medicare would have saved an average of $76.70 per person in inpatient care and $100.30 in outpatient care for every drop of 10 micrograms per cubic meter in air pollution.

Economist Randall Lutter, a resident scholar at the conservative American Enterprise Institute, said it's already known that air pollution affects health. He criticized the study, saying it appeared to him to use very crude measurements to get at the differences around the country. He noted, for instance, that stress also can affect health, and stress may be very different in New York City than in Des Moines.

"You can't measure stress very well, and that's kind of a fundamental problem," he said. "It (the study) has some value, but it needs to be taken with a grain of salt."

On the Net:

Health Affairs: http://www.healthaffairs.org

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Buyers of Foreign Meds, Beware (1 Hour, 23 Minutes Ago)

HealthScoutNews
Wednesday, November 13, 2002

WEDNESDAY, Nov. 13 (HealthScoutNews) -- If you buy medicines from other countries, you should be aware of some potential risks.

The U.S. Food and Drug Administration (news - web sites) (FDA) has an online brochure for consumers that explains the concerns the FDA has about Americans going to other countries to buy medications or ordering them from foreign countries via the Internet.

Those concerns include poor quality assurance, counterfeit versions of medicines, risks of unsupervised use of these medicines, labeling in different languages, the presence of untested substances, and lack of information about the medicines that would help in case of side effects.

More information

Here's where to go to find the FDA Web site.

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Inflammation Triggers Heart Attacks

The Associated Press
Daniel Q. Haney
AP Medical Editor
November 13, 2002

BOSTON (AP) - A landmark study offers the strongest evidence yet that simmering, painless inflammation deep within the body is the single most powerful trigger of heart attacks, worse even than high cholesterol.

The latest research is likely to encourage many doctors to make blood tests for inflammation part of standard physical exams for middle-aged people, especially those with other conditions that increase their risk of heart trouble.

The study, based on nearly 28,000 women, is by far the largest to look at inflammation's role, and it shows that those with high levels are twice as likely as those with high cholesterol to die from heart attacks and strokes.

Over the past five years, research by Dr. Paul Ridker of Boston's Brigham and Women's Hospital has built the case for the "inflammation hypothesis." With his latest study, many believe the evidence is overwhelming that inflammation is a central factor in cardiovascular disease, by far the world's biggest killer.

"I don't think it's a hypothesis anymore. It's proven," said Dr. Eric Topol, chief of cardiology at the Cleveland Clinic.

Inflammation can be measured with a test that checks for C-reactive protein, or CRP, a chemical necessary for fighting injury and infection. The test typically costs between $25 and $50.

Diet and exercise can lower CRP dramatically. Cholesterol-lowering drugs called statins also reduce CRP, as do aspirin and some other medicines.

Doctors believe inflammation has many possible sources. Often, the fatty buildups that line the blood vessels become inflamed as white blood cells invade in a misguided defense attempt. Fat cells are also known to turn out these inflammatory proteins. Other possible triggers include high blood pressure, smoking and lingering low-level infections, such as chronic gum disease.

Doctors theorize that a chronic infection anywhere in the body can produce these inflammatory proteins, which then make their way into the bloodstream and do their damage in the blood vessels.

The proteins are thought to weaken the fatty buildups, or plaques, making them more likely to burst. A piece of plaque can then lead to a clot that can choke off the blood flow and cause a heart attack.

For the first time, Ridker's study establishes what level of CRP should be considered worrisome, so doctors can make sense of patients' readings. However, experts are still divided over which patients to test and how to treat them if their CRP readings are high.

Some, such as Dr. Richard Milani of the Ochsner Clinic in New Orleans, recommend a CRP check for virtually anyone getting a cholesterol test. "If I have enough concern to check a patient's cholesterol, it seems naive not to include an inexpensive test that would give me even more information," he said.

Others are reluctant to test people at low outward risk. Dr. Sidney Smith, research director of the American Heart Association (news - web sites), said CRP testing is likely to be most helpful in guiding the care of the 40 percent of U.S. adults already considered at intermediate risk of heart attacks because of other conditions, such as age, obesity and high blood pressure.

In March, the heart association and the Centers for Disease Control and Prevention (news - web sites) held a meeting of 50 experts to review the evidence and make recommendations on CRP testing. Although it hoped to be finished this month, the committee went back to the drawing board after learning last week of Ridker's latest results, which are being published in Thursday's New England Journal of Medicine (news - web sites).

Though the study involved only women, Ridker said he is confident the findings apply to men as well, because earlier, small studies in men reached similar conclusions.

A skeptical editorial in the journal by Dr. Lori Mosca of Columbia University questioned the need for widespread testing, at least until more studies are done to show that lowering CRP actually saves lives.

Such studies are planned. Until then, Ridker said he believes a high CRP reading can help doctors persuade people with low cholesterol that they still need to diet and exercise.

"The CRP test can predict risk 15 to 25 years in the future," Ridker said. "We have a long time to get our patients to change their lifestyles, and the change does not have to be huge — modest exercise, modest weight loss and stop smoking."

However, Mosca said telling people they have low CRP may falsely reassure them they can continue their slothful living habits. "Why do we need a test to help us motivate patients to improve their lifestyles?" she said in an interview.

She also worried that doctors will immediately put patients on drugs to lower CRP before there is proof this saves lives.

Ridker's latest study is based on an eight-year follow-up of 27,939 volunteers in the Women's Health Study. About half of heart attacks and strokes occurred in those with seemingly safe levels of LDL, the bad cholesterol.

The lowest risk was in women whose CRP readings were below one-half milligram per liter of blood. It more than doubled when readings went over about three.

Dr. Wayne Alexander of Emory University in Atlanta said he already uses CRP testing to help guide treatment, such as deciding whether to prescribe statins for people with borderline high cholesterol.

"It changes your threshold about whether to initiate therapy or actually to withhold therapy," he said.

Editor’s Note: Medical Editor Daniel Q. Handy is a special correspondent for The Associated Press.

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

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Recognizing Alcohol Poisoning (1 Hour, 28 Minutes ago)

HealthScoutNews
Wednesday, November 13, 2002

(HealthScoutNews) -- Too much alcohol can lead to alcohol poisoning, which can prove fatal.

