The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
December 26, 2002

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of November 16-22

  1. Some Over-The-Counter Drugs Can Ease Migraines
  2. Coffee Jitters? Don't Blame the Caffeine
  3. Hormone Therapy, Alcohol Use Studied
  4. Marrow Transplant Grows New Vessels in Legs
  5. Fat Lurks Behind Slim Asian Frames
  6. Spinal Tap May Help Alzheimer's Diagnosis
  7. Tissue May Help Fix Damaged Hearts
  8. A Fish a Day Keeps Heart Woes at Bay
  9. Court Refuses Organ Harvesting Case
  10. Springtime Ragweed Allergy Is Real, Study Finds

    SUNDAY, NOVEMBER 17, 2002 

  11. Emergency Angioplasty Alone Works
  12. Marrow, Muscle Grafts Revive Broken Hearts
  13. Research Offers New Hope for Heart Bypass Patients

    SATURDAY, NOVEMBER 16, 2002 

  14. Drug-Resistant Germs: Food for Thought
  15. Fighting Fat in Kids
  16. 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.

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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.

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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/

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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."

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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'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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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/

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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.

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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

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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."

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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."

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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.

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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.

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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, fasting insulin, blood pressure, body measurement index, weight-hip ratio, diet, alcohol consumption, smoking and education achievement.

The study found CHD was more common in men with high hostility levels than in men with risk factors such as smoking, high cholesterol and drinking.

Specifically, 5.8 per cent (45) of the men with high hostility levels had at least one episode of CHD.

In a prepared statement, the authors say the study shows that hostility is associated with and predicts CHD above and beyond other traditional risk factors.

They suggest hostility may predispose people to CHD through other mechanisms such as cardiac arrhythmia, nervous system imbalances and endocrine-neuroendocrine responses to stress.

More information

Here's where to go to learn more about cardiovascular health.

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Filters Reduce Angioplasty Risks

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Tuesday, November 19, 2002

CHICAGO (AP) - Doctors have found they can substantially improve the safety of balloon angioplasty to clean out the arteries in the neck by temporarily inserting a tiny filter to trap stirred-up gunk before it floats to the brain.

This approach could make angioplasty the preferred way of treating blockages in the carotid arteries, the main blood vessels to the brain, researchers say.

Currently, doctors usually do this with surgery. That operation, called carotid endarterectomy, is now done on about 200,000 people in the United States annually.

Doctors tested the filter on people considered at especially high risk and found it found it cut strokes and other serious complications in half.

"It is a big deal. I consider it a watershed event," said Dr. Donald La Van of the University of Pennsylvania, who was not involved in the testing.

Dr. Jay Yadav of the Cleveland Clinic led testing of the filter approach using an experimental device called the Angioguard, made by Johnson & Johnson, which paid for the study. He presented the results Tuesday at the annual scientific meeting in Chicago of the American Heart Association (news - web sites).

For a generation, surgeons and heart specialists have debated whose approach works best: surgery or angioplasty.

For the carotid arteries, the surgical approach — opening up the blood vessels and cutting out the bad spots — has been the standard since the 1950s. The goal is to restore blood flow before clogging leads to strokes. However, the operation itself occasionally triggers strokes by loosening particles that get lodged in the brain.

As an alternative, heart specialists sometimes perform angioplasty, similar to the technique widely used to open up blocked heart arteries. A balloon is threaded into the neck artery and briefly inflated to squeeze open the artery. Then a stainless steel wire coil, called a stent, is left behind to keep the artery propped open.

Recent studies suggest angioplasty and endarterectomy are roughly equal in effectiveness and complications. The new study concludes that using the filter makes angioplasty better.

"This is the first time that an interventional procedure has been shown superior to surgery in cardiovascular disease. It's a turning point," Yadav said.

In the procedure, doctors temporarily insert a skinny filter that opens like an umbrella. They do the angioplasty, insert a stent, then collapse the filter, cover it with a tiny sheath and drag it out of the artery. The filter catches lumps of translucent fatty debris stirred up by the stent.

In the study, 307 patients were randomly assigned to get either the angioplasty or surgery. After a month, 6 percent of those getting the angioplasty had died or suffered a stroke or heart attack, compared with 13 percent of the surgery patients.

While longer follow-up is necessary, Yadav said the first month's experience is usually a good indicator of long-term results.

He said that 80 percent of the filters used this way were visibly coated with particles. Typically about half of the filter surface was covered with material that broke loose from the patients' arteries.

In 5 percent to 10 percent of patients, the filter gets so clogged that blood flow to the patients' brains slows considerably. In such cases, Yadav said doctors quickly withdraw the filter before brain damage occurs.

