FRIDAY, NOVEMBER 22, 2002 

1. Acne Cream Also Eases Wrinkles in Older People
2. Some Teens Deliberately Harm Themselves
3. Study Links Cancer Rates, Prevention
4. Statins Found Safe, Effective for Elderly
5. Acupuncture May Help Ward Off Migraine
6. Study Ties IVF To Rare Birth Defect
7. Arthritis of Spine Often Not Diagnosed
8. Frailty in Elderly Isn't Automatic
9. Past Yo-Yo Dieting Cuts Women's Weight Loss Success
10. Snug as a Bug
11. Mail-Order Drugs Get High Marks, Some Glitches
12. Nose Bleed
13. More Boy Babies Born Late Than Girls
14. Cockroaches a Health Threat to Older, Urban Asthmatics
15. Report Supports Folic Acid for Heart Health
    
16. Survey: Being Fit Is Sometimes in Your Head
    
    THURSDAY, NOVEMBER 21, 2002 
    
    
17. Drug Based on Mistletoe in Trials Against Cancer
18. Men's Deep Throat Linked to Sleep Problems
19. Study Looks at Rare Syndrome, Test-Tube Babies
20. Keep the Home Fires Burning
21. Widely Used Drug Boosts Radiation for Brain Cancer
22. Drug-Resistant Gonorrhea on the Rise in 2 States
23. Tooth Troubles
24. Touted Hormone Has No Effect on Autism
25. Smoking During Pregnancy Linked to Kids' Obesity
26. 'Junk' Gene Tied to Both Diabetes and Obesity
27. Mutations Identified for Early Parkinson's
28. Redefining a Healthy Diet
29. Smoking, Drinking Affect Mental Speed in Middle Age
30. Study: Folic Acid Can Protect the Heart
31. Computer Images Provide Better Melanoma Detection
32. Water-Related Infections Hit New High
33. Arthritis Drugs Studied to Prevent Oral Cancer
    
    WEDNESDAY, NOVEMBER 20, 2002 
    
    
34. FTC Targets Deceptive Diet Ads
35. Glivec Boosts Effects of Chemotherapy: Animal Study
36. Outpatient Heart Attack Care Studied
37. Vaccine Aimed at Cervical Cancer Shows Promise
38. Study: Gene Therapy Shows Promise
39. Vaccine Protects Women Against Genital Herpes
40. Got You Covered
41. ID Checks Don't Deter Teens from Buying Cigs
42. Alarming News for Black Men's Heart Health
43. Protein Plays Role in Obesity, Diabetes in Mice
44. Best Drug for the Job
45. New Cancer Drug Surprisingly Good in Early Study
46. Heart Misfiring May Cause Some Cases of SIDS
47. Type, Frequency of Migraine May Sway Stroke Risk
48. Can Ticks Spread Hepatitis C Virus?
49. Niacin Slashes Heart Attack Risk in Diabetics
50. Just Can't Wait? High Blood Pressure May Be Result
51. Aggressive Treatment Urged for 'Mini-Strokes'
52. Leptin May Play Role in Obesity-Breast Cancer Link
53. Gene May Help Predict Lung Cancer Patient Survival
54. Arsenic in Water Tied to Bladder Cancer Mutations
    
    TUESDAY, NOVEMBER 19, 2002 
    
    
55. Toxic Trouble
56. Free range hens 'food poisoning' scare
57. Co. Gives FDA Ephedra Complaints
58. Sweet Tooth Substitutes
59. Hormone Therapy, Vitamins Don't Help Heart: Study
60. Anger Tears Your Heart Apart
61. Filters Reduce Angioplasty Risks
62. Statins Help Those With Heart Valve Problems
63. Blood Test May Identify Ovarian Cancer: Study
64. Stem Cell Study May Aid Diabetics
65. New and Improved CPR
66. Gene, Ulcer Bug Types Linked to Stomach Cancer
67. Controlling Hypertension Doesn't Help Kidney Function
68. More Liquor Stores, More Cases of Domestic Abuse
69. Doctors' Groups Issue Migraine Guidelines
70. AHA Responds to Atkins Study Reports
71. Too Many College Kids Ignore Dangerous Allergies
72. US Report Backs 'Closed' Open Heart Surgery
73. US Study Finds Equal Costs for Heart Techniques
74. For-Profit Dialysis May Be Deadlier for Patients
75. US Study Sees Better Carotid Artery Procedure
76. Sleep Apnea, Stuttering May Be Linked
77. New Compounds May Block Cancer Spread to Bone
78. Study Shows Some Crib Deaths Are Heart-Related
79. Many U.S. Adults Not Controlling Blood Pressure
    
    MONDAY, NOVEMBER 18, 2002 
    
    
80. Many Schools Bar Allergy, Asthma Meds, Group Says
81. Savvy Food Shopping
82. Popular Buckwheat Pillows May Trigger Allergy
83. Herbal Menopause Remedy Ineffective
84. US Study Finds Offspring of Centenarians Healthier
85. The Inherited Benefit of Old Age
86. Tiny Water-Borne Bugs Could Be Allergen
87. Hospice Care Is Being Started Later
88. Study: Older Patients Benefit from Statin Use
89. Secondhand Smoke Bad for Kids
90. Cells Engineered Into Blood Vessels, Pacemakers
91. Blood Thinner May Cut Death Risk
92. Drug Cuts Women's Stroke Risk-Study
93. Treatment Guidelines Call for ACE Inhibitors
94. Dutch Board to Study Risks of Antidepressant Drug
95. Kids' Acupuncture Gaining Interest
96. Study Backs Longer Post-Angioplasty Therapy
97. New Drug Found to Fight Anthrax
98. Unstable Chromosomes Could Kick Off Colon Cancer
99. Cholesterol Drugs May Aid Elderly
100. Some Over-The-Counter Drugs Can Ease Migraines
101. Coffee Jitters? Don't Blame the Caffeine
102. Hormone Therapy, Alcohol Use Studied
103. Marrow Transplant Grows New Vessels in Legs
104. Fat Lurks Behind Slim Asian Frames
105. Spinal Tap May Help Alzheimer's Diagnosis
106. Tissue May Help Fix Damaged Hearts
107. A Fish a Day Keeps Heart Woes at Bay
108. Court Refuses Organ Harvesting Case
109. Springtime Ragweed Allergy Is Real, Study Finds
     
     SUNDAY, NOVEMBER 17, 2002 
     
     
110. Emergency Angioplasty Alone Works
111. Marrow, Muscle Grafts Revive Broken Hearts
112. Research Offers New Hope for Heart Bypass Patients
     
     SATURDAY, NOVEMBER 16, 2002 
     
     
113. Drug-Resistant Germs: Food for Thought
114. Fighting Fat in Kids
115. A New Look at Lyme Disease
     

FRIDAY, NOVEMBER 22, 2002 

Acne Cream Also Eases Wrinkles in Older People

 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, November 22, 2002

FRIDAY, Nov. 22 (HealthScoutNews) -- A prescription acne cream appears to moderately reduce sun damage in older people, says new research.

Tazarotene cream, known by the brand name Tazorac, is in the same Vitamin A family as Retin-A, another acne drug considered to be a potent wrinkle reliever. While federal officials have already approved the drug for use by people with sun damage, the study's authors say their research, which was funded by the makers of the cream, offers more proof of its value.

"The cream was better than moisturizer alone in improving fine wrinkling and mottled pigmentation of the skin, in combination with protecting skin from the sun," says study co-author Dr. Tania J. Phillips, a professor of dermatology at the Boston University School of Medicine.

Sun damage to skin begins at the first exposure to sunlight and accumulates over a lifetime, says Dr. Richard G. Glogau, a clinical professor of dermatology at the University of California at San Francisco. Ultraviolet light penetrates the skin and damages its internal structure by wreaking havoc on the DNA of cells, he explains.

"The initial changes are a loss of 'glow,' change in pigmentation -- freckles, splotchiness, brown or muddy tones -- and damage to elastic and collagen fibers resulting in wrinkles and fine lines," he adds.

In its worst forms, sun damage can lead to skin cancer. More commonly, it simply makes people look old and leathery.

In the study funded by the pharmaceutical company Allergan, which makes tazarotene cream, researchers recruited 563 people with sun damage and told all of them to apply a cream to their face each day for six months. While the subjects didn't know it, half of them received a 0.1 percent tazarotene cream, while the others used a non-medicated cream.

All of the people in the study had to have mottled discoloration of the skin and fine wrinkling to be enrolled, Phillips says. Researchers also looked at age spots, yellowish leathery skin, white spots, large pores, skin roughness, dilated blood vessels and precancerous spots.

A total of 511 patients finished the study; their average age was 56 and almost all were women. Compared to those who received the placebo cream, those who used the tazarotene cream looked better at the end of treatment, the researchers say.

Among other things, the tazarotene users had less wrinkling, mottled pigmentation and skin roughness. Most of the patients continued using the tazarotene cream for another 28 weeks, and researchers reported that their faces continued to improve.

However, 20 of the 283 patients initially treated with tazarotene cream had to stop because of side effects. Among other things, the drug can cause peeling, redness, burning and dryness, Phillips says.

The study, which appears in the November issue of the Archives of Dermatology (news - web sites), didn't compare tazarotene cream to other drugs. However, Phillips says the findings suggest that it works about as well as other medications in the Vitamin A family. Those drugs appear to work by boosting production of a component of skin known as collagen, she explains.

Glogau says tazarotene cream may be a good alternative to Retin-A (known by the brand name Renova) because it may work more quickly and be less irritating. However, he adds, "the endpoints are still the same."

What To Do

To find the daily level for ultraviolet rays in your city, check The Interactive Weather Information Network. To see how knowledgeable you are about sun damage and its connection to skin cancer, take this test from the American Academy of Dermatology.

BACK TO TOP 

Some Teens Deliberately Harm Themselves

 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, November 22, 2002

FRIDAY, Nov. 22 (HealthScoutNews) -- New British research confirms something that psychologists across the Atlantic have already discovered: It's not uncommon for teenagers to try to harm themselves, especially through rituals like cutting.

Sometimes, suicide is the goal of those self-inflicted injuries.

Seven percent of British teens surveyed admitted that they had tried to harm themselves within the past year. By comparison, U.S. studies have found that about 8 percent of high school students said they had tried to commit suicide during the same time period, says Daniel Romer, a suicide expert and research director for the University of Pennsylvania's Institute for Adolescent Risk Communication.

"We get a remarkably similar percentage," Romer says.

British researchers surveyed 6,000 students aged 15-16 from 41 schools in England. The surveys were anonymous.

The findings appear in the Nov. 23 issue of the British Medical Journal.

While 7 percent of the students reported trying to hurt themselves, only 13 percent of the incidents resulted in a trip to a hospital.

By contrast, American research shows that teens in the United States who try to commit suicide appear to be much more likely to do serious harm to themselves, Romer says.

About two-thirds of the British incidents involved teens who cut themselves. Most of the rest involved drug overdoses, sometimes of painkillers, says study co-author Keith Hawton, a professor of psychiatry at the Center for Suicide Research at Warneford Hospital in Oxford, England.

The British study also found that females were four times more likely to try to hurt themselves than males. Both boys and girls were more likely to harm themselves if they used drugs, suffered from low self-esteem, or were exposed to friends or family members who were violent toward themselves. "Self-harm" problems among girls were aggravated by depression, anxiety and impulsive behaviors, according to the study.

Both sexes attributed their desire to hurt themselves to depression and problems with family members and boyfriends or girlfriends, Hawton says.

Britain is stepping up efforts to prevent suicide and self harm among teen-agers, Hawton says.

Romer says the issue is also getting more attention in the United States, especially since the Centers for Disease Control and Prevention (news - web sites) issued guidelines to schools last December about the prevention of self-inflicted injuries among teens.

"Schools can definitely do more in the way of suicide prevention to help those at risk, including programs to reduce stigma for seeking help, crisis management for those who identify themselves as suicidal, and primary prevention in the curriculum," he says.

The challenges in the future include figuring out how to prevent depression in teens and determining the best ways to identify suicidal teens, Romer says.

What To Do

For suicide prevention resources, try the American Foundation for Suicide Prevention or the National Center for Injury Prevention and Control.

BACK TO TOP 

Study Links Cancer Rates, Prevention

 

By Justin Pritchard

Associated Press Writer

The Associated Press

Friday, November 22, 2002

SAN FRANCISCO (AP) - Many states with the highest lung cancer rates are squandering tobacco settlement money intended for disease prevention on unrelated programs, according to a study of health and fiscal data released by a national anti-cancer group.

Anti-smoking advocates say states with the gravest need for stop-smoking programs often spend the least on them.

In 1998, 46 states won $206 billion from major cigarette makers. Since then, policy-makers have struggled over how much of that money should be earmarked for anti-smoking programs.

Many states have missed an important opportunity, according to the report by the non-profits Cancer Care and The Chest Foundation.

Last year, the 10 states with the highest lung cancer rates received an average of more than $29 per person in settlement funds and the Centers for Disease Control recommended they spend about $7 per person on tobacco-control programs, the study said.

Instead, lawmakers in those states, which include several in the South, allocated an average of a little less than $2 on tobacco-control programs, according to the study released Thursday.

States got an average of nearly $164 million, yet allocated just 6 percent for tobacco control, the study said. That ended up being less than half the CDC-recommended level of $7.47 per person.

The cold realities of budget deficits make the settlement money an attractive option for cash-strapped states. And earlier this week, a federal appeals court here reaffirmed states' right to spend settlement funds at their discretion.

But that doesn't make it sound policy, according Mike Moore, Mississippi's attorney general, who spearheaded the settlement.

"They think that the money just fell out of heaven, and, 'OK, I have a deficit,' or 'I have a political whim,' or 'I need to build a highway,'" Moore said Thursday in an interview at a national anti-smoking conference here. "I call it moral treason. I call it stupid. It's so shortsighted."

According to the American Cancer Society (news - web sites), 170,000 Americans will be diagnosed with lung cancer this year. Researchers believe more than 90 percent will die from the disease.

Smoking prevention programs such as ad campaigns and buying-age enforcement can save tens of thousands of lives annually, anti-cancer advocates say.

"We've developed a cure for lung cancer," said Gregory Connolly, director of the oft-lauded Massachusetts Tobacco Control Program. "All we need is the political will to apply it."

Several states confronted the issue on Election Day. Montana voters passed a measure directing that a larger share of its settlement money be spent on health and anti-smoking programs; Michigan voters rejected a similar proposal.

With 122 deaths per 100,000 men during the mid-90s, Kentucky had the highest rates of lung cancer — but the state spent less than $1 per person of federal anti-tobacco funds.

At the other extreme, Mississippi spent nearly twice the CDC-recommended $6.88 per person on smoking cessation programs. Its cancer rate was 84 deaths per 100,000 men.

Lawmakers in some states have "securitized" future settlement money to plug holes in their budgets.

California's current budget, for example, includes $4.5 billion in expected settlement receipts — money that helped fill a $23.6 budget shortfall.

In 2001, California received $22.41 per person from the settlement but spent just $3.44 on anti-smoking programs — the CDC suggested a $5.12 per capita expenditure. Its cancer rate was 66 deaths per 100,000 men.

"The budget situation was such that we had to come up with a multifaceted solution," said Anita Gore, spokeswoman for California's finance department. "The tobacco settlement securitization allows us to keep from making further, deeper cuts in health programs and social services programs."

On the Net:

http://www.lungcancer.org/

BACK TO TOP 

Statins Found Safe, Effective for Elderly

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Friday, November 22, 2002

FRIDAY, Nov. 22 (HealthScoutNews) -- Pravastatin, a cholesterol-lowering medicine often used by middle-age people, is also safe and effective in reducing heart disease in the elderly, new Scottish research shows.

Researchers from the University of Glasgow divided 5,804 men and women ages 70 to 82 into two groups. Half were given 40 milligrams a day of pravastatin for three years. The rest took a placebo.

All the people in the study had a history of heart disease or were at high risk of developing heart disease because of diabetes, smoking, or hypertension.

At the end of the research, the group taking pravastatin had a 15 percent reduction in the incidence of heart disease and heart attacks compared to the group on the placebo, according to the study, which is published in tomorrow's issue of The Lancet. Those on the drug saw their bad cholesterol levels fall 34 percent, and the overall death rate was 20 percent lower in the pravastatin group.

"The study provides clear evidence that, as in middle-aged people, statin therapy in elderly individuals reduces the risk of coronary disease," wrote the authors.

The study was funded by Bristol-Myers Squibb, which makes pravastatin under the brand name Pravachol. The authors say the company had no role in the research or writing of the report.

Statins are a class of drugs that are known to reduce low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol.

Most previous research on statins has been in middle-age men and women, said Dr. Dan Fisher, a cardiologist at New York University Medical Center. As a result, doctors are typically very hesitant to prescribe statins to older people because little was known about what effect they might have, Fisher added.

"The biggest reason for the caution was a fear of side effects and intolerability in the elderly," Fisher said. "And there was a lack of research showing the benefits in older patients."

This new study makes him more confident of statin safety and effectiveness, Fisher said. "The study isn't perfect, but it's good evidence showing a benefit of pravastatin in the elderly population."

Still, some previously touted benefits of statins didn't pan out in the study.

Earlier research had shown that statins can reduce the incidence of stroke, but the Scottish study found no such evidence. However, the incidence of "mini-strokes" was 25 percent lower.

The authors did note that the study lasted only three years. Previous research that found a reduction in stroke had lasted five years.

"Maybe they would have seen a difference if they'd followed the patients a few years longer," Fisher said.

What To Do

Read more about statins at the National Heart, Lung and Blood Institute. The American Heart Association has information on lowering cholesterol and other treatment options for heart disease.

BACK TO TOP 

Acupuncture May Help Ward Off Migraine

 

Reuters Health

Friday, November 22, 2002

NEW YORK (Reuters Health) - Women who opt for acupuncture instead of a drug to prevent migraines report feeling fewer initial symptoms, attacks, and side effects from the treatment, new study findings report.