Recognize the signs, advises The University of Toronto Medical Health Center, and call 911 if the person:

  • is known to have drunk large quantities of alcohol in a short period of time.
  • is unconscious and can't be woken.
  • has cold, clammy skin and is unusually pale or has a bluish hue.
  • is breathing slowly or irregularly; usually this means less than 8 times a minute.
  • vomits while passed out and doesn't wake up during or after.

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Autism Diagnosis Comes Later for Blacks Than Whites

Reuters Health
Alison McCook
Wednesday, November 13, 2002

PHILADELPHIA (Reuters Health) - Many children are diagnosed with autism years after they first show signs of the condition, and African Americans are diagnosed around 1 1/2 years later than US whites, new research shows.

The signs of autism are visible from before a child turns 2, according to Dr. David S. Mandell of the University of Pennsylvania in Philadelphia. However, he and his colleagues discovered that white children enrolled in the government health insurance program Medicaid were diagnosed at an average of 6 years of age, while African-American children tended to receive a diagnosis almost 2 years later.

Autism "is being picked up too late in everybody in this population," Mandell told Reuters Health.

This lag time could have important implications for a child's health, Mandell noted, for all children with autism are eligible for behavior treatments and enrollment in a classroom geared toward their condition.

"There's an increasing body of evidence that suggests the earlier you get into treatment, the better you do," Mandell said.

Children with autism tend to have trouble playing and interacting with others and difficulty communicating, and may perform certain behaviors or routines repetitively.

During the study, Mandell and his team examined the files of 406 children enrolled in Medicaid who were incurring health costs related to autism. The authors reviewed each patient's medical history to determine when he or she was first diagnosed with autism.

In an interview with Reuters Health, Mandell explained that by the time a child is 18 months old, he or she can make eye contact, return smiles and point to a desired object. Children with autism often do not exhibit these behaviors at this age, the researcher noted.

However, he and his team discovered that children appeared to be diagnosed with autism years after those first symptoms likely appear, and the diagnosis arrived later for blacks than whites. The authors found that white children logged an average of four visits in a four-month period between the first time they visited a mental health specialist and the moment they were diagnosed with autism, while the same process required black children to log an average of 13 visits over 10 months. Mandell noted that recent reports suggest that autism strikes an equal proportion of children from all ethnic groups.

Mandell and his colleagues presented their findings here Tuesday during the 130th Annual Meeting of the American Public Health Association (news - web sites).

In terms of why children with autism are diagnosed later than they could be, Mandell speculated that pediatricians may hesitate to tell parents their child has a condition for which there is no obvious treatment, relying on "watchful waiting" to see if something changes.

As to why autism is identified later in black children, Mandell noted that African Americans are less likely than whites to see the same doctor over time, and a pediatrician who watches a child for many years may spot autism sooner than others. He said that clinicians may also interpret symptoms differently in children of different races.

Mandell explained that one symptom of autism can be attributed to a number of causes. If a child doesn't respond when his parents call him, for instance, the doctor or the parent could believe different things: the child is deaf, he doesn't recognize his name or the fact that he is being called, or he is simply misbehaving.

"I don't know--is it because the parent says 'something is wrong with my child they won't mind me,' or is it the clinician interpreting that behavior differently for black kids as they do for white kids?" Mandell asked.

He recommended that experts work to educate parents and clinicians about the symptoms of autism, provide parents with the right language to explain their child's behavior, and help physicians recognize and ferret out their own biases in how they treat patients.

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The Life of Leftovers

HealthScoutNews
Wednesday, November 13, 2002

 (HealthScoutNews) -- Food left on the counter top can become contaminated. According to the U.S. Food and Drug Administration (news - web sites), you should refrigerate hot foods within two hours after cooking. If the food has been sitting out longer than that, throw it out.

The agency also suggests you date leftovers and then eat them within three to five days.

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Protein May Predict Spread of Cancer

The Associated Press
Janet McConnaughey
Wednesday, November 13, 2002

Measuring levels of a certain protein in a tumor could give doctors an astonishingly accurate way of predicting whether early breast cancer (news - web sites) is likely to spread to the rest of a woman's body, a study suggests.

If the preliminary findings hold up, doctors could someday use a growth protein called cyclin E to tell which women need surgery plus chemotherapy and which ones just need the tumor cut out.

Cyclin E appeared six times more powerful a predictor than the current methods — measuring tumor size and how far cancer cells have spread, said biochemist Khandan Keyomarsi of the M.D. Anderson Cancer Center in Houston.

In women with early-stage cancer that showed no sign of spreading, cyclin E was 100 percent accurate in telling who would be alive six years later and who would die within that time. It was more than 90 percent accurate in those whose cancer had spread to the lymph nodes.

However, Keomarsi cautioned that the results might not be as impressive in a bigger study.

Cyclin E "could potentially be very useful in helping to identify those patients who may not need the grueling nature of chemotherapy, as well as those who should be treated more aggressively," said Keyomarsi, whose findings were reported in Thursday's New England Journal of Medicine (news - web sites).

Cyclin E is seen as a good marker, or predictor, because it plays a role in cell growth, and cancer is essentially cell growth gone wild. Keyomarsi said the protein could be the first reliable biological marker that can distinguish between aggressive and non-aggressive breast cancer before it spreads.

Other researchers described the research as intriguing, but they, too, cautioned that it must be confirmed through additional studies and longer follow-up of patients.

"It's very provocative, and I look forward to evolution of this particular marker," said Dr. Larry Norton, head of solid tumor oncology and director of the Breast Center at Memorial Sloan Kettering Cancer Center in New York.

Keyomarsi said earlier, conflicting studies of cyclin E used antibodies to find the protein. She instead employed a test that uses electric current to separate proteins, and said it did better in head-to-head comparisons against the antibody technique.

However, clinical laboratories generally do not have equipment for that test. Moreover, breast tumor tissue is usually embedded in wax for diagnosis, and the test that Khandan found to be superior needs fresh or fresh-frozen tissue.