Stents are also used to hold open arteries in the heart after angioplasty. However, in roughly a quarter to a third of cases, those stents quickly clog up again as tissue grows over them.

To help solve that problem, companies are testing stents coated with medicines that prevent this regrowth. Last month, a Food and Drug Administration (news - web sites) advisory committee recommended approving the first of these, developed by Johnson & Johnson.

At the heart meeting on Tuesday, Dr. Jeffrey Moses of Lenox Hill Heart and Vascular Institute of New York presented the results of testing on 1,101 patients. After eight months, 9 percent of the new stents had clogged up, compared with 36 percent of the standard variety.

"We achieved an over 75 percent reduction, which is profound and remarkable," Mose said.

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

On the Net:

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

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Statins Help Those With Heart Valve Problems

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Tuesday, November 19, 2002

TUESDAY, Nov. 19 (HealthScoutNews) -- The cholesterol-lowering drugs known as statins may slow the narrowing of arteries in the heart, but new research suggests their effect has nothing to do with their ability to lower cholesterol.

"We observed that progression of aortic stenosis [AS] is half the speed in patients on statins," says senior author Dr. Maurice E. Sarano, director of the valvular heart clinic at the Mayo Clinic. However, "we noted no association between total cholesterol and AS progression."

Aortic stenosis is a narrowing of the aortic valve opening that often occurs in people older than 60. This causes the left ventricle to pump harder to push the blood forward. Eventually not enough blood gets to the heart, and heart failure may result. Since plaque is thought to narrow the heart's arteries, those with AS are often treated with statins to reduce their cholesterol.

While neither total cholesterol nor low-density lipoprotein, or "bad," cholesterol was found to be significantly associated with AS progression, being on statins was found to be beneficial to patients, Sarano reports.

The study, published in tomorrow's issue of the Journal of the American College of Cardiology, included 156 patients with AS, 38 of whom were on statins. Those on statins had a notably slower rate of progression of the disease, Sarano says. This was true despite the fact that most were on a relatively low dose of statins.

Researchers followed the patients for an average of 3.7 years. In that time, those not taking statins had their aortic valve area reduced by about 7 percent per year. Those on statins had the same area shrink by only about 3 percent annually.

Many of the untreated patients progressed from moderate stenosis to severe stenosis. As a result, some of the untreated patients became candidates for valve-replacement surgery while those on statins avoided the need for surgery.

Sarano says he cannot be sure that cholesterol does not play a role in AS, or that statins do not effectively lower cholesterol. "We cannot discard the effect of cholesterol" as the cholesterol may be exerting its effect in the tissue rather than the blood, Sarano says. However, the real effect of the statins may be that they decrease inflammation in the aorta, or "they slow calcium metabolism, which may also prevent the progression of aortic stenosis," he says. "Statins probably have a combination of effects."

Patients with severe AS may eventually require surgery. However, those needing surgery are usually elderly and not the best candidates for the operation, Sarano says. If there is a way to drastically slow the progression of the disease, as this study indicates statins may do, it is possible that some patients may never require surgery at all, he adds.

Dr. Stephen Smith, inpatient director of cardiology at Henry Ford Hospital in Detroit, says many drugs that come on the market do not end up being widely used for their first indication. He points out that Viagra was originally touted as an anti-anginal drug, and statins may prove to be most beneficial for reasons other than lowering cholesterol.

Although he would like to see the results of more studies before switching patients to statins, this study is very exciting, Smith says: "The best thing would be if we could forestall the operations."

Dr. Rodman Starke, former executive vice president of the American Heart Association (news - web sites), thinks this study "is quite convincing" as is. There are not many serious side effects associated with the use of statins, although a small number of patients have liver abnormalities that return to normal when the medication is stopped, he says. Patients who clearly have AS may benefit from statins, he says: "It would do more good than harm."

Sarano says they are hoping for funds from the National Institutes of Health (news - web sites) to start clinical studies. "We should conduct clinical trials that prove the medications work."

What To Do

Learn more about aortic stenosis from the National Institutes of Health or the American Heart Association.

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Blood Test May Identify Ovarian Cancer: Study 

Reuters Health

Tuesday, November 19, 2002

NEW YORK (Reuters Health) - Genetic imbalances in DNA found in blood samples may one day help identify women with early-stage ovarian cancer, the results of a preliminary study suggest.

Although the findings need to be confirmed, testing for these abnormalities may make it possible to identify patients who would benefit from treatment, according to the report published in the November 20th issue of the Journal of the National Cancer Institute (news - web sites).

Ovarian cancer is highly treatable when caught early, but most cases are diagnosed when the disease is advanced and survival is much less likely. Because symptoms may not occur until later in the course of disease and are typically vague--such as abdominal discomfort and swelling, bowel problems and appetite loss--finding a reliable test is crucial to improving early detection.