Dr. Gianni Allais of the Woman's Headache Center in Torino, Italy, and colleagues found that women who received acupuncture reported fewer migraine attacks during the first 4 months of treatment, and less need for pain medication during the initial treatment period, than did those who took flunarizine to prevent migraines.

However, by 6 months, there were no differences between the two groups in terms of the number of headaches.

The people included in this study suffered from migraines without auras, which are visual disturbances and other symptoms that signal an impending migraine attack. Flunarizine belongs to a class of drugs known as calcium channel blockers, and is often used to help people prevent migraines.

Migraines are marked by intense, throbbing pain, sensitivity to light and sometimes nausea and vomiting. The process underlying migraine headaches is not fully understood, but researchers generally believe that it involves some changes in the brain's blood vessels.

An ancient therapy that arose in China more than 2,000 years ago, acupuncture involves placing fine needles at specific points on the body's surface. Traditional theory holds that these points connect with energy pathways, or meridians, that run through the body, and acupuncture helps keep this natural energy flow running smoothly.

Previous studies have suggested that acupuncture may help relieve people from new migraine episodes, but these studies have typically included design flaws.

During the current study, reported in the recent issue of Headache, Allais and colleagues asked 80 women to undergo acupuncture once each week for 2 months, then once monthly for an additional 4 months. Needles were placed in the same points during each treatment, and left in the patient's body for 20 minutes.

Another group of 80 women took the drug flunarizine, 10 milligrams each day for 2 months, then 20 times per month during the next 4 months.

Both treatments worked, and the women experienced fewer headaches overall. However, women who used acupuncture had fewer migraines than did those taking flunarizine during the first 4 months of the study (an average of 2.3 in the acupuncture group versus 2.9 in the flunarizine group). What's more, acupuncture appeared to reduce the strength of migraine pain and lower the need for patients to take medicine to relieve their pain. Six months after the therapy started, the groups were similar in terms of number of headaches.

Overall, women taking flunarizine were more likely than those receiving acupuncture to drop out of the study, for reasons that included depression, weight gain and sleepiness.

However, the authors note that a greater "placebo effect" could have occurred in patients getting acupuncture, as they received "much more attention and hands-on treatment" than those taking medication.

Source: Headache 2002;42:855-861.

BACK TO TOP 

Study Ties IVF To Rare Birth Defect

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Friday, November 22, 2002

FRIDAY, Nov. 22 (HealthScoutNews) -- In vitro fertilization (IVF) procedures may be associated with a rare birth defect syndrome that predisposes children to certain cancers, scientists say.

However, an IVF pioneer says the study is small, the association is not proven, and there is absolutely no cause for concern until much more research is done.

The study authors agree that the findings need to be validated and the association needs to be confirmed by looking at larger numbers of people.

The research is "not trying to raise a red flag," says Dr. Andrew Feinberg, a professor of medicine at Johns Hopkins and co-author of the study, published online now and in the January 2003 issue of the American Journal of Human Genetics. However, the issue, he says, "deserves study."

Feinberg and his co-author, Dr. Michael DeBaun of Washington University School of Medicine in St. Louis, looked at data from a national registry of patients with Beckwith-Wiedemann syndrome (BWS), a rare condition marked by excessive growth of various tissues in the body. The registry was set up in 1994.

They found that IVF-initiated conception was six times more common in the registry than in the general population.

In all, they found seven infants in the registry of 344 who had been conceived via IVF. At least five had been conceived with a procedure called intracytoplasmic sperm injection, in which a single sperm is injected into a mature egg to overcome male fertility problems.

BWS affects about one of every 15,000 newborns, occurring when genes are abnormally altered. The alternations are not to the DNA sequence itself, Feinberg says, but are so-called "epigenetic" changes, ones that modify the gene in some way other than changing the DNA sequence.

Children born with BWS may have an enlarged tongue, defects in the abdominal wall, weigh more than most children, have earlobe creases or pits behind the upper ear, and other characteristics. Experts say the condition may predispose children to a malignant kidney condition called Wilms tumor, neuroblastoma (a malignant tumor in the autonomic nervous system or in the adrenal gland), and other cancers.

The study originated by chance, Feinberg says. "Mike [DeBaun, his co-author] had noticed there were a fair number of patients who had been born via IVF. So, two years ago we decided to add to the questionnaire and ask, 'Did you have assisted reproductive technology?'"

Exactly how IVF and the syndrome might be associated is not known, Feinberg says. It might be some aspect of the culture during the procedure or the method of combining the sperm and the egg.

Feinberg emphasizes that the finding should not cause concern for those who have used IVF or most who are considering it. "If someone has a family history of BWS, they should probably talk to a genetic counselor," he says.

An IVF pioneer says there is absolutely no cause for concern. "The problem with this report is that it's not really a formal study looking at Beckwith-Wiedemann syndrome and IVF," says Dr. Richard P. Marrs, director of the Center for Reproductive Medicine at Santa Monica-UCLA Medical Center. "Basically, what they've got are seven kids born via IVF with BWS out of 344 in the registry."

That's a small number, he notes, considering the number of children born via IVF annually, and it's not certain that the IVF had an impact on the development of the disorder. More than 30,000 births in the United States were IVF-assisted in 1999, the latest year for which figures are available from the U.S. Centers for Disease Control and Prevention (news - web sites).

Feinberg counters that it was a formal study, that they systematically assessed the method of conception and found that the prevalence of assisted reproduction births in the registry was six times the number of assisted reproduction births in the United States as a whole.

Overall, Marrs says, research has shown the incidence of abnormalities in IVF babies is actually lower than in natural birth babies year to year. That's partly due, he says, to the selection process in IVF, in which the healthiest embryos are selected.

"What they need to do, if they are saying this syndrome is related to IVF -- which it could be, but we don't know -- is to look at 30, 40, 50 thousand IVF births." That would give a more accurate picture, Marrs says, and help the scientists determine if there is a true cause-and-effect relationship.

Feinberg says they want to look at bigger numbers, too, and hope to work with the IVF community to research the association they found more intently.

What To Do

For more information on infertility, go to the American Society for Reproductive Medicine. For information on Beckwith-Wiedemann syndrome, visit the Beckwith-Wiedemann Support Network.

BACK TO TOP 

Arthritis of Spine Often Not Diagnosed

HealthScoutNews

Friday, November 22, 2002

FRIDAY, Nov. 22 (HealthScoutNews) -- A new survey says many people who suffer from arthritis of the spine experience delayed diagnosis, putting them at increased risk for permanent spinal damage.

Ankylosing spondylitis (AS) typically strikes people in their 20s. The disease can progress to the point where the spine fuses, making it difficult or impossible for a person with the disease to move the spine or neck.

The survey included more than 2,000 people with AS and was commissioned by the Spondylitis Association of America. It found that 61 percent of the people with AS have symptoms by the time they're 29, and that many have to see a number of doctors before they receive a correct diagnosis.

The survey found that 54 percent of the respondents weren't diagnosed with AS until at least five years after initial symptoms, and 30 percent said they had to wait more than 10 years before they were diagnosed with AS.

Almost a quarter of the respondents said they saw at least five health professionals during their efforts to get a diagnosis.

Two out of three of the people in the survey said that AS has forced them into a foward-stooping posture, and 55 percent said they have at least partial fusing of the spine.

About 60 percent said AS limits their ability to walk, get into a car, sleep and/or have a satisfying sex life, and 25 percent said AS forced them to change their job or career.

Early warning signs of AS include: gradual onset of lower back pain before age 35; early-morning spine stiffness; pain and stiffness that worsen with immobility; pain and stiffness that improve with physical activity; symptoms that last longer than three months.

Treatments for AS include stretching and strengthening exercises, deep breathing, attention to posture, and medicines to counter pain and stiffness.

More information

To learn more, go to the Spondylitis Association of America.

BACK TO TOP 

Frailty in Elderly Isn't Automatic

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Friday, November 22, 2002

FRIDAY, Nov. 22 (HealthScoutNews) -- Frailty is a specific medical condition characterized by muscle weakness, lack of stamina, and weight loss.

And not everyone becomes frail as he or she ages. In fact, most people do not.

Now, researchers at Johns Hopkins University are beginning to discover why. It turns out that some people seem to be predisposed toward frailty, because they have certain biological "markers" such as inflammation, insulin resistance and increased blood-clotting activity.

By identifying these markers, doctors could potentially prevent or delay the onset of frailty.

"This is a very young field, but our hypothesis is that frailty is a biological syndrome, and that the weakness of frailty is a manifestation of something else," says Dr. Linda Fried, director of Johns Hopkins' Center on Aging and Health, and senior author of a study of frailty in nearly 5,000 people over the age of 65.

"We are pretty sure that this biology is complicated. Many systems are affected by aging, and it is the multitude of systems that are affected that create frailty," she says.

This is important, Fried says, because people afflicted with frailty are those most likely to suffer in old age.

"This is a most vulnerable, high-risk subset of older adults who are most likely to be hospitalized, become disabled and dependent," says Fried.

"There is a continuum of the severity of frailty, and a lot of the consequences may not be remediable, but there is evidence that some consequences are potentially preventable or treatable," she adds.

The results of Fried's study appear in the November issue of Archives of Internal Medicine (news - web sites). It uses data from the Cardiovascular Health Study and was supported by the National Institutes of Health (news - web sites).

Dr. Robert McCann, a geriatric specialist at the University of Rochester in New York, calls Fried's research a "fascinating study, the first that begins to explore the markers for frailty. Now we can start to come up with predictors for this condition, knowing that physical vulnerability doesn't necessarily have to lead to disability."

In the study, Fried and her colleagues found an association between frailty and increased inflammation, insulin resistance and increased blood-clotting activity.

Inflammatory cells are always present in the blood. But when they are stimulated over a long period of time, they have an adverse effect on many biological functions, Fried says.

"When stimulated, inflammatory cells can cause arthritis, contribute to the development of arteriosclerosis, and those with chronic inflammation are likely to lose muscle and bone mass," she says.

Those study subjects diagnosed with frailty were also more likely to suffer from insulin resistance, when the body is not able to use the insulin produced by the pancreas, the study reports.

Frailty was also associated with a mild increase in blood-clotting activity, Fried says, "which could be a consequence of chronic inflammation."

In the study, Fried and her colleagues used standardized criteria to identify frailty, including measuring grip strength, walking speed based on a distance 15 feet, unintentional weight loss of more than 10 pounds a year, daily feelings of exhaustion, and physical activity that used fewer than 400 calories a week.

Overall, 6.3 percent of the 4,735 study participants, age 65 or older, met the criteria of frailty. There were more frail women (7.3 percent) than men (4.9 percent). Forty-eight percent of the study participants were not frail, and 45.3 percent fell in an intermediate range, with some characteristics of frailty.

The prevalence of frailty increased with age, with 2.5 percent of those aged 65 to 70 meeting the criteria for frailty; 32 percent of those aged 90 and older met the criteria.

"We don't want people to run out and start taking anti-inflammatory medicine. Those decisions need to be based on more conclusions than we know now," Fried says. "But we could envision developing treatments to decrease frailty."

What To Do

The importance of exercise as you age is outlined at the National Institute on Aging. Because the Hopkins' study says women are at higher risk for frailty, they should check these American Medical Association tips for women and exercise.

BACK TO TOP 

Past Yo-Yo Dieting Cuts Women's Weight Loss Success

 

By Charnicia E. Huggins

Reuters Health

Friday, November 22, 2002

NEW YORK (Reuters Health) - Overweight middle-aged women who want to shed a few pounds will be most successful if they are highly motivated, if their ideal weight is not vastly different from their actual weight, and if their dieting history does not include yo-yo dieting, according to study findings.

The findings may help women and weight-loss specialists predict if an individual will be successful in achieving their desired weight reduction.

"One has to be aware of their individual psychological status and history because it can limit their success in following any program," study author Dr. Timothy G. Lohman, of the University of Arizona in Tucson, told Reuters Health.

In short, he explained, "you need to understand your own barriers to eating less and exercising more to be successful."

Lohman and his colleagues looked at 112 overweight women, aged 40 to 55, who were enrolled in a 2-year weight loss and maintenance program. Their findings are based on the women's success during the first 4 months of the program.

All of the women lost some weight during the study, the investigators report in the December issue of the Journal of Behavioral Medicine.

However, the 37 women who were most successful in losing weight initially reported the lowest number of recent and repeated diet attempts and the highest levels of body satisfaction--i.e. their target weights were the closest to their actual weights, the report indicates.

These women lost 6.4 or more kilograms (about 14 pounds) and achieved a minimum 90% of their target weight loss, the report indicates.

The least successful women, in contrast, achieved only about 25% of their target weight loss, losing a maximum 1.9 kilograms (about 4 pounds).

These women initially reported a history of yo-yo dieting, higher levels of body dissatisfaction, lower self-esteem and lower self-motivation to lose weight. They also indicated that they would be less satisfied with smaller weight losses at the start of the study and perceived their weight to have a greater impact on their quality of life, particularly their work life.

In light of these findings, "an assessment of weight loss readiness before an attempt to lose weight would help women be aware of their barriers or resistance to weight loss," Lohman said.

Source: Journal of Behavioral Medicine 2002;25:499-523.

BACK TO TOP 

Snug as a Bug

HealthScoutNews

Friday, November 22, 2002

(HealthScoutNews) -- If you toss and turn at night, the Johns Hopkins Medical Institutions suggests some strategies for catching some undisturbed zzzz's:

• Limit late night TV and reading time.
• Keep your room on the cool side.
• Some constant background noise can help filter out distractive sounds, for example, you can buy a white noise machine or turn on a bedside fan for a gentle background hum.
• If sleeplessness persists, discuss your problem with a doctor.

BACK TO TOP 

Mail-Order Drugs Get High Marks, Some Glitches

 

By Karen Pallarito

Reuters Health

Friday, November 22, 2002

NEW YORK (Reuters Health) - An overwhelming percentage of patients who use mail-order pharmacies to fill prescriptions say, on the whole, they are highly satisfied with the option, a new survey finds.

The survey underscores what pharmacy benefit managers (PBMs) claim are key advantages of mail service: that it's often more convenient and less costly for patients and delivers a high quality of care. PBMs are companies that negotiate on behalf of clients to get drug discounts.

But the report also reveals far less enthusiasm about the timeliness of prescription deliveries, the ability of customer service to answer questions, and all aspects of mail-service pharmacies' Internet services.

Mail service is booming in the US, accounting for 15.7% of all retail sales in 2001, according to NDCHealth, an Atlanta-based healthcare information service company. It also represents a growing source of revenue for PBMs with mail-service operations. PBM companies are aggressively pushing mail service, sometimes called "home delivery," as a way to save clients money and provide added convenience.

Medco Health Solutions, the largest of the mail-service providers, filled about 75 million prescriptions by mail last year, roughly 50% more than its three largest competitors combined. The company, a unit of Merck & Co., has a good track record when it comes to customer service. For 4 straight years, it ranked highest in overall customer satisfaction in surveys by JD Power and Associates.

Ann Smith, a Medco Health spokeswoman, says the high scores partly reflect the company's unique focus on the distinct components of providing home delivery. Prescription processing and review, drug dispensing and customer service are handled separately by the company's processing pharmacies, dispensing pharmacies and customer call centers.

While not a panacea for rising healthcare costs, many health plan sponsors see home delivery as part of the solution. Patients often pay the same co-payment for a 90-day supply of medication by mail as they do for a 30-day supply filled at their local pharmacy, so mail service can reduce their out-of-pocket expenses.

Last fall, the Pharmacy Benefit Management Institute (PBMI), an independent organization that conducts research for the PBM industry, surveyed people who use mail-service pharmacies as part of a managed prescription drug benefit program. The findings are based on a sample of more than 13,000 people nationwide.

Nearly 9 out of 10 respondents (88%) said they were pleased with overall performance of their mail-service pharmacy. Seventy percent were very satisfied.

Virtually all (95%) agreed they use mail service because they pay less than they would at a retail pharmacy. Eighty-two percent use it because it's more convenient than a retail pharmacy, the survey found.

But mandates also appear to be a significant factor in driving mail service. Half of all patients said they use it because their benefit provider requires them to do so.

"Patients' high satisfaction levels make mail-service pharmacies among the fastest growing ways for Americans to get prescription drugs," according to the Pharmaceutical Care Management Association, which represents the PBM industry. The association cites data from IMS Health showing 22% year-over-year growth in mail-service pharmacy sales for the period ended June 2002.

But the PBMI report reveals certain weaknesses in mail service. Only 65% of patients were highly satisfied with the timeliness of their prescription delivery, for example. Timely delivery was the area of performance in which the lowest- and highest-rated mail-service pharmacies showed the greatest gap in satisfaction.

The survey also found that just over half (62%) were highly satisfied with the ease of reaching a pharmacist.

By contrast, most Americans live within 5 miles of drugstore where they can get help from a pharmacist if they need it, noted Crystal Wright, a spokeswoman for the National Association of Chain Drug Stores.

"Consumers should ask themselves, 'If I have a very serious problem or question about a medication, how easy is it for me to get in touch with a real, live pharmacist rather than a customer service representative?"' Wright said.

"For really ill patients or patients taking multiple medications, it can be a problem when economically they're forced to use mail order and taken out of the retail setting where they have access to a pharmacist," she told Reuters Health.

BACK TO TOP 

Nose Bleed

HealthScoutNews

Friday, November 22, 2002

(HealthScoutNews) -- Is your kid a nose-bleeder?

The American Academy of Pediatrics has this advice for curbing the flow:

• Keep the child in a sitting position with his head tilted slightly forward.
• Squeeze both nostrils between your thumb and index finger for 10 minutes.
• This should stop the bleeding. If it doesn't, call your doctor or go to the emergency room.