That could complicate efforts to develop a test for cycylin E, since fresh tissue decays rapidly. Also, because mammograms are spotting cancer earlier, many tumors are so small there is nothing left over for analysis after the diagnosis, Norton said.

"If it turns out to be this useful as a prognostic factor, it would be worth it," Norton said. "We'll have to wrestle with ways to accomplish this."

James Roberts, a scientist at the Fred Hutchinson Cancer Research Center in Seattle, said researchers there did some early studies that suggested cyclin E is a good marker for aggressive breast cancer. But he said more standard markers of excessive cell growth may be just as good.

Keyomarsi's study looked at cyclin E levels in tissue from 395 women diagnosed between 1990 and 1995.

A total of 114 of the women were diagnosed with early cancer that had not yet spread. Twelve of them died, and all 12 had high levels of the protein. The other women had low levels of the protein, and all of them survived.

The difference was not quite as clear-cut for cancer in its later stages, and there was no difference at all for cancer that had already spread past the lymph nodes.

Generally, if cancer has not spread and the tumor is less than a centimeter — smaller than a fingernail — doctors just remove it without radiation or chemotherapy.

On the Net:

http://www.mdanderson.org

American Cancer Society (news - web sites): http://www.cancer.org

National Alliance of Breast Cancer Organizations: http://www.nabco.org

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Turning the Tide on Antibiotics for Kids

HealthScoutNews
Wednesday, November 13

WEDNESDAY, Nov. 13 (HealthScoutNews) -- Doctors are being more careful when prescribing antibiotics for children with viral respiratory tract infections, but inappropriate antibiotic use is still common.

That's the finding of a study in the November issue of The Archives of Pediatrics and Adolescent Medicine.

University of Pittsburgh School of Medicine's Dr. David R. Nash and colleagues used data from the National Ambulatory Medical Care Survey to study antibiotic-prescribing patterns between 1995 and 1998 of doctors caring for children 18 and younger.

They looked at diagnosis and prescription information from 13,078 visits by children to family doctors and pediatricians.

The study found that children who saw their doctor in 1998 and were diagnosed with upper respiratory tract infections (URTIs) or bronchitis were about two-thirds less likely to be treated with antibiotics compared to children with the same diagnoses who visited their doctor in 1995.

The researchers also found that children diagnosed with either sinusitis or otitis media in 1998 were about a third less likely to receive an inappropriate antibiotic than children in 1995.

The study notes the emergence of antibiotic-resistant bacteria strains is partly caused by doctors too often prescribing antibiotics for children with URTIs caused by viruses, which don't respond to antibiotics.

About 75 percent of outpatient antibiotic prescriptions given to children are for upper respiratory tract conditions, including viral URTIs, bronchitis, pharyngitis, sinusitis and otitis media.

The authors say that their study shows some improvements, but that inappropriate antibiotic use is still common.

"Almost half of patients with URTIs received antibiotics, even though these conditions are known to be of viral origin. Even in conditions like sinusitis and otitis media, for which antibiotic therapy is appropriate, an inappropriate antibiotic is used more than 10 percent of the time," write the authors.

"Our results suggest that interventions to improve the prescribing of antibiotics should focus on changing treatment patterns for both URTIs and bronchitis. The interventions should be aimed at all types of physicians and also directed toward parents and patients to dampen their enthusiasm for antibiotics," the authors add.

More information

The U.S. Food and Drug Administration (news - web sites) has more about antibiotic resistance.

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Ionized Bracelets for Pain Relief? Save Your Money

Reuters Health
Kathleen Doheny
Wednesday, November 13, 2002

NEW YORK (Reuters Health) - Although some consumers swear by the pain-relieving power of ionized bracelets--devices made of copper and zinc and widely sold over the Internet--a new study has found no evidence that they work, Mayo Clinic researchers report.

The study is published in the November 2002 issue of Mayo Clinic Proceedings and was presented at the American Academy of Family Physicians (news - web sites)' annual meeting in San Diego in October.

The bracelets are promoted as a natural way to keep the body's energy force, or qi (pronounced chee), healthy. The bracelets work, advocates say, by balancing qi's negative and positive components, called yin and yang. As long as yin and yang are in balance, you remain in good health and pain-free, believers say.

To test that claim, the research team from Mayo Clinic, Jacksonville, studied 610 patients, average age 48, who complained of some type of musculoskeletal pain, affecting such areas as the neck, lower back, elbows, wrists or feet. Half wore the ionized bracelets and half wore a bracelet that looked like an ionized model but was not, said Dr. Robert L. Bratton, the lead researcher and an assistant professor in the department of family medicine at Mayo. No one knew which bracelet they were wearing, nor did the researchers.

"We measured their pain rating over the course of the month," Bratton told Reuters Health. The subjects self-reported their pain six times during the 28 days. "There was improvement in both groups, but no difference between the two," he said. Both groups reported significant improvement in their pain.

Wearing an ionized bracelet is no more effective than wearing a placebo bracelet, Bratton concluded, although the study does support the idea that placebo can help pain.

Bratton noted that the bracelets are expensive, generally costing $50 and up. The belief that it will work, he said, may be as important as anything. "I think that people would do just as well to put a rubber band around their wrist, if they believe it will reduce their pain." In an initial survey, 80% of the 409 study participants who responded said they did believe the ionized bracelet could help reduce their joint or muscle pain.

Bratton's golf buddies inspired him to do the study, he said. They kept asking him if the bracelets might help after observing so many professional athletes wearing them.

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Twins Not Identical in Every Way

 HealthScoutNews
Wednesday, November 13, 2002

WEDNESDAY, Nov. 13 (HealthScoutNews) -- Identical twins may be alike in most every way, but their levels of emotional distress can differ depending on their religious beliefs and their relationships with their mothers and teachers.

That's what a study in the November-December issue of Child Development found.

The study was done by researchers at the University of Texas at Austin and the University of North Carolina at Chapel Hill.

They looked at 289 pairs of identical twins, average age 16.2 years, whose emotional distress was measured by depressive symptoms such as hopelessness and feelings of guilt. There were similar numbers of male and female twin pairs. They came from different ethnic groups, and most were from intact families.