In the new study, Dr. Le-Ming Shih of Johns Hopkins University in Baltimore, Maryland, and colleagues report on a method for identifying genetic imbalances in DNA that seem to be correlated with ovarian cancer.

The technique is called digital SNP analysis. SNPs, or single-nucleotide polymorphisms, are variations in the genetic material DNA. Digital SNP analysis allows researchers to count one-by-one the number of alleles--copies of individual genes--to detect imbalances caused when portions of chromosomes are lost.

Using this technique, Shih's team evaluated blood samples taken from 54 women with early- or late-stage ovarian cancer. The test was able to identify allelic imbalances in 87% of women with early-stage disease and 95% of women with advanced disease. Samples from 31 healthy women showed no allelic imbalances, according to the report.

"The digital SNP tests detected ovarian cancer quite well," Shih said in an interview with Reuters Health. However, Shih noted that the test is both costly and time consuming, which may limit its potential for widespread use.

The next step will be to construct a clinical trial to see how well the test holds up in a much larger group of women and to streamline it, perhaps through automation, to help bring down the cost, Shih explained.

Source: Journal of the National Cancer Institute 2002;94:1697-1703.

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Stem Cell Study May Aid Diabetics

By Paul Recer

AP Science Writer

The Associated Press

Tuesday, November 19, 2002

WASHINGTON (AP) - Embryonic stem cells were turned into insulin-making tissue that was able to keep diabetic mice alive in an experiment that experts say is an important step toward a new treatment for diabetes.

Researchers cautioned that the technique was not yet ready for testing in humans, but said it could lead eventually to using embryonic stem cells to make new insulin-producing islets. The islets of Langerhans are groups of cells in the pancreas, including the beta cells that produce insulin.

In a study appearing this week in the Proceedings of the National Academy of Sciences (news - web sites), Stanford University researchers say they cultured mouse embryonic stem cells until they developed into a tissue that made insulin. After they put the tissue into diabetic mice, the animals were sustained by the insulin produced by the tissue graft.

"We've made something that shares several important properties with the beta cells, but we have not made beta cells," said Ingrid C. Rulifson, a first author of the study. "We believe this is the furthest anyone has gone (in making insulin-producing cells from embryonic stem cells). The fact that we were able to achieve rescue survival in these mice hasn't been demonstrated before in this way."

Dr. Robert Goldstein, chief scientific officer for the Juvenile Diabetes Research Foundation International, said the Stanford finding is "a significant advance" in diabetes research using embryonic stem cells, but he said it will have no immediate human application.

"The principle of being able to take embryonic stem cells and reverse diabetes is an extremely important observation," said Goldstein. He said researchers ultimately hope to use embryonic stem cells to make new beta cells that could be transplanted into diabetics (news - web sites) and produce normal levels of insulin.

He called the Stanford study "one of the necessary steps toward achieving this goal," but emphasized that the next steps — translating the mouse data into human therapy — could take many years.

"We can't fix people tomorrow," said Goldstein.

Embryonic stem cells are the ancestral cells from which all the tissue in the body develops. Scientists believe that if they can learn how to direct the transformation of embryonic stem cells they will be able to grow fresh cells to replace those that have died or stopped functioning.

Some forms of diabetes are caused by the death or malfunctioning of the beta cells that make insulin, a hormone essential for regulating sugar in the blood. Researchers hope to use human embryonic stem cells to grow new beta cells, which could then be grafted into diabetic patients to normalize the metabolism of sugar.

In the Stanford study, researchers used special chemicals to cause mouse embryonic stem cells to transform into cell masses that resembled pancreatic islets. Test-tube experiments showed that the cells made insulin.

The researchers then used chemicals to kill the beta cells in a group of laboratory mice, turning the mice into diabetics. The scientists then grafted some of the insulin-producing tissue into the animals. The transplanted tissue made insulin, responding to the levels of sugar in the blood stream of the mice, and kept the mice alive.

Control mice, which had diabetes but did not receive the graft, died.

To prove that it was the transplanted tissue that was making the insulin, the researchers removed the grafts after three weeks. The mice soon died from excess sugar in the blood.

"At least for a short period, we extended the life of these animals convincingly and showed that upon removal of the graft the animals suffered severe relapse of the disease," said Seung K. Kim, a Stanford researcher and senior author of the study.

Kim said that the transplanted tissue produced insulin at only 10 percent to 12 percent of the levels in normal mice and did not produce some of the other hormones or factors made by the normal beta cell.

"This is one step in the right direction," said Kim. He added that "we have a long way to go" before human diabetics can be treated with tissue from embryonic stem cells.