BACK TO TOP 

More Boy Babies Born Late Than Girls

 

Reuters Health

Friday, November 22, 2002

NEW YORK (Reuters Health) - Boy fetuses are more likely to extend their stay in the womb beyond their due date than girls, a new report suggests.

But the reasons for the difference are unclear, the team of US and Swedish researchers concludes.

Based on the most recent data, a pregnancy should be considered prolonged if it lasts for 41 weeks or longer, Dr. Michael Divon of Lenox-Hill Hospital in New York City and colleagues from Lenox-Hill and Sweden's Karolinska Institute note in their report. Babies born after extended pregnancy face an increased risk of health problems and death.

In some cases, a rare enzyme deficiency found only in males can cause the fetus to produce too little estrogen, prolonging the pregnancy. To see if fetal gender itself might be linked to extended pregnancy, Divon and colleagues studied nearly 660,000 babies delivered in Sweden between 1987 and 1996.

The investigators found that, on average, males spent about one day longer in the womb than females. And 26.5% of male babies were delivered at 41 weeks or later, compared with 22.5% of females, while 7.6% of males and 5.5% of females spent 42 weeks or longer in the womb. Males were 1.5 times more likely than females to be born at 43 weeks or later.

The most common reason for prolonged pregnancy, the researchers note, is a mistake in the determination of a baby's due date. Women having their first babies are also more likely to deliver late, as are women who have had prolonged pregnancies in the past. Fetal abnormalities can also lead to extended pregnancies.

But none of these reasons adequately explain the gender gap seen in the study, the authors note.

It's possible that the results might be different if conducted in North America or other ethnically diverse populations, or those with different obstetric practices, according to the report. "However, our results raise the possibility that gender-specific mechanisms are involved in the initiation of labor and delivery in the human subject."

Source: American Journal of Obstetrics and Gynecology (news - web sites) 2002;187:1081-1083.

BACK TO TOP 

Cockroaches a Health Threat to Older, Urban Asthmatics

By Richard Zitrin
HealthScoutNews Reporter

HealthScoutNews

Friday, November 22, 2002

FRIDAY, Nov. 22 (HealthScoutNews) -- Cockroaches may be more than a nuisance to many city dwellers. The elusive insects also may be a danger to their health.

Researchers say cockroach allergens may be a major contributor to the health problems of urban asthma sufferers of all ages, now that a new study is shining light on the extent of the threat to people aged 60 and older.

The study by researchers at New York University School of Medicine shows cockroach allergens are a leading cause of increased breathing problems for nearly half of elderly urban asthma sufferers.

"Research has shown cockroach as the most significant allergen in children and adults with asthma. However, there is very little known about asthma and the elderly," says Dr. Linda Rogers, lead author of the study. "This study suggests that cockroach is a highly significant allergen to all age groups."

Dr. Dennis Ownby, an allergist at the Medical College of Georgia, says he's not totally surprised by the study, since cockroaches are probably the leading allergen for people living in urban areas. However, he adds, he was struck by the study's finding that so many older asthma sufferers are still allergic to cockroaches.

"I think there's a bias among physicians that while allergies may contribute to the severity of asthma in children and young adults, we typically think that among older adults, there's almost no relationship between allergy and the severity of asthma," Ownby says. "There's kind of a general presumption that the older you get, the less likely allergy plays a role in your asthma."

"It's generally accepted cockroach is a very important allergen in the inner city, it's just kind of surprising in this 60 and up age group to see that half of them are still sensitive to cockroach and that it does seem to make a real difference to their asthma," he says.

Rogers, an assistant professor of medicine at New York University's School of Medicine and an attending physician at Bellevue Hospital Asthma Clinic, had a similar reaction to her study's findings because there has been a perception in the medical community that older asthmatics generally do not have allergies.

"We're actually surprised by how much allergy there was in our elderly population," Rogers says.

The study sends the message that older asthmatics in urban areas, as is the case with any city dweller suffering from the disease, should try to take steps to better manage their environments, including trying to get rid of cockroaches in their midst, Rogers says.

The problem, as people who have had cockroaches scurrying around their homes know, is that it's not so simple.

"Easier said than done," Rogers admits.

She points to a study several years ago on the link between cockroach allergies and increased visits to the emergency room for city children with asthma.

"They went into a number of buildings and tried to eradicate [the cockroach problem], but what they found is you get rid of them in one apartment and they come in next door essentially," Rogers says. "So even with very extensive measures, it's difficult to get rid of them."

The NYU study, which is published in the new issue of Chest, involved 45 non-smoking asthma patients evaluated at Bellevue Hospital Asthma Clinic between 1991 and 1998.

Tests showed that 53 percent of the patients were sensitized to at least one indoor allergen and 20 percent were sensitized to at least one outdoor allergen.

The leading indoor allergen was the cockroach. Forty percent of the subjects in study were allergic to the nocturnal insect.

The patients allergic to indoor allergens suffered decreased lung function, but there was no correlation between pulmonary function and outdoor allergens.

More than 17 million people in the United States have asthma, and more than 5,000 people die from the disease each year, according to the American Academy of Asthma, Allergy and Immunology.

Asthma is a chronic disease in which air flow to and from the lungs may be blocked by muscle squeezing, swelling and excess mucus.

What To Do

To learn more about asthma and allergies, visit the American Academy of Allergy, Asthma and Immunology or the Asthma and Allergy Foundation of America. To learn more than you probably want to know about cockroaches, try this PBS site.

BACK TO TOP 

Report Supports Folic Acid for Heart Health

 

By Amy Norton

Reuters Health

Friday, November 22, 2002

NEW YORK (Reuters Health) - High blood levels of the amino acid homocysteine may raise the risk of heart disease, stroke and blood clots in the legs, a new study confirms. The good news, researchers say, is that supplements containing the B vitamin folic acid might help reduce this risk.

Homocysteine is a normal byproduct of metabolism, but high levels of the amino acid in the blood have been linked to heart disease, stroke and blood clots. Folic acid is known to aid in breaking down homocysteine, and researchers are studying whether the vitamin can help ward off cardiovascular disease by lowering homocysteine in the blood.

But while this question is not yet answered, existing research gives "strong evidence" that high homocysteine levels do promote cardiovascular disease, according to the new report, published in the November 23rd issue of the British Medical Journal.

The researchers, led by Dr. David S. Wald of Southampton General Hospital in the UK, base that conclusion on their review of 92 studies on homocysteine and cardiovascular disease risk.

Across the studies, they report, each unit increase in blood homocysteine was associated with a 32% to 42% increase in the risk of ischemic heart disease, in which blood flow to the heart is reduced. Similar patterns were found for stroke and deep vein thrombosis (DVT)--blood clots in deep veins, usually in the legs, that can be life-threatening if they dislodge and travel to the lungs.

On the bright side, though, Wald's team estimates that lowering homocysteine levels by an amount achievable with daily folic acid supplements could cut the risks of heart disease, stroke and DVT.

To "maximally" cut homocysteine levels--and, potentially, disease risk--a person would have to take about 0.8 milligrams (mg) of folic acid a day, according to Wald's team. US dietary recommendations call for adults to get 0.4 mg of folic acid daily.

In the US, where many grains are fortified with folic acid, Wald told Reuters Health, a healthy diet plus a daily multivitamin containing folic acid may help maintain normal homocysteine levels.

"Adults," Wald said, "particularly those aged 55 and older, stand to benefit from taking a folic acid supplement everyday."

Currently, the American Heart Association (news - web sites) does not recommend taking folic acid specifically for the prevention of cardiovascular disease, due to the lack of studies showing the vitamin prevents these conditions. However, it does advise that people at risk of cardiovascular disease be especially sure to get enough folic acid, as well as vitamins B-6 and B-12, in their diets.

Besides fortified grains, good dietary sources of folate--the form of the vitamin that naturally occurs in food--include beans, leafy green vegetables and orange juice.

Source: British Medical Journal 2002;325:1202-1206.

BACK TO TOP 

Survey: Being Fit Is Sometimes in Your Head 

HealthScoutNews

Friday, November 22, 2002

FRIDAY, Nov. 22 (HealthScoutNews) -- Some American workers are manufacturing their own reality when it comes to their health.

Nearly 1 in 5 American workers is grossly obese, smokes, drinks heavily and never exercises, yet believes he is fit as a fiddle, says a recent national survey of 1,450 employed adults by Oxford Health Plans, Inc.

The survey found that while these workers rated their health as excellent (9 or 10 on a 1-10 scale), they tended: to be at least 25 pounds overweight (55 per cent), to smoke (31 per cent), to drink at least three glasses of alcohol a day (21 per cent), to never exercise (36 per cent), to be least likely to eat a balanced breakfast (25 per cent), and most likely to eat fried foods (24 per cent) or salty/sugary snacks (26 per cent).

The survey also found that workers who have healthy lifestyle habits, including good diet and frequent exercise, have the least amount of workplace stress and are the most motivated at work.

The healthy-lifestyle workers are least likely to lose sleep over their jobs and least likely to miss personal or family activities due to work.

About 300,000 deaths in the United States each year are linked to obesity, which causes serious health problems such as diabetes, stroke and heart disease.

Obesity costs U.S. industry $56 billion in lost productivity each year, and smoking costs $82 billion in reduced productivity each year.

More Information

Here's where you can learn more about the social and economic costs of obesity and smoking.

BACK TO TOP 

THURSDAY, NOVEMBER 21, 2002 

Drug Based on Mistletoe in Trials Against Cancer

By Paula Moyer

Reuters Health

HealthScoutNews

The Associated Press

Thursday, November 21, 2002

FRANKFURT (Reuters Health) - A drug based on a component of mistletoe is being studied as a possible treatment for drug-resistant cancers, German researchers said at a cancer conference on Thursday.

Mistletoe is the most commonly used alternative medicine for cancer in Europe, although the weight of scientific evidence shows it offers no benefit.

But the protein used in this study is synthetically developed and has a more consistent quality than natural mistletoe extracts, according to Dr. Patrick Schoeffski, a cancer researcher at Hannover Medical School.

Although it is based on a chemical found in mistletoe, the formulation used in the current research bears little resemblance to the many different versions sold in Germany and other northern European countries, he said.

"We wanted to investigate a compound that was structurally similar to mistletoe lectin, because of the evidence that this substance is biologically active against cancer," he told Reuters Health. "However, in natural mistletoe, it's in such low concentrations that the substance has virtually no therapeutic value."

He discussed the trial here at the joint meeting of the European Organization for Research and Treatment of Cancer, the National Cancer Institute (news - web sites) and the American Association for Cancer Research.

The investigative product, known as rViscumin, is a recombinant protein grown in the bacterium E. coli.

In the current study, more than 30 patients with varying types of drug-resistant cancer are being given intravenous rViscumin. In another study, patients are receiving the drug under the skin surface. Prior research showed that patients who received rViscumin had a definite immune system response to treatment; investigators detected increased levels of cytokines, cells that help the body to form antibodies, in the patients' bodies.

Schoeffski cautioned that research with rViscumin is preliminary, and that its benefit to patients is not yet known. However, he and colleagues are hopeful about its potential, he said.

"We're very excited about this compound," he told Reuters Health. "It's the first opportunity to study a recombinant protein similar to mistletoe in a scientific manner in order to assess its potential role in the treatment of cancer."

BACK TO TOP 

Men's Deep Throat Linked to Sleep Problems 

By Alison McCook

Reuters Health

Thursday, November 21, 2002

NEW YORK (Reuters Health) - Men are more likely than women to develop breathing problems during sleep that can seriously cut into their quality "z" time, and new research suggests that one portion of the male anatomy may be to blame.

Dr. Atul Malhotra of Brigham and Women's Hospital in Boston and his colleagues discovered that a section of the breathing passage known as the pharyngeal airway, which starts at the roof of the mouth and extends to the throat, tends to be much longer in men than in women.

In an interview with Reuters Health, Malhotra explained that this anatomical difference between the genders may explain why men are also more likely than women to develop sleep apnea, a condition in which people temporarily and frequently stop breathing each night during sleep.

Malhotra said the longer this portion of the airway, the more likely the pharynx--the region that connects the mouth and nose to the organs they supply with food and air--is to collapse back around the mouth, bringing the tongue with it and cutting off air to the lungs.

"This explains why men are more at risk of (sleep apnea) than women," Malhotra said.

To discover the anatomical differences behind the gender gap in sleep apnea, Malhotra--who also holds positions at Massachusetts General Hospital and Harvard University--and his colleagues compared the head and neck anatomies of 19 men and 20 women, none of whom had sleep apnea.

Reporting in the second November issue of the American Journal of Respiratory and Critical Care Medicine, the authors discovered that men have significantly longer pharyngeal airways than women.

The authors then tinkered with the impact of longer versus shorter pharyngeal airways on the risk of sleep apnea using a mathematical model. "And when we modeled that, the longer airway was more likely to collapse," Malhotra said.

The researcher explained that sleep apnea can have a significant impact on a man's life. When the airway closes, he said, lungs can't bring the body oxygen and remove carbon dioxide, which induces the body to release adrenaline. The only way to keep breathing is to wake up, Malhotra added, and people with severe sleep apnea may be roused between once and twice each minute while snoozing.

Interrupting sleep to such a degree can render people seriously drowsy during the day, Malhotra said, and sleep apnea has also been shown to up the risk of a host of other problems, such as high blood pressure and other cardiovascular problems.

People who are obese are more likely to develop sleep apnea, Malhotra said, so one thing men can do to reduce their risk is to avoid gaining weight or lose weight if they need to.

Source: American Journal of Respiratory and Critical Care Medicine 2002;166:1388-1395.

BACK TO TOP 

Study Looks at Rare Syndrome, Test-Tube Babies

Reuters Health

Thursday, November 21, 2002

NEW YORK (Reuters Health) - Many studies have shown that children born with the help of assisted reproduction techniques, such as in vitro fertilization, are no more likely than other youngsters to have birth defects or other problems. However, researchers are now trying to determine if a rare syndrome might be slightly more common in such children.

Their small study suggested there might be a link.

This does not mean that people should reconsider using in vitro fertilization (IVF) to conceive, according to the study's lead author, who cautioned that the findings are preliminary and must be confirmed in a larger study.

"This analysis should not affect people's decisions about whether to have IVF, because our findings still need to be validated," Dr. Andrew P. Feinberg of Johns Hopkins University in Baltimore, Maryland, said in a press release.

During in vitro fertilization (IVF), a woman's eggs are harvested and then fertilized with a man's sperm in the laboratory. The resulting embryos are then transferred into the uterus. In some cases, the man's sperm is injected directly into eggs in a procedure called intracytoplasmic sperm injection (ICSI).

IVF and other forms of assisted reproduction technology (ART) are well known to increase a woman's odds of having twins, triplets or even more babies since several embryos are usually transferred to the uterus to increase the chance that a pregnancy will result.

But Feinberg and his colleagues detected some evidence that children conceived through ART are more likely to be born with a collection of birth defects called Beckwith-Wiedemann syndrome (BWS). BWS is characterized by overgrowth, including a large tongue and internal organs, as well as an increased risk of several types of cancer.

BWS is rare, affecting about 1 out of every 15,000 newborns. But in a small registry of BWS cases that Feinberg and his colleagues started in 1994, several children with the birth defect had been conceived through ART. At that point, the researchers took a close look at all new cases in the registry to see how many had been born after ART.

Feinberg's team found that 3 out of 65 children in the BWS registry, or nearly 5%, had been born after ART. That rate was about 6% times higher than expected, the researchers report. Their findings will be published in the January issue of the American Journal of Human Genetics.

BWS and similar conditions are marked by epigenetic changes, which influence the behavior of a cell without having a direct effect on its DNA. Feinberg's team detected BWS-related errors in imprinting--marks on DNA that tell whether a gene came from the mother or father--in several children with BWS who had been born after ART.

"These results confirm the clinical diagnosis of BWS and demonstrate a specific imprinting defect in most BWS patients who were products of ART," according to the report.

Based on the results and previous research, the authors conclude that "sufficient evidence exists to suggest that some aspect of the ART procedure increases the frequency of epigenetic abnormalities" leading to defects such as BWS. The researchers did not examine how ART may cause these abnormalities, but they suggest that ART may affect the epigenetics of embryos.

Source: American Journal of Human Genetics 2003;72.

BACK TO TOP 

Keep the Home Fires Burning 

HealthScoutNews

Thursday, November 21, 2002

(HealthScoutNews) -- An extreme drop in temperature can happen overnight. The Centers for Disease Control and Prevention (news - web sites) recommends you listen regularly to winter weather forecasts and gear up your home for frigid weather.

Here are some of the things you can do:

• If you plan to use a fireplace or wood stove for emergency heating, have your chimney or flue checked annually.
• If you use a fireplace, wood stove, or kerosene heater, install a smoke detector and a battery-operated carbon monoxide detector near the area to be heated. Test them monthly and replace batteries twice a year.
• Older people are less able to feel a change in temperature. If you're over 65, keep a thermometer inside your home and check the reading frequently during the winter months.

BACK TO TOP 

Widely Used Drug Boosts Radiation for Brain Cancer 

By Stephen Pincock

Reuters Health

Thursday, November 21, 2002

FRANKFURT (Reuters Health) - A drug widely used to treat transplant patients may also boost the effectiveness of radiotherapy for people with cancer, according to preliminary research presented here Thursday at a cancer drug conference.

Rapamycin, also called sirolimus, was originally used as an immunosuppressant to prevent transplanted kidneys being rejected by the body. It is also used in cardiovascular stents--tiny mesh structures designed to keep blocked arteries open.

More recently, a lot of interest has been focused on the potential role of rapamycin and its derivatives as anti-cancer drugs. Scientists now know that rapamycin blocks the activity of a protein called mTOR, which plays a part in several aspects of the survival and proliferation of cancer cells, as well as the growth of new blood vessels to keep them alive.

Dr. Jann Sarkaria, assistant professor at the Mayo Clinic in Rochester, Minnesota, and others looked at the effect of combining rapamycin with radiotherapy in mice transplanted with human brain tumors.