The study found that in only 11 percent of the pairs did both twins have the same levels of emotional distress.

In the other pairs, the twin with less distress tended to be closer to his or her mother, as well as teachers, and attended church more often. Girls were less distressed when they and their twin sisters shared positive feelings about teachers, the study says.

In low-income families, twins given more autonomy by their parents than their twin siblings had less emotional distress.

The researchers say the differences in emotional distress between twins are partly the result of social differences, where the twins have different relationships inside and outside the home.

Also, twins may actively choose settings that let them create separate sets of experiences from each other, the researchers say.

More information

The U.S. National Library of Medicine has more about twins, triplets and multiple births.

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Health Group Urges Less Salt in Food

The Associated Press
Wednesday, November 13, 2002

PHILADELPHIA (AP) - The nation's largest public health group is recommending a 50 percent decrease in salt in processed food and restaurant meals over the next 10 years.

The American Public Health Association (news - web sites) said the reduction could save 150,000 lives a year from strokes, heart attacks and other illnesses linked to high blood pressure.

Government guidelines already recommend limiting intake of sodium — which increases blood pressure — to no more than 2.4 grams daily, or the equivalent of about a teaspoon of table salt. But the average American adult consumes nearly 4 grams a day, according to the association.

A resolution passed Tuesday at the health association's annual meeting in Philadelphia urges a collaboration with food manufacturers to meet the goal.

"Americans are consuming an ever-increasing amount of processed foods high in sodium at home, at work, at school and in restaurants," said Dr. Stephen Havas, the lead author of the new policy. "The excess sodium in these foods is unnecessary and leads to a large, preventable toll of hypertension, premature death and disability."

About 50 million U.S. adults have high blood pressure, or hypertension. About 710,000 die annually from heart disease and more than 166,000 die of stroke, according to government statistics.

"Appealing to individuals as well as to industry to take simple but effective steps to limit sodium in our diets will yield measurable results in lowering Americans' risk for cardiovascular diseases and related conditions," said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute.

Alison Kretser, director of scientific and nutrition policy for the Grocery Manufacturers of America, said the policy should have had a broader focus. A diet rich in fruits, vegetables and dairy products could also help lower blood pressure, she said.

"My concern is that just reducing the sodium levels in diets becomes very unpalatable," she said. "People may potentially feel discouraged and deprived."

On the Net:

Public Health Association: http://www.apha.org

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Exercise Keeps Disabilities on the Run

HealthScoutNews
By Serena Gordon
HealthScoutNews Reporter
Wednesday, November 13, 2002

WEDNESDAY, Nov. 13 (HealthScoutNews) -- Regular aerobic exercise may keep you healthy well into your golden years.

Researchers from Stanford University found that people over 50 who belonged to a running club were more than three times less likely to die during the 13-year study period and they were able to postpone disability by almost nine years on average.

"Those people who were exercisers lived longer and had lower rates of cardiovascular disease and cancer," says the study's lead author, Dr. Benjamin Wang, who is now an assistant professor of medicine at the University of Tennessee Health Science Center in Memphis.

It wasn't just running that provided benefits. "Any form of aerobic exercise seemed to be beneficial," Wang says.

The study findings appear in the new issue of the Archives of Internal Medicine (news - web sites).

The Stanford scientists compared a group of 370 members of a runner's club to a control group of 249 residents from the same community who were not involved in the running club. The volunteers were between 50 and 72 years old at the start of the study, with an average age of 59.

Not surprisingly, the researchers found the runners pursued healthier lifestyles. They smoked less, drank less alcohol and engaged more regularly in exercise. Community members reported more smoking, alcohol use and they had higher body mass indexes.

Members of the running club reported running an average of almost 26,000 kilometers in just over 11 years before the start of the study, while the community members reported running an average of 1,374 kilometers in 2.2 years before enrolling in the study.

The volunteers filled out yearly health-assessment questionnaires during the study period. The level of disability was assessed by having each volunteer rate his or her functional abilities in eight different activities: walking, reach, grip, rising, dressing and grooming, hygiene, eating and activities such as running errands. They would score each activity between "zero" and "three," with "zero" meaning they had no difficulty performing the task, and "three" signifying they couldn't do the task.

The members of the runner's club had significantly lower levels of disability than community members, delaying any significant disability by an average of 8.7 years. Any exercise showed a reduction in disability at some point during the study, but only moderate- to high-intensity exercise consistently reduced levels of disability.

The death rate for community members was 3.3 times higher than for runner's club members, according to the study. Also, men and smokers appeared to have an increased risk of death.

Because the runners reported running an average of 10.8 years before the study, Wang points out that these were "not all lifelong runners. Many began in mid-life. The implication is that it's never too late to begin exercising," he adds.

While agreeing that it's never too late to enjoy the benefits of exercise, Dr. Lewis Rosenbaum, a geriatric medicine specialist from William Beaumont Hospital in Royal Oak, Mich., says he has some problems with the design of the study.

"If you take people who are engaged, disciplined exercisers, and compare them to most people, it's not a fair comparison," he says.

"These are go-getters," Rosenbaum says, adding that along with running, they probably have many more healthful habits, such as eating healthy foods. Most people, he says, can't maintain the kind of high-intensity exercise that running club members do.

But, he says, "People of all ages should be active to the extent their condition allows."

He recommends that seniors who would like to start exercising should join a group program at a health club or through a community organization. Some good activities to start with are low-impact aerobics or tai chi, he says.

If it's been a long time since you've exercised, or if you have health problems, it's wise to check with your doctor before you start any new exercise program, he adds.

What To Do

For more information on the benefits of exercise for seniors, visit the National Institute on Aging or the Mayo Clinic.

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Most with Parkinson's Don't Take Meds as Directed

Reuters Health
Paula Moyer
Wednesday, November 13, 2002

MIAMI (Reuters Health) - Most people who live with Parkinson's disease (news - web sites) deviate from the medication schedule, either by taking less medication, adding an extra dose or missing doses altogether, according to a new report.

