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
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
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
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.
The U.S. Centers for Disease Control and Prevention (news
sites) has a resource page on how
Obesity Alone Can Damage
Arteries, Study Shows
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
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
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
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
SOURCE: Stroke 2002;10.1161/01.STR.0000038989.90931.BE.
Home Water Safety
November 14, 2002
(HealthScoutNews) -- According to the American Academy of Pediatrics,
small children can drown in as little as one inch of
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.
Tests Could Reach More Pregnant Women
November 14, 2002
NEW YORK (Reuters Health) - Two different approaches can help
ensure that most pregnant women get an HIV (news
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
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
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
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.
The Good Doctor
November 14, 2002
-- Do you have a new baby at home and want to find the
best care available for your child?
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
- What's the cost of an
- What's the schedule for
- How is insurance handled?
- Do you have to pay at
- When can you call with
questions and concerns?
Trial of 'Global' HIV Vaccine Launched
November 14, 2002
NEW YORK (Reuters Health) - American researchers have reached
what they hope is a milestone in AIDS (news
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
The first trial phase of the so-called "global vaccine"
was launched yesterday by the National Institutes of
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
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
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
It Comes to AIDS, Parental Honesty Has Its Limits
November 14, 2002
THURSDAY, Nov. 14 (HealthScoutNews) -- A new study of parents
infected with the AIDS (news
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
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
There was no difference in disclosure rates between ethnic
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.
for Disease Control and Prevention or the National
Institute of Allergy and Infectious Diseases.
Treating Anemia May Resolve
Restless Legs Syndrome
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
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
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
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."
Aneurysm Screening Saves
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
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
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,"
"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
"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,"
What To Do
You can learn more about aortic aneurysms from the American
Heart Association or the National
Library of Medicine.
Study: Skiers and Snowboarders
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,"
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
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
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
"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.
No Amount of Alcohol Safe
for Expectant Moms
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 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.
Learn more about the dangers of drinking
Vaccine Causes Brain Bleed
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
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
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,
SOURCE: Science 2002;298:1379-1380.
Sepsis Vaccine Shows Promise
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
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 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,"
"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.
Secondhand Smoke May Cost
$70 Per Person in US
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,
"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
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,
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.
The Risk is Lifelong for Those Who've Tried It Once
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
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
"The rate did not decline with time," the researchers
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,"
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
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.
Not Enough Older Americans
Getting Flu Shot: CDC
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
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
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
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,
Lungs Still Harmed Even
When Smokers Cut Down
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.
Too Many Baby Bottles
Can Add Pounds in Kids
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
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 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.
Expectancy Gap Due to Smoking, HIV, Diabetes
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
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
"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
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
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
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.
of Excuses? Deflecting Blame Not Always Wise
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
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,"
SOURCE: Journal of Social and Clinical Psychology 2002;21:497-516.
WEDNESDAY, NOVEMBER 13,
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
"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
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
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
"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
of Foreign Meds, Beware
(1 Hour, 23 Minutes Ago)
Wednesday, November 13, 2002
WEDNESDAY, Nov. 13 (HealthScoutNews) -- If you buy medicines
from other countries, you should be aware of some potential
The U.S. Food and Drug Administration (news
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
Here's where to go to find the FDA
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
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
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
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
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
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
"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
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.
Editors Note: Medical Editor Daniel Q. Handy is a special
correspondent for The Associated Press.
the Net: http://content.nejm.org
(1 Hour, 28 Minutes ago)
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:
Diagnosis Comes Later for Blacks Than Whites
- is known to have drunk
large quantities of alcohol in a short period of time.
- is unconscious and can't
- 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
- vomits while passed out
and doesn't wake up during or after.
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
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,"
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
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
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.
The Life of Leftovers
November 13, 2002
Food left on the counter top can become contaminated.
According to the U.S. Food and Drug Administration (news
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.
May Predict Spread of Cancer
The Associated Press
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
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
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
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:
American Cancer Society (news
National Alliance of Breast Cancer Organizations: http://www.nabco.org
Turning the Tide on Antibiotics
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
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
The U.S. Food and Drug Administration (news
sites) has more about antibiotic
Ionized Bracelets for
Pain Relief? Save Your Money
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
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
"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.
Twins Not Identical in
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
The study was done by researchers at the University of Texas
at Austin and the University of North Carolina at Chapel
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
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
Also, twins may actively choose settings that let them create
separate sets of experiences from each other, the researchers
The U.S. National Library of Medicine has more about twins,
triplets and multiple births.
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
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
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
"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
Exercise Keeps Disabilities
on the Run
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
The study findings appear in the new issue of the Archives
of Internal Medicine (news
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
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,"
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
"If you take people who are engaged, disciplined exercisers,
and compare them to most people, it's not a fair comparison,"
"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
Most with Parkinson's
Don't Take Meds as Directed
Wednesday, November 13, 2002
MIAMI (Reuters Health) - Most people who live with Parkinson's
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,
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.
Tumor Marker Identified
(1 Hour, 32 Minutes Ago)
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
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
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
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
"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
"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
Questions Infection Treatment
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
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
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
Four weeks later, 78 percent of those on the placebo had bacteria
in their urine, compared with 20 percent of those on
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
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
Arthritis Pain Has a Daily
Wednesday, November 13, 2002
WEDNESDAY, Nov. 13 (HealthScoutNews) -- What do the U.S. Navy
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,
Learn more about arthritis at the Arthritis
Smoking Starts in Summer
Months, When School's Out
Wednesday, November 13, 2002
PHILADELPHIA (Reuters Health) - More teens start smoking during
the summer months than any other season, according to
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,"
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
When students entered the course, Stevens and her team asked
them to indicate the year and the month when they had
Reporting here Tuesday at the 130th Annual Meeting of the American
Public Health Association (news
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,
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,"
Tai Chi May Help Parkinson's
Wednesday, November 13, 2002
MIAMI (Reuters Health) - While people with Parkinson's disease
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
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
"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
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.
Sexually Compulsive Co-Eds
Take More Sexual Risks
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
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
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
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.
Links Teen Drinking, Pressure
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
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
_ 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
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
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
Diabetic Heart Disease
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
In a study appearing this week in the Proceedings of the National
Academy of Sciences (news
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
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,
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
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