Intermittent doses of targeted radiation are used to kill a variety of cancers, but the tumor cells can regrow between doses. The Mayo Clinic group hoped that the drug would inhibit this regrowth.

In mice given only radiotherapy, or only rapamycin, the tumors grew quickly to three times their original volume, but in mice treated with the combination, regrowth was delayed by 19 days, the researchers found.

"The exciting finding from our study is that this is the first evidence that mTOR is involved in the cellular response to radiation. It's not clear yet how it works but we think rapamycin slows tumor proliferation during radiation treatment," Sarkaria told reporters at the conference.

"These data suggest that, at least in one model system, the combination of rapamycin plus radiation is much more effective than radiation alone," he said.

The researchers now plan to test the combination in people with the deadly brain cancer glioblastoma multiforme and lung cancer, both of which are known to over-express the mTOR molecule.

Earlier at the meeting, other researchers reported that drugs to block epidermal growth factor receptors (EGFR), including AstraZeneca's Iressa, also worked well with radiation.

"This (rapamycin) approach has similarities to EGFR inhibitors," said Sarkaria. "It is similar to the newer targeted approaches that might enhance the effectiveness of radiation, and the amount of effectiveness you see is similar to what you get with EGFR inhibitors."

Dr. Edward A. Sausville, associate director of the developmental therapeutics program at the US National Cancer Institute (news - web sites), noted that one benefit of rapamycin would be that it is already well known and doctors would feel comfortable using it.

"This report continues a theme we've seen at this meeting where newly appreciated pathways or targets really suggest ways of refining and making better what is already out there--in this case with a drug that is also already out there," Sausville said.

"So, I think that if there is an indication of value here, it is something that would be very rapidly translated, certainly in the treatment of brain tumors," he added.

Professor Jaap Verweij, head of experimental chemotherapy at the Department of Medical Oncology at the Erasmus University in Rotterdam, added that the low toxicity of rapamycin was another plus.

"We're increasingly using chemoradiation, which can be pretty toxic, so if you can diminish that toxicity then that becomes very attractive," he said.

The conference is sponsored by the European Organization for Research and Treatment of Cancer, the National Cancer Institute and the American Association for Cancer Research.

BACK TO TOP 

Drug-Resistant Gonorrhea on the Rise in 2 States  

Reuters Health

Thursday, November 21, 2002

NEW YORK (Reuters Health) - Gonorrhea resistant to one widely used class of drugs is on the rise in California and Hawaii, which has federal health officials concerned.

The drugs, known as fluoroquinolones, include ciprofloxacin and levofloxacin, are commonly used to treat the sexually transmitted disease because they are relatively inexpensive, require only a single dose and can be given orally.

But the new data indicate that fluoroquinolone-resistant gonorrhea has reached the continental US, making it more likely to spread through the rest of the country, Dr. Lori M. Newman of the Centers for Disease Control and Prevention (news - web sites) (CDC) and colleagues note in the November 22nd issue of the Morbidity and Mortality Weekly Report.

Surveillance conducted in San Francisco, Long Beach and San Diego during 1999 and 2000 found that less than 1% of gonorrhea samples tested were resistant to fluoroquinolones, while nearly 6% of samples from Orange County showed resistance to the drug.

In 2001, 2.5% of gonorrhea samples tested from these areas were fluoroquinolone resistant, on average.

In Hawaii in 2001, 20% of gonorrhea samples tested were fluoroquinolone resistant, up from 11% in 2000 and 10% in 1999.

In a telephone interview with Reuters Health, Newman said: "The increases in gonococcal resistance in California were a surprise to us but not in Hawaii where they have been rising for several years." Only a handful of isolated cases have been reported in other states, she added.

The CDC is urging doctors to be alert for possible cases of resistant gonorrhea. They recommend obtaining a travel history of all patients suspected to have gonorrhea and to use cephalosporins, not fluoroquinolones, for infections acquired in California and Hawaii as well as Asia.

"Fluoroquinolones are still very important drugs for most of the country," Newman emphasized. "We don't have a whole lot of antibiotic choices for gonorrhea. But when these drugs are used, state and local health departments need to monitor for gonococcal resistance so that when it does arise we can respond appropriately."

Source: Morbidity and Mortality Weekly Report 2002;51:1043-1045.

BACK TO TOP 

Tooth Troubles 

HealthScoutNews

Thursday, November 21, 2002

(HealthScoutNews) -- It's the middle of the night and your child wakes up with a throbbing tooth. What can you do to soothe the pain?

The Children's Hospital in Richmond, Va., offers this advice:

• Gently clean the area near the tooth with a toothbrush and use dental floss to dislodge trapped food.
• Don't place aspirin on the tooth or gum.
• If your child's face is swollen, apply a cold compress.
• Give your child an over-the-counter pain reliever.
• Get to the dentist as soon as possible.

BACK TO TOP 

Touted Hormone Has No Effect on Autism 

HealthScoutNews

Thursday, November 21, 2002

THURSDAY, Nov. 21 (HealthScoutNews) -- The hormone secretin, once touted as a possible cure for autism, doesn't even reduce the symptoms of the developmental disorder.

So says a new American study in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

The study, by researchers at the University of Washington and the University of Colorado Health Sciences Center, involved the largest and most comprehensive trials of secretin. It found no evidence that the hormone is effective or that it has any role in the treatment of autism.

Secretin is a naturally occurring human hormone that's produced in the small intestine. Secretin helps control digestion and is used in diagnosing gastrointestinal problems.

The study examined the effectiveness of a synthetic form of secretin and a natural version from pigs. It included 85 children, aged 3 to 12, diagnosed with autism. They were given either a single injection of one kind of secretin or a placebo.

They were then evaluated in a number of ways, including language, social functioning and behavior problems. The children were evaluated by parents, teachers and researchers a week before receiving the injection and then again four weeks after the injection.

The study found no difference between those who received either kind of secretin or the placebo.

Autism interferes with a child's ability to communicate and relate socially with other people. It can also restrict their range of activities and interests. About 75 percent of children with autism also have some form of mental retardation.

Autism affects more than half a million Americans.

More information

The U.S. National Institute of Mental Health has more about autism.

BACK TO TOP 

Smoking During Pregnancy Linked to Kids' Obesity

By Charnicia E. Huggins

Reuters Health

Thursday, November 21, 2002

NEW YORK (Reuters Health) - Smoking in pregnancy is dangerous for a number of reasons. Now a new study suggests one more-children whose mothers smoked during pregnancy may be more likely to become obese than other youngsters.

These findings give prospective mothers one more reason to kick the smoking habit, according to lead study author Dr. Rudiger von Kries of Ludwig Maximilian University of Munich in Germany.

"Women at risk of becoming pregnant should stop smoking--not only to reduce the well established risks of perinatal morbidity, sudden infant death syndrome, childhood asthma but also--and this is new--to reduce the risk for obesity in offspring," von Kries told Reuters Health.

His findings are based on an analysis of 1999-2000 data from 6,483 children whose parents--mother, father or both--completed school entry health questionnaires in six German communities.

Overall, 638 mothers smoked during pregnancy, and their children were twice as likely to be obese and 43% more likely to be overweight than children of nonsmoking mothers, the investigators report in the November 15th issue of the American Journal of Epidemiology.

A child's risk of obesity and overweight also rose with the number of cigarettes the mother smoked during pregnancy, the researchers note.

Further, the effect of maternal smoking during pregnancy on the children's risk of overweight and obesity was similar to the effect of children's frequent television viewing, regular eating of snacks while watching television and video game playing.

The association remained even after the researchers took these factors into consideration, along with others that can influence childhood obesity such as the parents' educational level and whether or not the child had been breast-fed.

The association between maternal smoking during pregnancy and childhood obesity "cannot be explained by a considerable number of confounders," von Kries said.

The reason for the association is unknown, but one explanation may be that the nicotine exposure adversely affects the child's brain during development, resulting in later problems with appetite control, the researcher speculates.

Source: American Journal of Epidemiology 2002;156:954-961.

BACK TO TOP 

'Junk' Gene Tied to Both Diabetes and Obesity 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Thursday, November 21, 2002

THURSDAY, Nov. 21 (HealthScoutNews) -- Researchers have identified a gene involved in both diabetes and obesity, a finding that helps explain how the conditions are linked and that may also present a new target for drugs to combat them.

The JNK gene (known as "junk") was shown to be overly active in obese mice and in mice that were fed a high-fat diet. Mice without the gene were thinner and had less insulin resistance.

"This points to a central mechanism, really the heart of the disease," says Dr. Gökhan S. Hotamisligil, an associate professor of nutrition at the Harvard School of Public Health and senior author of the paper, which appears in today's issue of Nature.

Together, obesity and Type II diabetes affect more than half of the adults in the United States. Obesity is a leading risk factor for this form of diabetes.

At the center of both obesity and diabetes is a phenomenon called insulin resistance. Insulin, a hormone produced by the pancreas, is responsible for guiding glucose out of the bloodstream and helping to store it so it can be used later for energy. People with Type II diabetes are resistant to insulin, meaning that although they produce the hormone, their bodies don't respond the way they should.

Scientists have long been seeking to unravel the mechanisms that link the two metabolic diseases of obesity and diabetes.

In this study, Hotamisligil and his colleagues at Harvard, in collaboration with researchers at the University of California at San Diego, bred three sets of mice: one set with normal genes; one that lacked the JNK1 version of the gene (the gene comes in three "flavors"); and one that lacked the JNK2 version of the gene. They then tried to make the rodents obese by feeding them a high-fat, high-calorie diet or by cross-breeding with a genetic model of obesity and diabetes.

JNK activity turned out to be much higher in the high-fat tissue (liver, muscle, and fat) when compared with lean tissue.

Obese mice with the JNK1 gene also developed mild hyperglycemia (excess glucose in the blood) and their bodies also stopped responding to insulin. The group of mice without the JNK1 gene had significantly lower insulin and blood glucose levels and were less obese.

Apparently, obesity and diabetes produce inflammation in fatty tissues. This triggers the JNK gene, which, in turn, interferes with insulin sensitivity. "What this research shows is that the cellular stress and the resulting inflammation due to obesity is translated by this protein into insulin resistance in diabetes," Hotamisligil says.

The finding that the pathway was central not only to diabetes but also to obesity was a bonus, Hotamisligil reveals. "We have been chasing this activity for many years and all of this was based on the hypothesis that this pathway, if we discovered it, would be central to diabetes," he says. "But that it was also central to obesity. That was a surprise. This is a very exciting discovery."

"It seems that if you have this protein you're worse off than if you don't," says Dr. Steven Heymsfield, deputy director of the Obesity Research Center at St. Luke's-Roosevelt Hospital in New York City. "This could be that little missing piece. This could partially explain why one person is insulin-resistant and one isn't and why some get diabetes and some don't."

The finding is also, Heymsfield points out, "a drug company's dream." "Now they have a protein that seems pivotal in insulin and glucose metabolism. They can make antagonists or agonists to those genes or to the receptor which might then be a treatment for diabetes," he says. "The therapeutics could be quite interesting."

In fact, Hotamisligil reports, compounds that can block JNK pathways are already in development, although they haven't yet been tested on humans. Preliminary analyses may therefore happen relatively quickly. "This is the song of the optimistic," Hotamisligil says.

What To Do

For more information on diabetes, visit the American Diabetes Association or the National Institute of Diabetes and Digestive and Kidney Diseases.

BACK TO TOP 

Mutations Identified for Early Parkinson's

By Merritt McKinney

Reuters Health

Thursday, November 21, 2002

NEW YORK (Reuters Health) - European scientists have identified a gene that is defective in a rare, early-onset form of Parkinson's disease (news - web sites).

Although the gene mutations are unlikely to cause the more common form of Parkinson's, studying the rare version of the disease may lead to a better understanding of what causes the neurological disease, according to the study's lead author.

Parkinson's disease causes tremor, muscle rigidity and movement problems. The underlying cause is the slow loss of neurons that produce the neurotransmitter dopamine, a brain chemical involved in movement. Current Parkinson's therapy relieves symptoms, but it does not slow the progression of the disease.

Most cases of Parkinson's disease do not run in families, but some families are prone to a rare, early-onset type of the disease.

Dr. Vincenzo Bonifati of Erasmus Medical Center Rotterdam in the Netherlands and La Sapienza University in Rome, Italy, and colleagues discovered the genetic mutations when they mapped the genes of two families with a history of early-onset Parkinson's.

The families, one in Italy and the other in the Netherlands, had a mutation in a gene for a protein called DJ-1, the researchers report in Sciencexpress, the advance online edition of the journal Science. In the Dutch family, the DJ-1 protein was completely absent, while in the Italian family, it was inactive.

In comments to Reuters Health, Bonifati said that "until now, only two genes had been firmly implicated in Parkinson's disease: alpha-synuclein and parkin." The discovery of another mutated gene represents a "new key to clarify the mechanisms underlying Parkinson's disease," he said.

The normal purpose of the DJ-1 protein is a mystery, but Bonifati said that there is preliminary evidence that it plays a role in protecting cells from oxidation, a process in which cell-damaging substances called free radicals accumulate.

"This is intriguing," he said, "because it is well known that oxidative damage occurs in the brain in classical Parkinson's disease forms."

According to Bonifati, "Clarifying why defects in the DJ-1 function lead to development of parkinsonism will foster our understanding of the mechanisms of the common forms of Parkinson's disease."

Source: Sciencexpress 2002;10.1126/science.1077209.

BACK TO TOP 

Redefining a Healthy Diet 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, November 21, 2002

THURSDAY, Nov. 21 (HealthScoutNews) -- A few simple changes to the federal government's "Dietary Guidelines for Americans" could further reduce the risk of major chronic diseases, Harvard University researchers say.

The trouble with the guidelines is that they don't make a distinction between different types of fat or protein; they lump red meat, chicken and nuts together as sources of protein; and they place too much emphasis on carbohydrates, the researchers say.

A 15-year study showed that men who ate white meat instead of red, unsaturated rather than saturated fat, and whole grains rather than refined grains lowered their risk of major chronic diseases by 20 percent. The reduction for women was 11 percent, says a report by the researchers in the new issue of the American Journal of Clinical Nutrition (news - web sites).

Marjorie McCullough, a nutritional epidemiologist who was part of the Harvard University School of Public Health team that looked at the U.S. Department of Agriculture (news - web sites) dietary guidelines with a critical eye, says the recommended changes were prompted by a closer look at specific parts of the guidelines.

For example, the USDA guidelines emphasize lowering intake of all sorts of fats.

"We agree with that in general, but we look at a higher ratio of polyunsaturated fat to saturated fat," says McCullough, who now is a nutritional epidemiologist with the American Cancer Society (news - web sites). That means consuming more liquid vegetable oil and fish oil, she says. The Harvard guidelines -- dubbed the Alternative Healthy Eating Index -- also recommend lower intake of total trans fats, which come from margarine and vegetable shortening.

Potatoes are out because people generally consume them in the form of French fries. Baked potatoes are OK, McCullough says, but "they don't have the same benefit of risk reduction as other vegetables do, such as broccoli."

Four servings of fruit daily, 15 grams a day of cereal fiber, one serving a day of nuts and soy protein, moderate alcohol consumption -- one or two drinks a day -- and multivitamin supplements are also recommended.

These recommendations are not based on any abstract laboratory study. Instead, the Harvard team had more than 150,000 men and women enrolled in the "Health Professionals Follow-Up Study" and the "Nurses Health Study" give detailed lists of what they were eating, and then looked at the diseases they got over a 15-year period.

The men whose diet most closely followed the Harvard recommendations cut their risk of cardiovascular disease by 39 percent, compared to those whose diets strayed farthest from the guidelines. For women, the reduction was 28 percent. By comparison, the reduction for those who followed the federal dietary guidelines was 11 percent for men and 3 percent for women. No reduction of cancer risk was found for either set of guidelines.

A U.S. Department of Agriculture spokesperson says the federal dietary guidelines are coming up for review and possible revision. The review will be done in collaboration with the U.S. Department of Health and Human Services (news - web sites). A notice requesting nominations for a committee to do the review will be placed in the Federal Register, possibly as early as next month, according to the spokesperson.

What To Do

The current federal dietary guidelines are available from the U.S. Department of Agriculture. The National Cancer Institute offers a program to help you eat five servings of fruits and vegetables a day.

BACK TO TOP 

Smoking, Drinking Affect Mental Speed in Middle Age

By Amy Norton

Reuters Health

Thursday, November 21, 2002

NEW YORK (Reuters Health) - Middle-aged adults who enjoy a drink or two a day may be somewhat quicker mentally than their non-drinking peers, new study findings suggest.

Smoking, on the other hand, may put the brakes on mental speed, researchers report in the November 15th issue of the American Journal of Epidemiology.

They found that both smokers and non-drinkers in their study scored lower on tests of mental speed and flexibility--an effect comparable to that of being about 4 years older.

"The results certainly give an additional motivation to stop smoking," the study's lead author, Dr. Sandra Kalmijn of the University Medical Center Utrecht in the Netherlands, told Reuters Health.

The study of nearly 2,000 mostly middle-aged adults in the Netherlands showed that those who reported moderate drinking 5 years earlier logged better scores on timed mental tasks, with the association being particularly strong among women.

As for smoking, participants who 5 years earlier had said they currently smoked performed more poorly on these same measures, compared with their non-smoking peers. Self-described former smokers appeared to fall somewhere in between, Kalmijn and her colleagues note.

Past research, mostly in older adults, has suggested that both moderate drinking and refraining from smoking may protect against age-related mental decline. Investigators suspect that effects on the body's blood vessels may help explain both relationships.

For example, smoking can lead to hardening and narrowing of the blood vessels supplying the brain, and the habit is an established risk factor for stroke and vascular dementia--a form of dementia caused by an inadequate blood supply to the brain. Light-to-moderate drinking, on the other hand, is thought to benefit the cardiovascular system, possibly by improving cholesterol levels or by reducing blood clotting.