The rate of "non-adherence," or the tendency to detour from prescription instructions, found in the study is similar to that seen for patients with other chronic illnesses, study author Dr. Norman A. Leopold noted here at the Movement Disorders Society's Seventh International Congress of Parkinson's Disease and Movement Disorders. He is a neurologist at the Parkinson's Disease Movement Disorder Center with Crozer-Chester Medicine in Upland, Pennsylvania.

Because of the high rate of non-adherence in other chronic health conditions, Leopold and his colleagues sought to determine whether Parkinson's disease patients made similar deviations from drug doses and schedules. He noted that physicians who treat Parkinson's disease often modify drug schedules if their patients are not responding adequately to a treatment regimen.

The researchers wanted to know if persistent symptoms or drug-related side effects may be due to non-adherence to the drug doses and schedule rather than problems with the medications and the schedule themselves.

Leopold's team gave a questionnaire to 39 patients whose medication practices were recorded by a computerized system that monitored medication use and compared how much medication patients took and when to their prescribed dosage and schedule. Patients with dementia or depression and those who only took their Parkinson's drugs on an as-needed basis were excluded.

During a 28-day observation period, the investigators found that only 4 of the 39 patients (10.3%) took their medications exactly as prescribed, with no missed, extra or mistimed doses. In the questionnaire responses, 24.3% of patients admitted to missing doses but the computer system data showed that 51.3% missed at least one dose per week, and that 20.5% patients missed three or more doses per week. Among the 39 participants, 73% admitted taking their doses at inappropriate times, but the computer records showed that 82% had mistimed doses.

Women and patients with higher education levels were more likely to adhere to the prescribed doses and schedules, Leopold said. He said that the findings point to a need for better communication between people who live with Parkinson's disease and their doctors.

Although the study by Leopold and colleagues did not address the issue of patient satisfaction with medications, investigators presenting other research here addressed several problems with Parkinson's disease medication, which may or may not contribute to non-adherence. These include delays between taking the medication and its effects being felt, failure of the medication to be absorbed due to digestion problems related to Parkinson's disease, and side effects specific to the medications such as involuntary movements and hallucinations.

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Breast Cancer Tumor Marker Identified (1 Hour, 32 Minutes Ago)

HealthScoutNews
By Amanda Gardner
HealthScoutNews Reporter
Wednesday, November 13, 2002

WEDNESDAY, Nov. 13 (HealthScout News) -- Researchers in Houston have identified a marker that may determine those patients who have more aggressive forms of breast cancer (news - web sites), a finding that could present a target for new drug therapies.

In a retrospective study reported in tomorrow's issue of The New England Journal of Medicine (news - web sites), high levels of a truncated form of the protein cyclin E indicated poor survival prospects in women with breast cancer, while women with lower levels had decidedly better prospects. More aggressive cancer was also indicated when the regular form of the protein was present throughout the cell cycle.

In normal cells, cyclin E appears at certain times to give cells the "go" signal to replicate. In tumor cells, however, two things can go wrong: the regular cyclin E never goes away and, therefore, doesn't stop giving the "go" signal. Also, this regular or "full-length" cyclin E can generate a truncated or low molecular weight version.

"Low forms are more active versions of the full-length version, and give the go signal more strongly," says Khandan Keyomarsi, lead author of the paper and an associate professor in the experimental radiation oncology department at the University of Texas MD Anderson Cancer Center in Houston. "The low forms by themselves, without even taking into account the full form, are a strong predictor of poor outcomes, as are the two together."

Right now, the prognosis for women diagnosed with breast cancer is based largely on whether or not the cancer cells have spread into neighboring lymph glands. Unfortunately, this method is far from foolproof: About one-third of women whose cancer has not spread to the lymph nodes have a recurrence, while about one-third of women whose cancer has spread to the lymph nodes don't have a recurrence within 10 years.

"It's very encouraging. If this holds true, then perhaps we'll be able to tell which women we don't need to treat, who don't need to go through the pain, inconvenience and cost," says Dr. Jay Brooks, chief of hematology/oncology at the Ochsner Clinic Foundation in New Orleans. "Hopefully, the results can be expanded to larger groups of patients. We could then reassure women."

In this study, the researchers looked at total cyclin levels in the tumor tissue of 395 patients who had had breast cancer. One hundred twenty seven of these women had been diagnosed with Stage 1 breast cancer, where the disease had not spread to the lymph nodes, and 10 percent within this group had a poor prognosis.

The truncated forms of cyclin E were over expressed in the group with a poor outlook but not in any of the other Stage I patients. In fact, each one of the women with high levels of the abnormal cyclin E died from a recurrence within five years of being first diagnosed. All the women with low levels survived.

All told, women with high total cyclin levels had an eight-times higher risk of dying than those with low levels, the researchers report.

"Cyclin can identify those patients who would metastasize. It detected them all," says Keyomarsi.

The findings have a number of implications.

"The more general part of this study is that it would identify those patients who are not going to benefit from additional chemotherapy, and chemo is extremely debilitating," Keyomarsi says. "That's the very positive part because the majority of patients don't over express [cyclin E]."

Conversely, Keyomarsi adds, high expression of total cyclin E would indicate which patients require more aggressive treatment from the start.

The study also opens up the possibility of developing drugs to inhibit the generation of cyclin E.

"We have already identified the mechanism by which these lower [molecular weight] forms of cyclin E are generated. That actually opens the road for drug screening," Keyomarsi says. "We are in the process of trying to come up with compounds that would target the enzymes that generate these forms." Between 20 percent and 25 percent of women over express this altered form of cyclin E, which is about the same percentage of women who experience a recurrence.

The use of cyclin E as a predictor of more aggressive cancer is not ready for clinical use, however. The test that was used to identify the altered forms of cyclin E, called the Western blot analysis, is currently only used in research labs and would need to be incorporated into a clinical setting.

The findings also need to be validated with patients who are newly diagnosed, as opposed to patients who were previously diagnosed.

"If confirmed with larger groups of patients, then I believe this will come to be very helpful," Brooks says. "There has been a history over a number of years of various tumor markers being discovered, and many of them, when applied to larger groups, have not stood the test of time. Hopefully, this will."