However, Kalmijn and her colleagues point out, chronic, heavy drinking can also be toxic to brain cells.

Whereas it is clear smokers should be encouraged to quit, Kalmijn said, "the drinking issue is more complicated. I don't propose to encourage alcohol drinking."

Instead, she added, it's more appropriate to conclude that people who are "very moderate" drinkers can probably keep up the habit.

The researchers also note that the mental effects their study tied to smoking and drinking in middle age were "small, and for most people, probably not even noticeable."

"But," Kalmijn said, "I do expect that these differences will become more pronounced when people become older, and eventually, it will be noticeable."

Source: American Journal of Epidemiology 2002;156:936-944.

BACK TO TOP 

Study: Folic Acid Can Protect the Heart 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, November 21, 2002

THURSDAY, Nov. 21 (HealthScoutNews) -- High blood levels of the amino acid homocysteine are a clear and present danger to the arteries, and lots of people should be taking folic acid to protect themselves, a British researcher says.

The warning is based on a survey of more than 100 studies on the association between homocysteine and cardiovascular disease by Dr. David Wald, a specialist registrar in cardiology at Southamptom General Hospital. Those studies show that "homocysteine is a cause of cardiovascular disease such as heart attack and stroke," Wald says. It is a view that differs from that of the American Heart Association (news - web sites) and other authorities, who say that a cause-and-effect relationship between high homocysteine levels and heart risk has not yet been established.

Wald's survey, appearing in the Nov. 23 issue of the British Medical Journal, included two different kinds of studies. One of them looked at the incidence of cardiovascular disease in people with a genetic condition that causes them to have high homocysteine levels. The other looked at the incidence of artery problems in people with a normal genetic makeup but who had high homocysteine levels.

Both kinds of studies point to the same conclusion, Wald says -- reducing homocysteine levels by taking folic acid can reduce the risk of heart disease by 16 percent, of stroke by 24 percent, and of deep-vein blockages by 25 percent.

Wald's finding is a new contribution to a simmering debate about the role of homocysteine in heart disease. His view is in sharp contrast to the American Heart Association position. The association's Web site says, "We don't recommend widespread use of folic acid and B vitamin supplements to reduce the risk of heart disease and stroke." The heart association has just concluded its yearly scientific meeting and Darby Stitz, a spokeswoman, says none of the presentations at that meeting would lead to a change in that cautious approach.

Wrong, wrong, wrong, Wald says. He says that some of his earlier work indicates that taking 800 micrograms a day of folic acid will effectively reduce the risk caused by elevated levels of homocysteine. B vitamins can also help, he says, but "their effect is much more modest. Folic acid is far and away more effective."

Bread and other grain products are fortified with folic acid in the United States to reduce the risk of the birth defect spina bifida. Folic acid is also found in beans and peas, nuts, orange juice, green leafy vegetables, and liver. The folic acid levels in foods, even those that are fortified, are not enough to provide optimum protection against heart disease and stroke, Wald says, and he is recommending widespread use of supplements.

"All people stand to benefit from taking folic acid, but the people who will benefit the most are those who already have cardiovascular disease, those who have had a heart attack, a stroke, or deep vein thrombosis," Wald says. "And the risk increases after age 55, and we are advising all people to take folic acid after that age."

The Food and Drug Administration (news - web sites) limits the amount of folic acid in nutritional supplements to 400 micrograms, the recommended daily allowance, so a doctor's prescription is necessary for preparations containing higher amounts.

Wald is aware of the Heart Association's doubting opinion. "This work may well help influence them" in making a change, he says.

What To Do

A detailed explanation of the cautious approach is offered by the American Heart Association. A government view is expressed by the National Heart, Lung and Blood Institute.

BACK TO TOP 

Computer Images Provide Better Melanoma Detection

By Michael Leidig

Reuters Health

Thursday, November 21, 2002

VIENNA (Reuters Health) - A new ultra-quick method of detecting skin cancer lesions has been developed in Germany.

Regensburg University Professor of Dermatology Wilhelm Stolz said the new test can detect malignant melanomas, the most deadly type of skin cancer, within seconds.

The professor, who is also head of the dermatology department at Munich Schwabing Hospital, said doctors in Germany and in the US are already using the method, even though it was only officially unveiled at a press conference this week.

He said that the system consists of a special microscope supported by computer-assisted imaging techniques.

He told Reuters Health, "The strategy is to recognize the black cancerous moles early so we can avoid removing harmless moles unnecessarily."

The professor explained that first of all, the microscope takes precise pictures of the deep structures of the skin's pigment layers. These pictures are then processed by the computer software and turned into color-coded images, which permit quick identification of benign and malignant lesions.

Stolz said that the heart of the system was an extremely careful image acquisition procedure, which he has developed with the help of physicists, statisticians and information technology experts. The system's imaging technique uses color-standardization and background correction. However, Stolz stresses that it does not use the device found in normal cameras that controls contrasts between dark and light areas within images.

Stolz says that the new system of creating precise and reproducible images can be used in many different ways to help doctors reach an accurate diagnosis.

Dermatologists can use the system to examine suspicious moles. Alternatively, they can store a particular image and ask a patient to come back within 6 months to see how a lesion has developed. Doctors can also send the image via E-mail to get a second opinion.

"The computer is as accurate in its diagnosis as an experienced cancer specialist," Stolz said.

Stolz thinks that the new system will be especially useful for making a diagnosis in cases where patients have numerous moles or asymmetric moles.

There are 12,000 new cases of malignant melanoma diagnosed in Germany each year alone and a further 60,000 to 70,000 people are believed to be at risk.

Munich-based company Linos is selling the whole system for about 30,000 euros.

The system is already being used in the US by the Mayo Clinic in Arizona and by the Pigmented Lesion Clinic in Seattle, Washington.

BACK TO TOP 

Water-Related Infections Hit New High 

By Adam Marcus
HealthScoutNews Reporter

Thursday, November 21, 2002

THURSDAY, Nov. 21 (HealthScoutNews) -- The number of swimming-related infection outbreaks hit a record high in 1999-2000, with 59 episodes that caused almost 2,100 illnesses and at least four deaths, according to a new government report.

Another 39 outbreaks linked to drinking water sickened 2,068 Americans and killed two during the period. Officials attributed those infections largely to unsanitary private wells.

Some of the increase is due to greater surveillance and reporting of waterborne infections. But part of the rise is real, said Michael Beach, a CDC water safety expert. It's "a tip of the iceberg thing," said Beach. "We don't detect most" of the infections.

Deborah Levy, who heads the CDC's water surveillance program, said the monitoring system "is not very sensitive to accuracy" in collecting cases. "We're basically limited to what comes in on the report forms" from states, which voluntarily provide the information each year, she added.

Recreational outbreaks in 1999-2000 hit the highest level since officials began tracking them in 1978, Beach said. The bulk of the episodes -- usually defined as infections of at least two people from the same source -- involved diarrheal ailments, which rose from 18 in 1997-98 to 36 in 1999-2000.

The most common culprits for diarrheal illnesses were Cryptosporidium in treated water and E. coli bacteria in fresh water. Cryptosporidium, a parasite, has shown signs of resistance to conventional levels of chlorine used to treat swimming pools, Beach said. Viruses, chemicals and unidentified agents also caused outbreaks, leading to gastric symptoms as well as skin irritation and even inflammation of the brain and spinal fluid.

Beach said swimmers need to "think about who you are swimming next to." People shouldn't go in the water if they have diarrhea, and they should shower before swimming. Parents should change diapers away from pools and be sure to wash up well afterwards. And remember, he warned: "Swimming water is not drinking water."

Better pool maintenance is also key to reducing waterborne outbreaks, Beach said.

Of the 39 drinking water outbreaks in 1999-2000, 11 involved surface water, an increase of 11 percent from 1997. The 28 groundwater outbreaks marked an 87 percent spike from 1997, when 15 occurred. Six in 10 involved untreated groundwater.

Sherline Lee, another CDC water official, said that while outbreaks involving municipal water supplies remain relatively rare in this country -- thanks to the efforts of water safety authorities -- unregulated wells pose a bigger problem. Americans drill 30,000 new wells a year, many of which are private.

"We urge the public to actively think about what they drink," Lee said.

What To Do

For more on water safety, try the CDC. You can also visit the Environmental Protection Agency or the National Resources Defense Council.

BACK TO TOP 

Arthritis Drugs Studied to Prevent Oral Cancer 

By Paula Moyer

Reuters Health

Thursday, November 21, 2002

FRANKFURT (Reuters Health) - A class of drugs often used to treat arthritis and other inflammatory conditions may be able to protect against oral cancer, according to Norwegian researchers.

Dr. Jon Sudbo and colleagues found that people with cancers and precancerous abnormalities in the mouth are more likely to have elevated levels of the enzyme cyclo-oxygenase 2 (COX-2).

Based on this, they looked to see if COX-2 inhibitors, or coxibs, can prevent these tumors from developing. Celecoxib (Celebrex) and rofecoxib (Vioxx) are examples of commonly used coxibs.

Sudbo, from the oncology department at the Norwegian Radium Hospital in Oslo, presented the investigative team's findings here at the joint meeting of the American Association for Cancer Research, the National Cancer Institute (news - web sites) and the European Organization for the Research and Treatment of Cancer.

Sudbo and colleagues recruited 81 patients including 30 with normal oral mucous membranes, 22 with premalignant tissue and 29 with oral cancer. They wanted to determine whether COX-2 levels were associated with an abnormal number of chromosomes in the tissue's DNA. A change in the number of chromosomes is a risk factor for cancer, Sudbo noted.

They found that COX-2 was more likely to be highly concentrated in patients with both premalignant tissue and cancer, in comparison to those with normal tissue. Among those with cancer, 26 (89.6%) had elevated COX-2 levels and 25 (86.2%) had abnormal numbers of chromosomes.

In the patients with premalignant lesions, COX-2 overexpression was found only in the nine patients with an aberrant number of chromosomes. The investigators followed seven of these patients for 5 years, in which time six (85.7%) developed oral cancer.

On the basis of these findings, Sudbo and his colleagues plan to see if treatment with a COX-2 inhibitor can prevent premalignant lesions from becoming cancerous.

Because 5 to 10 years can elapse between the identification of a premalignant oral lesion and progression to cancer, there is time to determine whether prevention is possible, he said. He and his colleagues chose to follow oral lesions because they are readily detectable, and investigators can follow them without using sophisticated equipment or subjecting patients to invasive procedures.

The ability to ward off such tumors would be a significant development, he said. Because oral cancers are typically aggressive, prevention would be a much more attractive treatment option than the "wait and see" approach that is typically practiced, he said.

The team plans to recruit 350 high-risk patients to a 5-year trial of the COX-2 inhibitor celecoxib, and to follow the patients for a total of 10 years. The primary risk factors for oral cancer are the use of tobacco and excessive consumption of alcohol, and 90% of oral cancer patients either smoke or use chewing tobacco.

"We're still waiting for the data to determine whether COX-2 inhibitors can prevent premalignant lesions in the mouth from progressing," Sudbo told Reuters Health. He urged people at risk for such cancers to wait along with the investigators to see what, if any, protective effect these medications have.

"I would not recommend that people who smoke, the primary risk group, to treat themselves with COX-2 inhibitors with the anticipation that they will prevent oral cancers," he said.

BACK TO TOP 

WEDNESDAY, NOVEMBER 20, 2002 

FTC Targets Deceptive Diet Ads

 

By Connie Cass

Associated Press Writer

The Associated Press

Wednesday, November 20, 2002

WASHINGTON (AP) - The government is urging television, newspapers and magazines to stop carrying deceptive advertising with promises like "eat all you want and lose weight" or "lose weight while you sleep."

"Reputable media should be embarrassed by some of the ads that run," Howard Beales, director of the Federal Trade Commission's consumer protection bureau, said Wednesday. "The claims are so ridiculous."

Beales said he believes that publishers and cable TV executives want to cooperate, but if they don't, regulators could consider legal action.

The FTC has brought 97 lawsuits since 1990 against companies it accused of marketing phony weight-loss products, winning $50 million in restitution to consumers and other financial remedies. The law also prohibits disseminating false ads, Beales said, suggesting that provision could be used against the media should the FTC decide it was necessary.

"We don't think there is a constitutional impediment to trying to stop false advertising, whatever it takes to do that," he said.

FTC Chairman Timothy J. Muris has been meeting with media industry leaders to encourage self-regulation, saying that law enforcement can't keep up with the growing number of phony weight-loss schemes — many run by people outside the United States or hiding behind aliases or middlemen.

The FTC plans to come up with a short list of weight-loss claims that clearly don't stand up to scientific scrutiny, in hopes that media executives will ban ads and infomercials that make those promises.

John Kimball, chief marketing officer of the Newspaper Association of America, said a list of false claims to avoid would be helpful to newspapers that run thousands of ads per day, with no practical way to screen them all for accuracy.

But the government should remember "that the decision to run advertising or not run advertising rests at the feet of the publisher," Kimball said.

Muris praised the major broadcast TV networks for strong screening practices, but acknowledged that most media outlets can't meet that standard.

"We are talking about screening out the most egregious examples — weight-loss earrings or shoe insoles, pills that tell consumers they can eat whatever they want and still lose weight, and products that make physically implausible promises like 'lose 30 pounds in 30 days,'" the chairman told media representatives at a meeting Tuesday.

Joe Ostrow, president of the Cabletelevision Advertising Bureau, said the industry already has voluntary guidelines, but the cable channels "have individual sets of operating standards and philosophies."

"We look forward to doing whatever seems to make sense" to curb deceptive advertising, Ostrow said.

On the Net:

Federal Trade Commission: http://www.ftc.gov/

BACK TO TOP 

Glivec Boosts Effects of Chemotherapy: Animal Study 

Reuters Health

Wednesday, November 20, 2002

FRANKFURT (Reuters Health) - The anti-cancer medicine Glivec increases the amount of other drugs taken up by tumors, according to early research presented here Wednesday at a cancer therapy meeting.

Swedish researchers who made the discovery said that if animal studies are confirmed in humans, combining Glivec with other drugs could improve treatment for some of the most common cancers including those affecting the breast, colon and lung.

Dr. Arne Ostman and colleagues based their study on the fact that tumors tend to be tightly packed with liquid, which hinders the entry of drugs. Glivec blocks a molecule called platelet-derived growth factor that increases this "interstitial fluid pressure."

The team at the Ludwig Institute for Cancer Research in Uppsala showed in rat and mouse studies that Glivec boosted the anti-tumor effects of the chemotherapy drug 5-fluorouracil, paclitaxel (Taxol) and the experimental drug epothilone B.

The increase occurred without any signs of increased toxicity, they said at the conference jointly sponsored by the European Organization for Research and Treatment of Cancer, the National Cancer Institute (news - web sites) and the American Association for Cancer Research.

"If future clinical trials based on these experiments show the same results that we have seen in animal models, then we have identified a new and possibly widely applicable strategy for improving drug treatment for cancer patients," said Ostman.

Adding Glivec could mean that lower doses of drugs are needed to have the same effect. "You could expect that you could reduce the amount given to the patient by about threefold or so and then you would still have the same therapeutic effect with smaller side effects," Ostman said.

Another possible benefit is making tumors that resist treatment with Taxol sensitive to the drug.

"It could have a massive impact on the uptake of chemotherapy into the tumors--whether that would really be enough increase to convert non-responsive tumors to responsive tumors only trials will tell," he told Reuters Health.

The first human study looking at this effect of Glivec is due to begin in Uppsala around the beginning of next year, the researcher said. The trial will be in breast cancer (news - web sites) patients, looking at the effects of Glivec on the uptake of Taxol, he said.

Glivec is sold by Swiss company Novartis and called Gleevec in the US.

BACK TO TOP 

Outpatient Heart Attack Care Studied

The Associated Press

Wednesday, November 20, 2002

BOSTON (AP) - Heart attack patients fare better if treated by a specialist after leaving the hospital rather than by a general-care doctor, a government-backed study suggests.

Earlier studies had indicated that such patients did better with hospital care by cardiologists, but less was known about how they fared in the months of outpatient care that followed.

The latest findings by Boston researchers at Brigham and Women's Hospital and Harvard Medical School (news - web sites) were published Thursday in The New England Journal of Medicine (news - web sites).

They studied Medicare data from 35,520 patients age 65 or older in hospitals in California, Texas, New York, Florida, Ohio, Pennsylvania and Massachusetts.

Patients under a cardiologist's outpatient care were more likely to be younger, white and male.

After two years, 14.6 percent of patients with outpatient care from a cardiologist had died, compared with 18.3 percent of a similar group of patients under the sole care of a family doctor or internist.

The patients under specialized care underwent more medical procedures and rehabilitation, perhaps accounting for the difference between the two groups.

Patients who saw both kinds of doctors showed an even lower death rate — 11.1 percent to 12.1 percent.

In an accompanying editorial, Nicole Lurie and Melinda Beeuwkes Buntin of the Rand research institute in Arlington, Va., said more care by cardiologists or medical teams could help ease the long-recognized disparities in health care between whites and minorities.

The study was funded by the federal Agency for Healthcare Research and Quality.

On the Net:

Journal: http://content.nejm.org

Agency: http://www.ahcpr.gov

BACK TO TOP 

Vaccine Aimed at Cervical Cancer Shows Promise 

By Amy Norton

Reuters Health

Wednesday, November 20, 2002

NEW YORK (Reuters Health) - A vaccine against a cervical cancer-causing virus can protect young women from infection--a success researchers hope will eventually allow them to prevent many cases of cervical cancer.

Their study of more than 1,500 young US women found that none of those vaccinated against human papillomavirus type 16 (HPV-16) developed a persistent infection with the virus.

In contrast, 41 cases of persistent HPV-16 infection occurred among the 700-plus unvaccinated women, according to findings published in the November 21st issue of The New England Journal of Medicine (news - web sites).

Because persistent infection with HPV-16--or with one of several other "high-risk" HPVs--raises a woman's risk of cervical cancer, researchers hope that vaccinating against the culprit HPV strains will one day slash rates of the cancer worldwide.

"This is a great study," Dr. Christopher P. Crum of Brigham and Women's Hospital in Boston, Massachusetts, told Reuters Health. He said that if HPV vaccination becomes reality, it could "drastically change" the face of cervical cancer care, which is currently best managed by early detection through regular Pap tests.

However, Crum stressed, "it's important for people to realize that this won't be available tomorrow."

And, unlike the therapeutic vaccines that are also under development, the vaccine in this study was not aimed at treating cervical cancer, noted Crum, who wrote an editorial accompanying the report.

There are around 100 HPVs, some of which cause genital warts. Although most HPV infections will not lead to cancer, a few sexually transmitted HPVs, including HPV-16, are thought to be the major cause of cervical cancer. Research suggests that HPV-16, specifically, is present in half of cervical cancers.

In the current study, Dr. Laura A. Koutsky of the University of Washington in Seattle and her colleagues gave about half of the women three doses of their HPV-16 vaccine. The rest received a placebo for comparison.

The researchers found that, after roughly a year-and-a-half of follow-up, none of the vaccinated women had developed a persistent HPV-16 infection, and only a few tested positive for a short-term infection. In addition, none of the vaccinated women showed any precancerous changes related to HPV-16 in their cervical cells, compared with nine of the unvaccinated women.

Crum called this lack of HPV-16-related cervical abnormalities "pretty profound."

Still, he and the study authors point out that several HPVs are implicated in cervical cancer, and vaccinating against only one type will not ward off the others. Koutsky's team notes that a vaccine that would protect against a "broad spectrum" of HPV types--an idea currently under study--would be "more advantageous."

Some co-authors on the study are with Merck Research Laboratories, which developed the vaccine and provided the funding.

Source: The New England Journal of Medicine 2002;347:1645-1651, 1704-1705.

BACK TO TOP 

Study: Gene Therapy Shows Promise

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Wednesday, November 20, 2002

 

CHICAGO (AP) - The largest study yet of gene therapy for heart disease shows the approach can significantly relieve severe chest pain, though the improvements may take months to become apparent.

Researchers have been working for several years on the idea of injecting genes directly into the heart to improve blood flow. Several smaller studies have suggested a benefit, but the latest experiment is the first to subject the approach to a careful comparison with standard treatment.

"This is the first trial to provide a clear indication of efficacy of gene therapy," said Dr. Duncan Stewart, cardiology chief at St. Michael's Hospital in Toronto.

Several teams around the world are competing to prove the benefits of various combinations of genes for people with severe chest pain that cannot be treated with drugs, angioplasty or bypass surgery. All involve delivering genes to the heart to promote the growth of new blood vessels to carry nutrition and oxygen to starved heart muscle.

Stewart's study was financed by GenVac Inc. of Gaithersburg, Md. He presented the results Wednesday at the annual scientific meeting of the American Heart Association (news - web sites).

Unlike earlier studies reported so far, Stewart's experiment randomly assigned 71 volunteers to have either gene therapy or receive the usual medical treatment. After three months, there was no difference. However, by six months, people who got the gene therapy could walk significantly farther on a treadmill.

"It was surprising how much better the patients felt," Stewart said. One man was so sick he could not play with his grandchildren. After the treatment, "he could enjoy his family and was just thrilled by that."

To deliver the therapy, doctors opened the patients' chests and injected the growth hormone genes 30 times into the patients' hearts. The operation itself was fatal to two of the volunteers.

After they recovered, the patients walked on treadmills until their electrocardiograms showed clear signs of oxygen deprivation. The treadmill time improved by one minute in the gene therapy patients but was unchanged in the comparison group. The gene patients could also walk 25 percent longer before getting intolerable chest pain.

The doctors also took nuclear scans of the patients' hearts, intended to show changes in their blood flow. Some earlier experiments have shown this improves after gene therapy, and those data will be available soon in the Canadian experiment.

One drawback of the study is that patients knew, because of the operations, whether or not they received the genes, and this could have affected their sense of improvement. A new study will deliver the genes with a catheter threaded into the heart, and a sham procedure will be done on the comparison group, so no one will know who actually got the genes.

"It shows feasibility," Dr. Augustus Grant of Duke University, president-elect of the heart association, said of the latest study. "The increase they saw in treadmill time is significant."

Among other studies at the conference:

_ Doctors from the University of Leipzig in Germany compared the effects of balloon angioplasty against an exercise program in 101 people with stable heart disease. They found that after a year, 88 percent of people trained to ride an exercise bike 20 minutes a day were free of major complications, such as heart attacks and repeat hospitalization, compared with 70 percent of those who got angioplasty.

Dr. Stephan Gielen said a larger study will test whether the approach is safe. "I would not advise patients to go home from an angiogram" — a common diagnostic procedure — "buy a bicycle and start training. We're not at that point yet," he said.

_ Dr. Russell V. Luepker of the University of Minnesota looked at the effect of exercise on medical costs on Medicare patients. Healthy people who did nothing ran up average bills of $11,300 during five years in the early 1990s, while those who got even modest exercise had bills of $6,800.

_ A study from the Hellenic Heart Foundation in Glyfada, Greece, shows that exercise significantly lowers C-reactive protein, a sign of inflammation that increases the risk of heart attacks. Men who worked out three times a week had levels 10 percent lower than sedentary people, and women's were 17 percent lower.

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

Heart meeting: http://www.scientificsessions.org

BACK TO TOP 

Vaccine Protects Women Against Genital Herpes 

By Alison McCook

Reuters Health

Wednesday, November 20, 2002

NEW YORK (Reuters Health) - A vaccine against genital herpes has been sought by researchers for decades, and new findings show the first sign that a vaccine against the chronic condition may one day be possible--at least, for women.

Dr. Lawrence R. Stanberry of the University of Texas Medical Branch in Galveston and his colleagues found that the vaccine protected approximately 75% of women who were free of HSV-1--the herpes virus that commonly causes cold sores around the mouth--from becoming infected by HSV-2, the virus behind genital herpes.

In women who had previously been infected with HSV-1, or in men, the vaccine proved less effective, Stanberry told Reuters Health. But a vaccine that shields only one portion of the sexually active population could still have a strong impact, he noted, for the fewer people who have the virus, the fewer people they can infect. This vaccine may prove particularly useful in protecting newborns from picking up their mother's virus, he noted.

"The fact that we were able to protect one part of the population is a really important discovery. And maybe someday we'll be able to make a better vaccine," Stanberry said.

If the current vaccine stands up to further investigations, Stanberry said that he would recommend that it be given to all young women before they become sexually active.

Stanberry and his colleagues tested the effectiveness of the new vaccine in a group of 847 people who were free of both HSV-1 and HSV-2, and in 1,867 others who were only free of HSV-2. All of the participants were having sex regularly with a person who had genital herpes. At the beginning of the study, one month and six months later, each person received either a vaccine or an injection of an inactive substance, and the researchers monitored them for 19 months to see if they acquired HSV-2.

In the first study, the partner with genital herpes agreed not to take medicines that suppress levels of the virus in the blood, while people in the second study could use those treatments if desired. Around 65% of all study participants said they either never used condoms or used them less them half of the time.

As reported in the November 21 issue of The New England Journal of Medicine (news - web sites), Stanberry and his colleagues found that, in the study in which people were free of HSV-1 and HSV-2, the vaccine protected a total of 38% from getting HSV-2 from their partners. However, looking solely at women, the vaccine's effectiveness jumped to 73%.

In the second study, the vaccine blocked infection in 42% of women, but proved most effective in women who were HSV-1 free, 74% of whom were also HSV-2-free by the end of the study.

In an interview, Stanberry cautioned that some of the women who were protected from HSV-2 actually became infected with the virus, but never showed any signs of developing genital herpes. It remains unclear whether these women can infect others, he said.

Stanberry explained that this vaccine may be an improvement on others because it contains a different ingredient from most other vaccines, whose purpose is to help the body prime itself to fight off future infections. The ingredient used in the new herpes vaccine "we think is giving us a different kind of immune response, a stronger immune response," Stanberry said.

In terms of why women may respond better to the vaccine than men, the researcher said that women may mount a stronger type of immune response that could protect them from the herpes virus. Alternatively, the vaccine could confer more protection along the mucosal membrane, such as in the vagina, where women tend to pick up genital herpes. In men, he noted, the virus typically enters their system through breaks in the skin, such as on the penis, and the current vaccine may be less able to protect them in those regions.

In terms of why women with HSV-1 were less protected from HSV-2 by the vaccine, Stanberry said that previous studies have suggested that people with HSV-1 may be less likely than others to become infected with HSV-2, and the vaccine may not be able to boost HSV-1's usual, protective effect.

The current study was funded by GlaxoSmithKline, the makers of the tested vaccine.

Source: The New England Journal of Medicine 2002;347:1652-1661.

BACK TO TOP 

Got You Covered

HealthScoutNews

Wednesday, November 20, 2002

(HealthScoutNews) -- Children are less able to handle the cold than you are. They're also less aware of the possible dangers of freezing temperatures.

 Doctors at the Mayo Clinic offer these C-O-L-D prevention tips for you and your kids:

Cover your child's head, face and neck as much as possible. Apply lip protection.

Overexertion can be dangerous. Avoid sweating, which produces wet clothes and chills.

Layers of loose clothing work best.

Dry is key. Stay as dry as possible and watch for gaps in mittens and boots where snow creeps in.

BACK TO TOP 

ID Checks Don't Deter Teens from Buying Cigs 

By Charnicia E. Huggins

Reuters Health

Wednesday, November 20, 2002

NEW YORK (Reuters Health) - Teens can often illegally buy cigarettes, even when they show store clerks a valid photo ID that proves they're underage, a new study shows.

In fact, store clerks in the study were much more likely to sell cigarettes to minors who presented identification than to those who had no ID-regardless of the date of birth on the ID--a team of Colorado researchers reports.

The "terrible irony" of this finding is that teens who proved they were too young were more likely to get cigarettes than those who were not able to verify their underage status, lead study author Dr. Arnold H. Levinson of the AMC Cancer Research Center in Lakewood, Colorado, told Reuters Health.

"The issue is that we remain unable so far to control access to cigarettes to kids," he added.

For the study, a group of 14- to 17-year-olds made 1,080 attempts to purchase cigarettes in retail stories in urban and suburban communities in Colorado. They carried a driver's license or other state-issued photo identification half of the time, and no identification the other half of the time.

Overall, 13% of the attempts resulted in illegal cigarette sales, Levinson and his team report in the December issue of Tobacco Control.

In almost 9 out of every 10 attempts, store clerks asked the teens to show proof of age, but those who made this request were six times more likely to sell cigarettes to minors who presented identification documenting their true age than to those who did not, the report indicates.

The reason for this is unknown, according to Levinson. "Whether it's because the clerks are just pretending to check or are too busy or can't do the math, we don't know yet why it happens," he said in a statement.

"My guess is that most stores are complying with the law, but that's not good enough," Levinson told Reuters Health.

Consequently, "we're failing" if we believe that one of the ways to keep minors from starting to smoke is to prevent them from buying cigarettes and to prevent stores from selling cigarettes to them, said Levinson, who conducted the research with colleagues at the University of Colorado Health Sciences Center and the Colorado Tobacco Enforcement Unit in Denver.

But the researcher does not suggest that these ideas be abandoned altogether.

"I am not ready to give up on the idea of keeping cigarettes sales to kids from happening," Levinson said, "(but) the methods we're using are not doing the job."

His co-author Dr. Tim Byers added, "There is no more important public health threat than nicotine addiction among youth who are beginning to smoke.

"This study has identified a big crack in the enforcement system, and reminds us that we need to redouble efforts on many fronts to protect our children from the harm that tobacco will bring," he said in a statement.

The study findings will be presented this week in San Francisco at the 2002 US National Conference on Tobacco Control.

Source: Tobacco Control 2002;11:296-299.

BACK TO TOP 

Alarming News for Black Men's Heart Health

HealthScoutNews

Wednesday, November 20, 2002

WEDNESDAY, Nov. 20 (HealthScoutNews) -- Black men with coronary heart disease are in worse shape and less capable of exercise than their white counterparts.

That's the alarming finding of a new study presented today at the American Heart Association (news - web sites)'s scientific sessions meeting in Chicago.

Researchers at the Ochsner Clinic Foundation in New Orleans looked at 5,069 people referred for stress testing and compared fitness levels of black men and white men.

White men had significantly higher exercise capacity than black men, who were found to be more obese. The researchers say they found that being black was an independent risk factor, although weak, for poor exercise capacity.

The researchers say in a prepared statement that an emphasis on weight loss and an increase in exercise and physical fitness is important for prevention of cardiovascular disease in black men.

Several previous studies of people with coronary artery disease have found that exercise capacity is a strong predictor of future health. However, there are few studies that have assessed exercise capacity in adult blacks or the effect of race on fitness levels, the researchers say.

More information

Here's where you can learn more about blacks and exercise.

BACK TO TOP 

Protein Plays Role in Obesity, Diabetes in Mice 

By Alison McCook

Reuters Health

Wednesday, November 20, 2002

NEW YORK (Reuters Health) - Harvard researchers have discovered that mice that lack a certain protein are less likely than normal mice to become obese when placed on a high-fat, high-calorie diet, and appear less likely to develop diabetes.

In contrast, mice with the protein, known as JNK1, tend to develop insulin resistance if they become obese, the investigators found. Insulin resistance is a condition that often leads to diabetes.

The protein may help induce the body processes that can lead to obesity and diabetes, suggesting possible new ways to treat or even prevent the conditions in people at risk, according to Dr. Gokhan S. Hotamisligil of Harvard School of Public Health in Boston, Massachusetts, and his colleagues.

Drug manufacturers have already produced a compound that can block the activity of JNK1 in humans, Hotamisligil told Reuters Health. Once further research into the compound occurs, he proposed that doctors may be able to give the product to overweight and obese people to help them shed pounds.

Researchers are many steps away from having a drug that is known to be safe and effective in people, Hotamisligil added, but the current study findings, published in the November 21st issue of Nature, represent "a small step in the right direction."

JNK1 is a member of a family of proteins that produces an enzyme that modifies other proteins in the cell, with each modification essentially instructing a protein to behave in different ways. In particular, the enzyme produced by JNK1 is thought to help the cell respond to certain stresses in the cellular environment.

During the study, Hotamisligil and his colleagues, some of whom hail from the University of California, San Diego, examined the effects of different diets on mice who lacked the JNK1 protein and on those who either lacked another type of JNK protein, JNK2, or were normal. When the mice were fed a diet high in fat and calories, the researchers found that both normal mice and those that lacked JNK2 gained similar amounts of weight, while mice that lacked JNK1 gained much less weight than either of the other groups.

In a similar experiment, the authors found a lack of JNK1 also decreased weight gain in mice that carried a gene that puts them at risk of developing obesity. Furthermore, both these mice and those that were obese and carried JNK1 showed relatively high activity of JNK1 in the liver, muscle, and fat--all tissues that are responsible for controlling metabolism.

In terms of diabetes, obese mice that lacked JNK1 were also less likely than other mice to become resistant to insulin, often a precursor to developing diabetes.

In an interview with Reuters Health, Hotamisligil suggested that different people may have different levels of JNK activity, and those that have a hyperactive JNK1 may be more likely than others to gain weight and become obese. However, he noted that further studies are needed before researchers can assert that as true, or doctors can think of giving people a JNK1-blocker to prevent or treat obesity. "All of this, of course, is yet to be seen," Hotamisligil said.

Source: Nature 2002;420:333-336.

BACK TO TOP 

Best Drug for the Job

HealthScoutNews

Wednesday, November 20, 2002

WEDNESDAY, Nov. 20 (HealthScoutNews) -- The anticoagulant drug enoxaparin should be used to treat heart attack victims who have diabetes.

That's the recommendation of a Duke University Medical Center study presented today at the American Heart Association (news - web sites)'s scientific sessions meeting in Chicago.

The study was a sub-analysis of data from an earlier study that compared the effectiveness of different agents used to restore blood flow to people after they've had a heart attack.

After looking at that data and coupling the information with cost and ease of use, the Duke researchers concluded the drug enoxaparin was most suitable for diabetics (news - web sites) who have a heart attack.

When people with heart attack are brought to a hospital emergency room, doctors try to restore blood flow to the heart, usually with drugs that dissolve clots in the coronary arteries.

The Duke researchers found that while treatment with enoxaparin resulted in a trend toward recurrent heart attacks and chest pain in diabetic heart attack patients, it was more likely to prevent death than another drug called abciximab.

More information

The American Heart Association has more information about the link between diabetes and cardiovascular disease.

BACK TO TOP 

New Cancer Drug Surprisingly Good in Early Study 

By Stephen Pincock

Reuters Health

Wednesday, November 20, 2002

FRANKFURT (Reuters Health) - A new drug that starves tumors of the blood supply they need to grow has proven unexpectedly effective in early human studies, shrinking tumors by half in 25% of patients who were given it, researchers reported Wednesday.

A team led by Dr. Eric Raymond from France's biggest cancer center, Institut Gustave Roussy in Villejuif, tested the drug, code-named SU011248, in people with a range of cancers that were unresponsive to standard treatment.

"Any activity in this situation is very promising since everything else has failed. But we did not expect to see such a high number of responses in a range of cancers," Raymond told reporters at a cancer therapy meeting here.

The researchers first thought the drug would only stabilize the size of the tumors, rather than shrinking them.

"We were happily surprised right from the first patient response--a reduction of more than 50% in the tumor for 6 months in someone with a renal cancer that had recurred and who also had adrenal and lung secondaries that had not responded to immunotherapy."

SU011248 is a signal transduction inhibitor acting against several enzymes involved in angiogenesis, or blood vessel growth. It is being developed by Sugen, a California-based company owned by Pharmacia.