What To Do

For more on breast cancer treatment, visit the Susan G. Komen Foundation or the National Cancer Institute

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Study Questions Infection Treatment

The Associated Press
Wednesday, November 13, 2002

Hunting down and treating symptom-free bladder infections in women with diabetes does nothing to ward off painful recurrences later, a study found.

Diabetic women are far more prone to bladder infections and to serious complications from those infections than other women. Because of that, some doctors recommend testing their urine for bacteria and — since urine is usually sterile — giving them antibiotics if germs show up.

That doesn't work, Dr. Lindsay E. Nicolle of the University of Manitoba's Department of Medical Microbiology wrote in Thursday's New England Journal of Medicine (news - web sites).

Doctors at the University of Manitoba and St. Boniface General Hospital in Winnepeg, Canada, tested 105 diabetic women who had bacteria in their urine but no symptoms. Fifty were assigned at random to get a placebo, 55 to get antibiotics.

Four weeks later, 78 percent of those on the placebo had bacteria in their urine, compared with 20 percent of those on antibiotics.

However, that short-term elimination of bacteria did not protect the women from painful infections later on. Forty percent of the women on the placebo, and 42 percent of those who got antibiotics, had at least one infection with symptoms over the next two to three years.

Moreover, some women who were given antibiotics suffered bad side effects from the medication.

Bacteria in the urine of diabetics (news - web sites) has long been considered "`the enemy of the gate.' So why not attempt to eliminate the enemy before serious harm is done to our patients?" Dr. Vincent T. Andriole of Yale University School of Medicine wrote in an accompanying editorial. But he said the study shows that the bacteria "may be just an innocent visitor."

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Arthritis Pain Has a Daily Cycle

HealthScoutNews
Wednesday, November 13, 2002

WEDNESDAY, Nov. 13 (HealthScoutNews) -- What do the U.S. Navy (news - web sites) Observatory Master Clock and your arthritis have in common? They both help you measure time.

Arthritis stiffness and pain closely follow the rhythms of your body clock, says a study in the Annals of the Rheumatic Diseases journal.

The study included 21 people with osteoarthritis in their hands. They were asked to rate their pain and stiffness levels at six specified points during the day -- on waking, at bedtime, and every four hours in between. They did this for 10 days.

Most of the participants were women and their average age was 62. None of them was being treated with steroids.

At the same time they rated their pain and stiffness, the study participants also performed manual dexterity tests. They picked up beads and fed them through a narrow tube into a container. If they dropped any of the beads, they had to start over again. The tests were timed.

The study found that pain and stiffness varied with the body's circadian rhythms. For 75 percent of the participants, pain and stiffness were greatest in the morning and at bedtime and lowest in mid-afternoon.

Those levels of pain and stiffness also affected manual dexterity, which peaked at 3:48 p.m. and was best within the zones of least overall pain, from 1:12 p.m. to 6 p.m., and stiffness, from 3:20 p.m. to 5:30 p.m.

This link between body rhythms and arthritis pain and stiffness, along with the effect on manual dexterity, can be used by people with arthritis to better schedule their daily activities, the researchers say. It might also be used to better time drug treatments for maximum benefit, they say.

More information

Learn more about arthritis at the Arthritis Foundation.

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Smoking Starts in Summer Months, When School's Out

Reuters Health
Alison McCook
Wednesday, November 13, 2002

PHILADELPHIA (Reuters Health) - More teens start smoking during the summer months than any other season, according to new research.

These findings suggest that programs aimed at stopping teens from starting the habit should not take place only in schools, and that some way to steer teens away from smoking is needed in the summer, as well, Dr. Stacey L. Stevens of the Texas Commission on Alcohol and Drug Abuse and her colleagues report.

"We can't rely on our schools totally," Stevens told Reuters Health. "The community needs to get involved to help keep kids from smoking--at least in the summertime," she said.

The findings are based on the responses of 826 adolescents, average age 16, who were attending a state-mandated program to help them stop smoking. Stevens explained that in the state of Texas, when a person under 18 is caught purchasing or using tobacco, they are required to perform some type of activity, which can entail attending this course.

When students entered the course, Stevens and her team asked them to indicate the year and the month when they had started smoking.

Reporting here Tuesday at the 130th Annual Meeting of the American Public Health Association (news - web sites), Stevens and her team found that 47% of teens said they started smoking during May, June, July or August. The most popular months to start the habit were May and June, they note.

In an interview with Reuters Health, Stevens pointed out that previous research discovered that teens tend to smoke more during the summer holiday than the school year, citing the fact that the warm months are associated with more freedom, more spending money, feeling bored and hanging out with friends. However, in this report, the students reported smoking the same number of cigarettes, on average--11 per day--during all seasons.

Although the current study did not determine why students are more likely to start smoking for the first time during the summer, Stevens said it makes sense that more freedom and free time could provide more opportunities to pick up the habit. "At school, they're supervised from at least 8 to 3," she said. In contrast, in the summer, much of that supervision can vanish, she noted.

Previous research has also found that teens who engage in more extracurricular activities are less likely than others to try drugs or drink alcohol--again, likely because they are supervised during those after-school hours, Stevens added.

Along with getting the larger community to realize that teens may be more likely to start smoking during the summer months, Stevens suggested that summer programs--such as overnight or day camps--be made more available to students. Many of these activities exist, she said, but are often too expensive for many parents to afford. "So making (these programs) so that they're accessible and affordable for kids I think is important," she said.

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Tai Chi May Help Parkinson's Patients

Reuters Health
Paula Moyer
Wednesday, November 13, 2002

MIAMI (Reuters Health) - While people with Parkinson's disease (news - web sites) are very interested in using complementary and alternative medicine to treat their symptoms, there has been little study on whether such therapies can help them, Lyvonne Carreiro reported here at the Seventh International Congress of Parkinson's Disease and Movement Disorders.

But two small studies--one conducted by Carreiro and her colleagues--suggest that Tai Chi and the herb yohimbine, respectively, may help reduce falls in Parkinson's patients. People with this progressive neurological disorder suffer from tremor, muscle rigidity and movement problems.

Carreiro, a Parkinson's disease care coordinator at the University of Florida in Jacksonville, surveyed 75 patients at her center about their knowledge of complementary and alternative medicine.

"There is a lot of interest in alternative therapies for Parkinson's disease, but not enough information," she told Reuters Health. "Patients should let their physicians know if they're interested in such treatments."

Carreiro's team found that 54% of the respondents understood the definition of complementary and alternative medicine. Among the respondents, 23% mistakenly believed these treatments were part of most medical schools' coursework, and 51% believed herbs can be safely taken with medication. Most said they were interested in such therapies, but would only use them if prescribed by their medical doctor.

In the past year, 48% of the respondents had used these treatments. Among those who had, 45% had taken Tai Chi classes; 36% had used yoga and 27% had used acupuncture. Carreiro noted that several respondents had used multiple strategies and that 36% of respondents had used massage, 24% had practiced meditation, 45% used spiritual healing or prayer, and 15% used herbal therapies.

Noting that 80% of respondents believe that complementary and alternative medicine could improve their Parkinson's disease, Carreiro pointed out that there is a need for more well-controlled scientific studies to see if this belief is warranted.

In her own practice, she and her colleagues found that Tai Chi appeared to reduce the number of falls in Parkinson's patients. The investigators followed 30 patients with Parkinson's disease who were randomly assigned to a Tai Chi group or a "control" group. The people who evaluated their records of falls and stability scores did not know which patients were controls and which received Tai Chi lessons. Tai Chi patients had one-hour weekly Tai Chi classes for 12 consecutive weeks.

The Tai Chi patients were less likely than controls to have an increase in the severity of their Parkinson's disease and less likely to have a decline in motor function. The reduction in fall frequency was 18 times greater for the Tai Chi patients, said Carreiro. She told Reuters Health that people with Parkinson's disease who want to study Tai Chi must make sure the instructor is familiar with their condition and will accommodate their needs.

Other research on complementary and alternative medicine shows that some herbal or botanical therapies bear out their good reputations while others deliver less than adequately.

In a study on yohimbine, Dr. Ruth Djaldetti and colleagues at Rabin Medical Center, Beilinson Campus in Petach Tiqva, Israel, found that the use of yohimbine was associated with a 50% reduction in the number of falls. They treated 11 patients who either had Parkinson's disease or other parkinsonian syndromes.

Dr. M. G. Jabre and colleagues in Byblos, Lebanon, studied the use of fava beans as the only treatment in five patients who had not yet received any Parkinson's medication. Their rationale was that fava beans are chemically similar to levodopa, the mainstay medication in Parkinson's treatment. Although the investigators found no statistically significant improvement in the patients' conditions, two of the five were satisfied and wanted to continue with fava beans.

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Sexually Compulsive Co-Eds Take More Sexual Risks

Reuters Health
Alison McCook
Wednesday, November 13, 2002

PHILADELPHIA (Reuters Health) - Male and female college students who report feeling persistent and escalating desires to have sex or be sexual with others are more likely than other students to have unprotected sex and to have sex in public places, new study findings suggest.

Unprotected sex can put students at risk of acquiring a number of diseases, the authors note. However, these so-called sexually compulsive students were also more likely than less sexually compulsive students to report having sought out information about sexually transmitted infections.

"Potentially, they realized there is an increased risk in their behavior," study author Sara L. Cole of Indiana University in Bloomington said here Tuesday.

Cole said that these findings indicate that sexual compulsivity among young adults could have a strong impact on their sexual health, and people who treat students should be aware of the potential dangers associated with the behavior. "We need to give more attention to sexual compulsivity," she said.

She and her colleagues presented their findings during the 130th Annual Meeting of the American Public Health Association (news - web sites).

Cole explained that previous research has sought to examine whether individuals deemed sexually compulsive are more likely than others to engage in risky sexual behavior, but these studies have been confined largely to men--in particular, men who have sex with men.

In one of the new reports, Cole and her colleagues looked solely at the behaviors of young women who were classified as sexually compulsive. In the study, the investigators surveyed 561 female students attending a Midwestern university, giving them a questionnaire that addressed sexual compulsivity along with other issues. For example, students were asked if their appetite for sex interfered with their relationships, or if they ever wanted sex so badly they felt they could lose control.

Female students were determined to have a tendency toward sexual compulsivity if their ratings on the sexual compulsivity questions fell within the highest 20% of the group. Based on this classification, Cole and her team determined that 45 students, or 8% of the women, had relatively high levels of sexual compulsivity.

Linking those ratings to behavior, the researchers found that sexually compulsive young women were more likely than others to have had unprotected oral and vaginal sex, and also to have had sex in public places during the past 3 months. These women were also less likely than others to say they were involved in a sexual relationship at the time of the study.

In another study also reported at the APHA meeting, Cole and her colleagues identified the same patterns of behavior among a sample of sexually compulsive men and women, indicating that these results do not apply solely to women.

In an interview with Reuters Health, Cole stressed that these results do not indicate that college students are all sex-crazy. Those who were rated as sexually compulsive represented only a small proportion of the total, she said, and the term sexually compulsive is often difficult to define.

However, some people also tend to peg obsession with sex as "normal" in college students, many of whom are independent for the first time, Cole said. In some students, she said, such inclinations may need to be recognized as more than just a phase.

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Study Links Teen Drinking, Pressure

The Associated Press
Jim Fitzgerald
Associated Press Writer
November, November 13, 2002

HARRISON, N.Y. (AP) - The home-alone drinking party is nothing new on the suburban teen scene, and there's always a kid or two showing up drunk at the high school dance.

But this year in Westchester County, a prosperous suburban area north of New York City, one youngster died at an unchaperoned bash, and as many as 200 high schoolers showed up drunk at a homecoming dance.

These and other startling episodes of underage drinking have officials searching for answers and parents worried more than ever — including concerns about a possible link between youngsters' drinking and the adults' affluent lifestyle.

The anxiety is compounded by a new study that has found a connection between the burden of expectations placed on some suburban youths and their attraction to alcohol.

Nationwide statistics show kids may be starting earlier — weekend binge drinking is not uncommon in eighth grade — but there has been no sudden rise in underage drinking overall.