In the Phase I study, 25 patients were given SU011248 orally for 4 weeks, at doses ranging between 50 milligrams (mg) every 2 days to 150 mg daily. In 6 of 23 evaluable patients--roughly one in four--tumors shrank by 50% or more.

"This was huge," Raymond told Reuters Health. "You are expecting in a phase I trial less than 5% response."

The drug was well tolerated at the daily dose of 50 mg, although debilitating fatigue was seen at higher doses. The drug also accumulated in the skin, temporarily turning it yellow. It also drained the color from patients' hair, turning it white.

Some adverse events were also linked to the fact that the drug caused the tumor to die too quickly.

"It is one of the first angiotoxic drugs with anti-tumor effects. In fact, we had too much effect in higher doses in some patients resulting in tumor necrosis that required surgery," Raymond said.

Blocking the growth of blood vessels to cancers has been a big field of cancer research for years, but the concept has not lived up to its early promise. Researchers think this drug may work where others have failed because it targets several of the cancer's defenses at once.

"The tumor has about 10 different shields and you're piercing them one by one," commented Dr. Michael Caligiuri, a professor of internal medicine at Ohio State University Comprehensive Cancer Center, who was not involved in the study.

"You are dealing with multiple mechanisms, you're dealing not with anti-angiogenesis alone, but one component and second component, probably a third component and maybe a fourth through the combination of those things."

BACK TO TOP 

Heart Misfiring May Cause Some Cases of SIDS

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Wednesday, November 20, 2002

 WEDNESDAY, Nov. 20 (HealthScoutNews) -- A heart malfunction known to cause sudden death in young people and adults could also be responsible for some unexplained deaths in babies.

In what appears to be the first proven evidence for a possible cause for sudden infant death syndrome (SIDS), Dr. Michael J. Ackerman of the Mayo Clinic found that 5 percent of the infants he studied had genetic mutations indicating a heart condition called the long Q-T syndrome, a proven cause of sudden death in children and adults.

"All we have been able to give is theories, but now we can provide direct proof for a small but important percentage of SIDS deaths," says Ackerman, who heads the Mayo Clinic's sudden death genomics lab and long Q-T syndrome clinic. He presented his findings yesterday at the American Heart Association (news - web sites)'s scientific sessions meeting in Chicago.

Robert D. Hinnen, program director of the SIDS Center of New Jersey, which is part of Hackensack University Medical Center, echoes Ackerman's words.

"This is a very important finding. This is a relatively new area of research that we need to take into serious consideration," he says.

"We know that the Q-T syndrome has a direct link to unexplained deaths in older people, but nothing has ever been done relating Q-T to SIDS. It's a logical area of research and sheds light on areas where we've only had a dim flashlight," Hinnen adds.

In the long Q-T syndrome, the heart electronically recharges itself too slowly or in a disorganized fashion and, in children and adults, sudden activation of the adrenal system triggers the syndrome, causing cardiac arrest and sudden death.

Ackerman says that same thing could be happening to infants who get the long Q-T syndrome, which is why he and his colleagues conducted the study.

"It was logical to think that some SIDS deaths could be explained by this genetic electrical problem," he says, "and now we can provide direct proof for a small, about 5 percent, but important percentage of SIDS deaths."

According to the U.S. government's National Vital Statistics reports, there were 2,500 deaths attributed to SIDS in 2000. However, this is a 40 percent reduction in the incidence of deaths from SIDS since 1992, when the American Academy of Pediatrics first recommended that babies be put to sleep on their backs instead of stomachs.

In the study, Ackerman and his colleagues performed a genetic autopsy on 93 infants whose unexplained deaths had been investigated by the Arkansas State Crime Laboratory between 1997 and 1999. Researchers extracted DNA from frozen heart tissue and studied the five genes linked to long Q-T syndrome.

They found that approximately 5 percent of the infants in the study had genetic anomalies in those genes, compared to none of a racially matched control group of 200 infants.

What triggers the heart malfunction in infants is unknown, Ackerman says, but it could be the same activation of the adrenal system that affects children and adults, albeit on a much smaller scale.

"We really don't know. It's possible that it could be anything that could catch the heart off guard -- we call them electrical hiccups -- like a phone ringing in the baby's room, or a breath-holding spell," he says.

However, he adds that the condition affects such a small number of babies that parents should not take any special precautions.

Better to focus on prevention, he says, because there are treatments to insure that long Q-T syndrome causes no harm.

"If we know someone has long Q-T syndrome, there are things we can do. We can put them on medical treatment," he says.

Screening for the syndrome, usually done by EKG, is one option, although Ackerman says it is time-consuming and expensive.

"We have to get smarter on how to identify it," he says.

In the meantime, parents should stick to the common sense recommendations for preventing SIDS.

"Every parent can already do the time-proven things that are free and have resulted in a dramatic reduction in SIDS," he says, including making sure babies sleep on their backs, not smoking in the baby's room and not sleeping with the baby.

What To Do

For a thorough review of Sudden Infant Death Syndrome (SIDS), go to National Institute of Child Health and Human Development Also on that site are prevention tips to reduce the risk of SIDS in your baby.

BACK TO TOP 

Type, Frequency of Migraine May Sway Stroke Risk 

Reuters Health

Wednesday, November 20, 2002

NEW YORK (Reuters Health) - Younger women who suffer migraines may have a slightly higher stroke risk than other women their age, but the risk may depend on the type and frequency of women's early migraines, new research suggests.

There is some evidence that, while strokes are rare among women of childbearing age, younger women who suffer migraines may face a somewhat higher risk. In addition, some research has suggested that this stroke risk may be particularly tied to migraine with aura--tell-tale symptoms, such as visual disturbances, that signal an impending migraine attack.

In this latest study, UK researchers again found a connection between migraine with aura and a higher risk of ischemic stroke, the form of stroke caused by a blockage in the blood vessels feeding the brain. The tie was particularly strong, however, among women whose first migraines were accompanied by aura, especially if these initial attacks occurred more than 12 times a year.

Despite these findings, however, women who experience migraines face a small risk of stroke overall. The study authors estimate that, based on existing evidence, about 15 per 100,000 of these women will suffer a first stroke every year.

Dr. Michael Donaghy, of Radcliffe Infirmary in Oxford, and his colleagues report the findings in the December issue of the Journal of Neurology, Neurosurgery & Psychiatry.

Migraines are marked by intense, throbbing pain, sensitivity to light and sometimes nausea and vomiting. The process underlying migraine headaches is not fully understood, but researchers generally believe that it involves some changes in the brain's blood vessels, and auras have been associated with reduced blood flow to the brain.

The current study involved 300 women between the ages of 20 and 44 from five European countries. Eighty-six of the women had been hospitalized for a first ischemic stroke.

Donaghy's team found an increased risk of stroke among women whose initial migraines had been accompanied by aura, with an even higher risk seen in those whose initial attacks occurred 13 or more times a year. Women who had been suffering migraines for more than 12 years also faced an elevated stroke risk.

These links remained after the researchers accounted for stroke risk factors such as smoking, high blood pressure, diabetes and oral contraceptive use. In an earlier study, Donaghy's team had found that oral contraceptives appeared to increase migraine sufferers' risk of stroke.

Experts advise that migraine patients concerned about stroke be especially vigilant in avoiding strong stroke risk factors like smoking and high blood pressure.

Source: Journal of Neurology, Neurosurgery & Psychiatry 2002;73:747-750.

BACK TO TOP 

Can Ticks Spread Hepatitis C Virus?

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, November 20, 2002

WEDNESDAY, Nov. 20 (HealthScoutNews) -- Everyone knows that ticks spread Lyme disease. But hepatitis C virus?

Scientists at the American Red Cross (news - web sites) say they've made a circumstantial case for a tick passing the infection to a Connecticut woman who had no other obvious means of contracting the liver-damaging malady.

"Ticks obviously ingest a fair amount of host blood and re-inject blood into the next animal or person they bite. They at least could act like little syringes," says Dr. Ritchard Cable, medical director for the Red Cross's blood services center in Farmington, Conn. He and his colleagues describe the case in a research letter in tomorrow's issue of The New England Journal of Medicine (news - web sites).

Cable admits the connection could be coincidence. He has seen no other evidence of ticks ferrying hepatitis C from one person to another, nor to a person from an infected animal -- assuming that animals can contract the virus. What's more, it's not even clear the microbe can survive in ticks.

Still, they have no better explanation for how the woman picked up the disease. She denies being infected on the job or having any high-risk lifestyle habits, such as multiple sex partners or drug use.

The woman, a health-care worker and regular blood donor, was participating in a 1999 Red Cross study of a disease called babesiosis that's transmitted by deer ticks. Blood she gave in July 1999 tested positive for that disease, but not for hepatitis C.

Yet when the woman gave blood five months later, hepatitis C appeared, a highly unusual event in regular donors. An August blood sample drawn as part of the study also turned up genetic evidence of the virus upon re-examination.

When doctors spoke to the woman, Cable says, she revealed that she'd been ill in September with symptoms that were consistent with hepatitis C, including fatigue, stomach cramps, loss of appetite and dark urine. Intriguingly, she seemed to have acquired the infection during roughly the same window of time that she also picked up babesiosis, he says.

Ticks do transmit at least one virus related to hepatitis C, causing tick-borne encephalitis, says Tom Schwan, an expert on the creatures at the National Institutes of Health (news - web sites)'s Rocky Mountain Laboratories in Hamilton, Mont. In Africa, ticks on rare occasions shuttle a disease called relapsing fever from person to person.

Even so, Schwan says catching hepatitis C from a tick bite would be "an extremely rare event that assumes many things" -- including that the parasites are suitable hosts for the virus. "I would be very cautious" about concluding that the Connecticut case isn't one of mistaken infectivity, he adds.

Hepatitis C, which can lead to fatal liver damage, affects nearly 4 million Americans. The disease typically causes no symptoms for years, earning it the nickname the "silent killer."

Most infections occur in drug users sharing tainted needles. Screening of the blood supply has driven the rate of transfusion transmission, once a major problem, to less than one case per million units, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

What To Do

To learn more about hepatitis C, try the U.S. Centers for Disease Control and Prevention. For more on the nation's blood supply, try the American Red Cross.

BACK TO TOP 

Niacin Slashes Heart Attack Risk in Diabetics

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Wednesday, November 20, 2002

WEDNESDAY, Nov. 20 (HealthScoutNews) -- Niacin supplements can reduce by about 50 percent the chance of a second heart attack in people with diabetes and milder blood sugar problems, who are at sharply increased risk of cardiac diseases.

So says a new study, which found that although the B vitamin nudges blood sugar higher, it more than overcomes that effect by suppressing dangerous blood fats that promote heart attacks. The study also found that diabetics (news - web sites) seemed to derive more heart protection from niacin than people without the disease.

"In the past, we've been hesitant to use it because of the increase in glucose levels," said Dr. Michael Davidson, director of preventive cardiology at Rush Medical College in Chicago, who was familiar with the findings. "But even though it goes up some, the benefits of raising HDL, lowering LDL and triglycerides more than offsets that risk. The net benefit is still significant."

LDL (the "bad" cholesterol) and triglycerides are linked to heart problems, while increasing levels of HDL (the "good" cholesterol) protect the heart and vessels. The magnitude of niacin's effects on lowering heart attack risk is similar to that of other drugs, including aspirin, statins and other treatments that cut cholesterol, and beta-blockers, experts said.

The latest work was led by Paul Canner of the Maryland Medical Research Institute in Baltimore, who presented the findings today in Chicago at a meeting of the American Heart Association (news - web sites). The study was funded by Kos Pharmaceuticals, which makes a slow-release prescription version of niacin called Niaspan.

The study used an immediate-release form of niacin, which is found in fortified cereals as well as grains, meats, nuts and other foods. But Dr. Mark McGovern, medical director for the Miami-based Kos, said his product would be similarly effective. The Food and Drug Administration (news - web sites) approved Niaspan in 1997. Since then, 8 million prescriptions have been written for the drug, McGovern said.

In a 1975 study called the Coronary Drug Project, Canner's group showed that people who took up to three grams a day of niacin reduced their risk of recurrent heart attacks by 28 percent after six years, compared to those who took sugar pills. And after 15 years of follow-up, their overall risk of death was 11 percent lower.

At the time, the researchers didn't ask whether the effect was different in people with blood sugar trouble. So in the new analysis, they divided 1,119 of the original subjects into four categories depending on their ability to process blood sugar.

This time, Canner and his colleagues found that niacin reduced the risk of a second, non-fatal heart attack by 28 percent in people without diabetes, and by 54 percent in those with the blood sugar disorder. The trends for overall mortality were similar.

Dr. John Buse, who directs the diabetes care center at the University of North Carolina School of Medicine, said the original formulation of niacin wasn't tolerated well. But Niaspan, which he has studied, appears to be a gentler product.

"There has been some discussion that perhaps there would be differences in the rate of absorption, but to date it looks good. It seems to do all the right things," Buse said.

An estimated 17 million Americans have diabetes, and 16 million have the Type II form of the disease in which their cells become resistant to insulin. Another 16 million people have "prediabetes," putting them at high risk of developing the full-blown sugar disorder.

Cardiovascular disease is the leading killer of diabetics, who face two to four times the normal risk of heart attacks as a result of their condition.

What To Do

Niacin isn't without side effects, the most common of which is flushing and itching in the face and neck, which in some people can be severe.

For more on diabetes, try the National Institute of Diabetes and Digestive and Kidney Diseases. For more on heart attacks, visit the American Heart Association.

BACK TO TOP 

Just Can't Wait? High Blood Pressure May Be Result 

By Martha Kerr

Reuters Health

Wednesday, November 20, 2002

CHICAGO (Reuters Health) - If you are impatient or often feel pressed for time, there is a good chance you will develop high blood pressure--and at a relatively young age. That finding is from the first study to look at a link between hypertension and a "type A" behavior trait called time urgency/impatience, researchers reported here at the American Heart Association (news - web sites) meeting.

Dr. LiJing L. Yan of Northwestern University in Chicago, Illinois, and colleagues looked at 13 years of data from the larger CARDIA (Coronary Artery Risk Development in Young Adults) study.

A sample of approximately 3,100 people between the ages of 18 and 30 who enrolled in the study in 1985 were asked four questions: Do you eat quickly? Do you often get upset if you have to wait? Do you often feel pressured? Do you often feel pressured at the end of the day?

Those who were the most likely to say those questions were true were two to three times more likely to develop high blood pressure than those in the calmest group. And Yan pointed out that the group is only between the ages of 33 and 45 now, so these people are developing hypertension at a young age.

Many factors can contribute to high blood pressure, including diet, exercise, smoking and other lifestyle factors.

In the study, about 6% of participants gave a positive response to all the questions. Those who felt a greater sense of impatience or urgency were more likely to be white, female and have more education, although those with high scores in general tended to smoke more, consume more alcohol and get less exercise.

However, the investigators found that white women still had a lower incidence of high blood pressure than other study participants.

Yan said that was most likely due to factors not related to personality traits.

"Lifestyle factors play a role. White women tend to pay more attention to their diet, they smoke less, in general have a higher socioeconomic status--and they may be able to modify their behavior better than the other groups," Yan commented.

Black men and women were more likely than other participants to develop high blood pressure during the study, but those who felt more urgency/impatience were more likely than their laid-back counterparts to develop high blood pressure.

Yan told Reuters Health that her team is planning to look at other risk factors for heart disease in this population--for instance, cholesterol levels and obesity. The investigators want to look at a person's sense of urgency and dietary habits, "but that depends on time and funding."

It is possible that those who feel constantly pressed for time are less likely to eat healthy foods, which could partly explain the link.

However, if the findings of her study are confirmed and personality traits are indeed linked with hypertension, Yan said it "indicates the health risks of a constant sense of time urgency/impatience and type A behavioral patterns."

Type A behavior and health consequences have been a matter of dispute for years, she acknowledged. In addition to urgency/impatience, type A personality traits include competitiveness, hostility, tenseness and aggressiveness.

BACK TO TOP 

Aggressive Treatment Urged for 'Mini-Strokes'

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Wednesday, November 20, 2002

WEDNESDAY, Nov. 20 (HealthScoutNews) -- The current definition of a "mini-stroke" is outdated, inaccurate and needs to be changed to reflect current knowledge, says a group of leading stroke experts.

Based on the old knowledge of these episodes, known medically as transient ischemic attacks (TIAs), doctors often wait them out. However, the experts, writing in tomorrow's issue of The New England Journal of Medicine (news - web sites), say most TIAs are emergencies and should be treated as such.

Strokes are caused either by a blocked blood vessel in the brain or a blood vessel that has burst and is causing excessive bleeding. In either case, parts of the brain stop receiving blood and are deprived of oxygen and other vital nutrients, resulting in brain damage. A TIA, on the other hand, is usually caused by a small blot clot that clears up naturally before any brain damage can occur.

Currently, if stroke symptoms last 24 hours or less, the event is considered a TIA. However, this definition was developed in 1965, before sensitive imaging tests and effective treatments were available for stroke.

"One of the problems with the old definition is that [doctors] felt they could wait around to see if stroke symptoms were getting better," says Dr. Gregory Albers, a professor of neurology and neurological sciences at Stanford School of Medicine and one of the experts proposing a new definition for TIA. "But if you have symptoms that last for 60 minutes or more, it's highly likely that it's a stroke. And the sooner you start treatment for stroke, the better the response."

Stroke is the third leading cause of death in the United States, killing about 167,000 people every year, according to the National Stroke Association. Until the mid-1990s there was little physicians could do to treat strokes caused by blocked blood vessels. Now, a drug called tissue plasminogen activator (tPA) can dissolve the blood clot, which can prevent much of the brain damage and death associated with stroke. However, tPA is effective only if given within the first three hours after the onset of symptoms, and Albers says getting the medication before 90 minutes has elapsed is even better.