An advocacy group, the National Center on Addiction and Substance Abuse at Columbia University, reported earlier this year that nearly a third of high school students say they binge drink at least once a month. At the same time, the government's Substance Abuse and Mental Health Services Administration estimated underage drinkers account for 11.4 percent of all alcohol consumed in the United States.

Many Westchester officials believe underage drinking is on the rise in their communities.

"Volume is definitely up," said Detective Richard Fatigate, Scarsdale's community resource officer. "As soon as they get to high school, the culture is one of Friday and Saturday nights, there's a keg or somebody gets cases of beer and they sit around and drink."

The routine has led to these incidents:

_ In September 2001, a high school football team in Chappaqua celebrated the start of the season with heavy drinking and a professional strip show at the home of one of the players.

_ One day in April, Harrison High School let out early because of a power failure. During an impromptu beer bash that followed, a 17-year-old boy was fatally injured when he was punched in the face and hit his head on a concrete patio. As he lay unconscious, other teens tried to hide evidence of the party rather than call 911.

_ As many as 200 Scarsdale High School students were drunk on arrival at this year's homecoming dance Sept. 20. Five had to be taken to hospitals and 28 were suspended.

_ A September party in Harrison left a star football player injured after he put his arm through a plate glass window. Eight boys were suspended from the team.

_ A woman and her 16-year-old son were arrested in Port Chester after she came home from work Friday evening to a noisy birthday party and found a 15-year-old girl, the guest of honor, passed out. The girl woke up on the way to the hospital. The mother and son were charged with endangering the welfare of a minor.

The incidents have triggered a series of soul-searching community meetings — the latest last week involving 150 law enforcement officials, school officials and students.

They also prompted District Attorney Jeanine Pirro to raid an alleged "ID mill" that was turning out fake driver's licenses as well as passports, visas and green cards.

State Assemblyman Richard Brodsky introduced a bill to require an elaborate registration process for every keg of beer and County Executive Andrew Spano is suggesting a law prohibiting anyone under 21 from being drunk in public.

The most startling incidents occurred in affluent communities with many career-oriented parents and achievement-oriented schools. Getting a party together is easier for kids who have cell phones, the $50 to $75 needed for a fake ID or a keg, and homes already well stocked with booze.

One research study may have found a link. A study of 10th-graders, published this fall in the journal Child Development, found significantly more anxiety, somewhat more depression and higher levels of alcohol and drug abuse in an unidentified affluent suburb compared with the inner city and the nation as a whole.

"In communities such as these, there is a very high level of pressure on these young people to do wonderfully well across multiple activities, not just academics but multiple extracurricular activities," said co-author Suniya Luthar, a psychology professor at Teachers College of Columbia University. "Children worry about which college they might get into as early as fifth or sixth grade."

Jasmine Robinson, a 15-year-old at Mamaroneck High School, suggests police should become more involved because parents are unwilling to take action.

"Arrest these kids," she urged. "In today's world, most parents don't seem like they'll do anything and the kids aren't going to change until somebody makes them change."

But Renee Wallace, also 15, knows some of the teenagers who were at Harrison party where a boy died. "They know what they did was really stupid," she said, "and they really, really regret it."

On the Net:

Westchester County government: http://westchestergov.com

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TUESDAY, NOVEMBER 12, 2002

Diabetic Heart Disease Risk Studied

The Associated Press
Paul Recer
AP Science Writer
Tuesday, November 12, 2002

WASHINGTON (AP) - Cooking food at minimum safe temperatures for short periods of time may lower the risk of heart disease for diabetics (news - web sites).

In a study appearing this week in the Proceedings of the National Academy of Sciences (news - web sites), researchers say a toxic compound is formed when sugar, proteins and fat are processed at cooking temperatures for long periods of time. This compound may increase blood vessel damage in diabetics, the study suggests.

Dr. Helen Vlassara, a diabetes researcher at Mount Sinai School of Medicine in New York and first author of the study, said the compound, called advanced glycation end products or AGEs, can prompt an angry reaction from the immune system, eventually damaging blood vessels.

"AGEs attack virtually every part of the body," said Vlassara. "It is as if we have a low-grade infection. They tend to aggravate the immune cells."

She said a lifelong diet high in AGEs leaves the immune system in a constant state of low-grade inflammation which damages the small and mid-sized arteries. This, in turn, can prompt heart disease and other problems common to diabetics, she said. Diabetics are particularly sensitive to the effects of vessels damaged by AGEs, she said.

But dietary AGEs can be controlled by cooking foods differently, she added.

Dr. Eugene Barrett, a professor of medicine at the University of Virginia and the president-elect of the American Diabetes Association, said the study by Vlassara is potentially important in the control of diabetes, but more research is needed to understand the role AGEs may play in heart disease.

He said research into AGEs is still at an early stage and it may be too soon to conclude that limiting AGEs will reduce heart disease among diabetics.

Vlassara's study used 24 diabetic patients divided into two groups. One group maintained a normal diet recommended for diabetics which included chicken, fish and meat. The other group had the same foods, but cooked differently.

At the end of six weeks, said Vlassara, the AGEs in the test group registered declines ranging from 33 percent to 40 percent. She said the study was too short to detect any fundamental changes in the patients' health.

However, she said studies using diabetic animals have shown that a reduction in AGEs can reduce the incidence of heart disease or delay its onset. Such studies need to be conducted in humans to prove the value of AGE control, she said.

The key to lowering AGEs, said Vlassara, is to cook for a short time in the presence of high humidity. This means either boiling or steaming meats for the minimum time required. Meat can be sauteed, she said, but it should be cut very thin and cooked quickly with a small amount of oil.

She said one of the worst AGE offenders is turkey cooked in the traditional American way.

"We cook for many hours," she said. "That would tend to make a tremendous number of AGEs."

Vlassara said coffee, cola and chocolate drinks also are loaded with AGEs. For diabetics, she recommends sugar-free versions of clear sodas instead of the diet versions of dark drinks. Some of the dark colas, she said, add caramelized products which are heavy in AGEs.

On the Net:

Proceedings of the National Academy of Sciences site: http://www.pnas.org

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