One of the biggest reasons Albers and other stroke experts from across the United States propose changing the definition of TIA is so that tPA can be administered more quickly, rather than waiting for 24 hours to see if the symptoms resolve on their own.

Albers points out that during the clinical trials of tPA, half of the patients received the medication and half received a placebo. Researchers later discovered that in the untreated group, only 2 percent of the patients had any significant recovery on their own after having symptoms for 24 hours.

"TIAs are very brief. They don't last for hours and hours," Albers says. "It's extremely unlikely to be a TIA after an hour."

The proposed new definition of a TIA is a short period of neurological dysfunction and no evidence of a blood clot on CT or MRI scans done soon after the symptoms begin. If the symptoms last more than a short time, such as an hour, or there is evidence of a blockage in a blood vessel on the imaging tests, it should be considered a stroke, says the expert group.

Symptoms of TIA and stroke are the same: sudden weakness or numbness on one side of the body, trouble speaking, sudden loss of vision, and loss of balance or coordination. In a TIA, these symptoms should disappear quickly. In a stroke, they will not go away without immediate medical intervention. That doesn't mean, however, that if you have these symptoms and they disappear in 20 minutes that you don't need to get to the emergency room.

"TIA is an urgent medical situation that needs to be reported right away," explains Albers. "TIAs are associated with a high risk of stroke. One in 20 people with a TIA will have a stroke within 48 hours," he adds.

Dr. Keith A. Siller, a neurologist at New York University Medical Center, agrees that people, and insurance companies, need to take TIAs more seriously.

"TIA is a strong warning sign for a future stroke," Siller says. "TIA is like the chest pain before a heart attack. It's a sign of underlying vascular disease."

He says the proposed new definition of TIA is something that stroke neurologists already know and practice, but says it might be helpful for other physicians who might hold back on giving tPA because they're not sure if it's a stroke or a TIA and they're concerned about tPA's side effects.

What To Do

The National Stroke Association explains what a stroke is, what the five most common symptoms are, and offers tips on preventing stroke.

For more information on TIA, visit the National Institute of Neurological Disorders and Stroke.

BACK TO TOP 

Leptin May Play Role in Obesity-Breast Cancer Link 

By Keith Mulvihill

Reuters Health

Wednesday, November 20, 2002

NEW YORK (Reuters Health) - Elevated levels of the obesity hormone leptin may be the "missing link" between obesity and increased breast cancer (news - web sites) risk, new study findings suggest.

"It has been well established that obesity and/or weight gain are risk factors for postmenopausal breast cancer," said lead investigator Dr. Margot P. Cleary. "However, the mechanism of action of linking obesity to this increased risk is not clear."

So far, experts have speculated that the elevated blood estrogen and insulin levels that occur in obese individuals may be possible links, explained Cleary, who is with The Hormel Institute at the University of Minnesota in Austin.

Now, Cleary and colleagues propose that leptin, a protein synthesized and released by fat tissue in proportion to the amount of body fat, may provide a more direct link from obesity and weight gain to an increased postmenopausal breast cancer risk.

The findings of their experiments with both cancerous and normal breast cells appear in the November 20th issue of the Journal the National Cancer Institute (news - web sites).

"In this paper we show that addition of leptin increased proliferation of both a breast cancer cell line and a normal mammary tissue cell line," Cleary told Reuters Health. "However, leptin stimulates cell proliferation to a much greater extent in the breast cancer cell line, 150% above the number of cells without leptin, than in the normal cells where a 50% increase was found."

In addition, Cleary and her team identified the presence of the leptin receptor--a tiny "docking site" for the protein--in these cell lines and showed that specific signaling pathways known to be activated by leptin in other tissues were activated in both the healthy breast cells and the breast cancer cell lines, she explained.

"We feel that these preliminary studies provide evidence that leptin may play an important role in...normal breast tissue development, and elevated serum leptin levels may promote breast tumor growth and development," Cleary concluded.

Source: Journal of the National Cancer Institute 2002;94:1704-1711.

BACK TO TOP 

Gene May Help Predict Lung Cancer Patient Survival 

By Paula Moyer

Reuters Health

Wednesday, November 20, 2002

FRANKFURT (Reuters Health) - Patients with lung cancer are more likely to survive longer if they have high levels of a protein produced by a so-called "repair gene," scientists told a cancer drug meeting on Wednesday.

In a study of patients who had undergone surgery for the most common type of lung cancer, known as non-small-cell lung cancer, the investigators found that those with high levels of the protein had the longest survival time.

"Currently, every patient with lung cancer gets the same treatment, chemotherapy, and surgery when possible," said Dr. Gerold Bepler, a professor of medicine and oncology at the University of South Florida in Tampa.

"However, we can't predict who will respond to chemotherapy and what factors are associated with survival of lung cancer," he told Reuters Health.

"If this gene turns out to be a reliable predictor, we could tell which patients could do without chemotherapy, and which ones should get it," he added. Most patients with lung cancer have, at best, a limited response to chemotherapy, Bepler noted.

The repair gene is known as ERCC1. It works by correcting mistakes made during cell division by removing the defective DNA portion and replacing it with a corrected version. Bepler and colleagues were surprised that high levels of ERCC1 expression were associated with longer survival because the gene has been known to repair damage inflicted on cancer cells that have undergone chemotherapy, so that they become resistant to treatment.

He and colleagues studied 51 patients with non-small-cell lung cancer in early to advanced stages. All of the patients' tumors had been surgically removed, and five had also undergone radiation treatment. One patient had received both radiation and chemotherapy.

The investigators assessed whether patients had low, intermediate or high levels of ERCC1 expression. Those with low levels had a median survival of approximately 35 months, slightly less than 3 years. The intermediate group had a median survival of approximately 62 months or slightly more than 5 years, and the group with high levels had a median survival of approximately 94 months, or nearly 8 years.

Bepler and his investigative team theorized that, following surgical removal of the tumor, patients with high levels of ERCC1 expression benefit because the gene begins to act against the remaining malignant cells. In patients with low levels, the likelihood of this cellular repair is reduced.

"This finding could help physicians refine which patients receive chemotherapy," Bepler said. He noted that people with low levels of ERCC1 expression were less likely to develop resistance to chemotherapy drugs, and would therefore benefit from this type of treatment. But patients with high ERCC1 expression levels did not respond well to chemotherapy.

The meeting was jointly sponsored by the American Association for Cancer Research, the National Cancer Institute (news - web sites) and the European Organization for the Research and Treatment of Cancer.

BACK TO TOP 

Arsenic in Water Tied to Bladder Cancer Mutations 

Reuters Health

Wednesday, November 20, 2002

NEW YORK (Reuters Health) - High arsenic levels in drinking water are already thought to raise the risk of bladder cancer, and now research suggests that heavy arsenic exposure may also cause bladder tumors to be more aggressive.

The study of bladder cancer patients in Argentina and Chile found that those whose drinking water contained high levels of arsenic tended to have more chromosome abnormalities in their tumors. These genetic alterations were also associated with later-stage and more-quickly growing tumors, according to findings published in the November 20th issue of the Journal of the National Cancer Institute (news - web sites).

All of this suggests that bladder tumors in people with high arsenic exposure "may behave more aggressively" than those of patients with lower exposure, report Dr. Lee E. Moore, of the National Cancer Institute in Bethesda, Maryland, and her colleagues.

A naturally occurring element found in the earth's crust, arsenic is released into water sources when rocks, minerals and soils erode. People are typically exposed to arsenic through water or food, but exposure can also come from industrial waste. High arsenic exposure has been linked to elevated risks of several cancers, including those of the bladder, kidneys, liver and lungs.

In the current study, Moore's team examined tumor samples from 123 patients who had been exposed to arsenic in their drinking water. Participants were separated into four groups according to their 5 years of highest arsenic exposure.

In the lowest-exposure category, patients had yearly been exposed to less than 10 micrograms per liter (mcg/L) of water--the new standard that has been adopted in the US, set to take effect in 2006. In the next-lowest group, exposure was between 10 and 99 mcg/L; the current US standard calls for arsenic levels of no more than 50 mcg/L.

Moore's team found that the average number of chromosome abnormalities per tumor went up in tandem with patients' arsenic exposure. For those in the two lower-exposure groups, there were five to six alterations per tumor, on average. Patients with the highest arsenic exposure--at least 300 mcg/L each year--showed nine chromosome alterations per tumor, on average.

According to the researchers, these findings suggest that higher arsenic exposure causes greater "genetic instability" in bladder tumors, possibly by disrupting the normal capacity of body cells to manage the DNA damage that causes cancer. This, they note, could both boost the rate of bladder cancer development, and--if the current findings are an indication--lead to bladder tumors that are more aggressive and deadly.

Source: Journal of the National Cancer Institute 2002;94:1688-1696.

BACK TO TOP 

TUESDAY, NOVEMBER 19, 2002 

Toxic Trouble 

Reuters Health

HealthScoutNews

The Associated Press

Tuesday, November 19, 2002

(HealthScoutNews) -- If your curious toddler drinks a cleansing detergent or other hazardous liquid, your immediate action is vital.

According to the University of California, Davis, Health System, first give your child water -- only water -- to drink and then call the poison center or doctor.

Antidote labels on products may be outdated and incorrect. Do not give salt, vinegar, or citrus fruit juices. Keep a one-ounce bottle of syrup of Ipecac for each child in the home but only use it on the advice of the poison center or other medical establishment.

BACK TO TOP 

Free range hens 'food poisoning' scare

Ananova.com

Tuesday, November 19, 2002

 A study has found that free-range and organic chickens are twice as likely to carry a food poisoning bacteria than battery hens.

Initial findings from Government-sponsored research show significantly higher levels of campylobacter in flocks reared outdoors.

The bacteria is thought to be carried by wild birds which is one theory for the high levels in outdoor-bred flocks.

The study, led by Professor Tom Humphrey at the University of Bristol, investigated 60 organic and 130 conventional flocks.

He found campylobacter in 58% of indoor-reared flocked but in all the organic flocks. All the chickens studied were destined for human consumption.

Campylobacter jejuni and coli are the most commonly identified bacterial cause of food poisoning in the UK.

Prof Humphrey, professor of food safety and well-known for his work on bacteria in poultry and eggs, was unavailable for comment.

His research is sponsored by the Food Standards Agency (FSA).

BACK TO TOP 

Co. Gives FDA Ephedra Complaints 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Tuesday, November 19, 2002

WASHINGTON (AP) - A leading seller of the dietary supplement ephedra gave the government records of 1,400 customer complaints Tuesday, including 14 that mention serious side effects.

Metabolife International already had turned over 14,700 customer health complaints as the Justice Department (news - web sites) began a criminal investigation into whether the company had lied about ephedra's safety.

Ephedra is a popular herb commonly used for weight loss and body building, but it also has been linked to heart attacks, strokes and other serious side effects. Critics have called on the Food and Drug Administration (news - web sites) to ban sales, and the agency has long sought manufacturers' records of consumer health problems as part of its safety investigation.

Metabolife's then-president told the FDA in 1998 that the company had never received any consumer complaints of serious side effects.

But in August, with disclosure of the Justice investigation, Metabolife announced that it was giving the FDA 14,700 records of telephone calls from ephedra customers about health-related issues.

Metabolife said the records mention three deaths, 20 heart attacks and 24 strokes. But the company stressed that the reports, unverified calls to a consumer hot line, are not medical records proving that ephedra actually caused any illnesses — meaning the company hadn't lied.

Late Tuesday, Metabolife sent the FDA records of an additional 1,480 consumer telephone calls. The latest batch was received during a five-month time period in 2000, but had been missed previously because of a computer glitch, said Metabolife attorney Lanny Davis.

The latest records include two heart attacks, two strokes and 10 seizures, but there's no proof ephedra was the cause, Davis said.

"Metabolife continues to maintain that ... its product is safe and effective when taken as directed and after consultation with a physician," he said.

FDA spokesman Lawrence Bachorik confirmed the agency had received the new records.

"We would rather have had them early, but we will look at them carefully," he said. "Any adverse event reports are potentially important."

The FDA already has cracked down on ephedra products, such as "yellow jackets," that are illegally sold as an alternative to street drugs. But federal law allows dietary supplements that don't make illegal claims to be sold with little oversight unless the FDA proves them harmful.

Manufacturers, including Metabolife, argue that the pills are safe when used by healthy adults as directed on the products' labels. Metabolife has called for the FDA to mandate warning labels similar to ones it uses, and to require reporting of side effects.

But several scientists told Congress last month that ephedra causes heart attacks by constricting blood vessels, thus raising blood pressure and pulse rates. Canada has warned consumers to avoid it, and use has been banned by several U.S. athletic organizations.

"It is clear to me that there is a serious problem here," said Sen. Richard Durbin, D-Ill., who also is investigating ephedra. "If the FDA and the Bush administration don't protect American consumers, people will get sick and some will die."

BACK TO TOP 

Sweet Tooth Substitutes

HealthScoutNews

Tuesday, November 19, 2002

(HealthScoutNews) -- Do you prefer artificial sweeteners to the real thing, but are concerned about their safety? According to the Medical College of Wisconsin, you shouldn't worry.

Research conducted years ago that linked saccharin to cancer was conducted on rats, and a person would have to swallow 850 cans of diet soda a day in order to consume the same amount of saccharin researchers used in their studies.

Both the American Dietetic Association and the American Diabetic Association say sugar substitutes are fine for most people. Pregnant women and individuals with Phenylketonuria should check with their doctors.

Here are some reasons to choose low-calorie sweeteners:

• You save calories: One teaspoon of sugar contains 16 calories, compared with less than 4 calories per teaspoon in sugar substitutes.
• Artificial sweeteners don't cause cavities.
• They are especially beneficial for diabetics (news - web sites) whose sugar intake is restricted.

BACK TO TOP 

Hormone Therapy, Vitamins Don't Help Heart: Study 

By Suzanne Rostler

Reuters Health

Tuesday, November 19, 2002

NEW YORK (Reuters Health) - Antioxidant vitamins, either alone or in combination with hormone replacement therapy (HRT), do not appear to provide any heart health benefits to postmenopausal women, researchers said Tuesday.

In fact, the treatments may even be harmful, although more study is needed to determine if this is true, according to the report in the November 20th issue of The Journal of the American Medical Association (news - web sites).

In the study, 400 postmenopausal women with heart disease were randomly assigned to take HRT, vitamins C and E, a combination of the two, or inactive placebo pills.

Annual measurements suggested that artery narrowing was the same or slightly worse for women taking HRT compared with women taking a placebo, and for women taking the antioxidant vitamins compared with women taking the placebo. Rates of death, nonfatal heart attack and stroke were also higher among women taking HRT and vitamins than women taking placebos.

"The results of this trial add to the accumulating evidence that neither HRT nor antioxidant vitamin supplements improve the clinical course of coronary disease in postmenopausal women," the researchers conclude. "Postmenopausal women with coronary disease should be discouraged from using both HRT and high doses of vitamins C and E."

However, the dietary supplement's leading trade group criticized the design of the study and the interpretation of the results, charging that the findings could be due to chance. What the study really suggests, said Dr. John Hathcock from the Council for Responsible Nutrition (CRN), is that HRT and levels of antioxidant vitamins used in the study provide neither benefit nor risk.

"If the data were interpreted in the most straight-forward, obvious way, the study shows that there is no large benefit under these set of circumstances," said Hathcock, vice president of nutritional and regulatory science, in an interview. "But I conclude that there is no large set of concerns, either."

Dr. Jeffrey Blumberg, an antioxidant researcher at Tufts University in Boston, Massachusetts, agreed.

"There was no statistically significant difference one way or the other that you can conclude this study showed harm," he said in an interview with Reuters Health.

Indeed, the study authors note that the increase in death among women taking high doses of antioxidant vitamins "may represent a chance finding," and state that more research is needed.

Still, the findings contribute to a growing body of research that calls into question the much-touted benefits of HRT, long believed to lower the risk of heart disease among older women. While natural estrogen reduces blood levels of LDL ("bad") cholesterol and inhibits clotting, synthetic forms of the hormone do not appear to have the same effect, recent studies have revealed.

"Women seem to be protected from atherosclerosis (hardening of the arteries) by their own estrogen until menopause, but at least three studies now have shown that when we give postmenopausal women estrogen, it either doesn't help or it makes things worse," said Dr. David D. Waters, the study's lead author, in an interview with Reuters Health.

Similarly, eating foods rich in antioxidants, compounds that squelch disease-causing free radicals in the body, reduce heart disease risk, but providing the same vitamins in pill form may not have the same effect, said Waters, of the University of California, San Francisco.

In the study, women who were assigned to the HRT group took either estrogen (Premarin) or estrogen plus progestin (Prempro) if they had not had a hysterectomy. A second group took 400 international units (IUs) of vitamin E plus 500 mg of vitamin C, twice a day, or a placebo. Some women took both HRT and the vitamins and a fourth group of women took only placebos.

Waters recommends that HRT be used to control menopausal symptoms such as hot flashes and night sweats. Diet, exercise, blood pressure control, and quitting smoking may be more effective ways to lower the risk of heart disease, he said.

Blumberg from Tufts said that healthy postmenopausal women should look at the totality of evidence when it comes to taking antioxidant vitamin supplements.

"The totality of evidence, in my view, is that there is benefit and there is no harm," he said. "The data still says that this is a reasonable idea."

Source: The Journal of the American Medical Association 2002;288:2432-2440.

BACK TO TOP 

Anger Tears Your Heart Apart

HealthScoutNews

Tuesday, November 19, 2002

TUESDAY, Nov. 19 (HealthScoutNews) -- Don't be hostile to your heart.

High hostility levels may predict heart disease more often than other more commonly recognized risk factors such as cigarette smoking, weight and high cholesterol, says a study in the November issue of Health Psychology.

The American study, which included 774 white men whose average age was 60, examined whether hostility was an independent or contributing factor in the development of CHD.

For three years, researchers assessed the men's hostility levels, blood lipids,