On the Net:

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

Juvenile Diabetes Foundation International: http://www.jdrf.org

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New and Improved CPR

HealthScoutNews

Tuesday, November 19, 2002

TUESDAY, Nov. 19 (HealthScoutNews) -- A battery-operated compression belt that's strapped around the chest works better than manual chest compressions used in conventional cardiopulmonary resuscitation (CPR).

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

American researchers tested the device on 20 pigs in cardiac arrest and found the device restored blood flow four times better than chest compressions done by hand and returned the pigs' hearts to pre-arrest condition.

The device resembles an 8-inch wide seatbelt. It's buckled around the chest and tightened. When it's switched on, it contracts against the chest and stimulates blood flow.

The researchers say the belt can compress a greater area of the chest than compressions done by hand. That means the belt is able to restore more blood flow than the manual method.

A study is being planned to test the compression belt on humans.

More information

Here's where you can learn more about CPR.

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Gene, Ulcer Bug Types Linked to Stomach Cancer 

By Alison McCook

Reuters Health

Tuesday, November 19, 2002

 NEW YORK (Reuters Health) - Researchers have long known that people infected with a certain type of bacteria are more likely than others to develop ulcers and stomach cancer.

However, not everyone who carries the bug, known as Helicobacter pylori, develops stomach cancer, and investigators have long wondered whether individual differences in either the people who become infected or the strain that infects them are to blame.

Now, new study findings suggest that both genetic differences in infected people and the type of strain they're infected with affect their chances of developing cancer.

"The answer is both," Dr. Martin J. Blaser of New York University and New York Harbor Veterans Affairs Medical Center in New York City, who wrote an accompanying editorial, told Reuters Health. "Both are true, and both are important," he added.

Dr. Ceu Figueiredo of the University of Porto in Portugal and his colleagues found that people with a particular type of H. pylori who carried a particular gene variant were more likely to develop stomach cancer than were patients with either the same gene or the same type of H. pylori, but not both.

Indeed, these two factors were linked to a greatly enhanced risk of developing stomach cancer, the authors note in the November 20th issue of the Journal of the National Cancer Institute (news - web sites). People with both the so-called "high-risk" strain of H. pylori and the gene variant were almost 90 times as likely to develop stomach cancer as those without the gene variant who were infected with a less virulent form of H. pylori.

The authors suggest that these findings could one day be used to determine who among the patients infected with H. pylori are at the greatest risk of developing stomach cancer, and who would therefore benefit most from antibiotics to eradicate the bug and increased monitoring by doctors.

"In our opinion, and if our results are validated by further studies, individuals who carry the polymorphism and are infected by a more virulent H. pylori strain are the ones to which eradication of H. pylori should be targeted," Figueiredo and co-author Jose Carlos Machado told Reuters Health in an E-mail interview.

The researchers cautioned that while the type of strain of H. pylori and the genetic variants present increase the risk of cancer, individual patients who carry both risk factors should not feel they are doomed to develop stomach cancer.

"At the individual level, the risk of having gastric cancer is very, very low, no matter the genetic constitution and the infecting bacterial strain," they said.

Figueiredo and colleagues base their findings on an analysis of 221 patients with chronic stomach inflammation called gastritis and 222 others with stomach cancer. The researchers determined which strains of H. pylori were in their bodies, and what gene types occurred more commonly in patients with stomach cancer.

Blaser explained that both the type of H. pylori and gene variants most linked to stomach cancer were those that increase inflammation in the body, and long-term inflammation can increase stomach cancer risk.

He noted that eradicating H. pylori is not always the best option, for studies have shown that while the bug can hurt the stomach, it can also help the esophagus. However, if these findings are validated in subsequent studies, Blaser suggested that they may one day be used to determine who is at the most risk of stomach cancer; in other words, "in which people to eradicate (H. pylori), and in which people to leave it alone."

Source: Journal of the National Cancer Institute 2002;94:1680-1687, 1662-1663.

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Controlling Hypertension Doesn't Help Kidney Function

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Tuesday, November 19, 2002

TUESDAY, Nov. 19 (HealthScoutNews) -- Stringent efforts to lower blood pressure in people with kidney disease don't prevent the loss of kidney function, but they do appear to save lives, a new study finds.

And one kind of pressure-lowering medication, an angiotensin-converting enzyme (ACE) inhibitor, clearly performed best in the patients with end-stage kidney disease caused by high blood pressure, says a report in tomorrow's Journal of the American Medical Association (news - web sites).

The report is the latest in a series on the African American Study of Kidney Disease and Hypertension (AASK). The 1,094 patients in the study are all black, an ethnic group especially prone to hypertensive kidney disease. Dr. Jason T. Wright Jr. and his colleagues at Case Western Reserve University undertook the study to see whether lowering blood pressure beyond a normal target level would prevent the loss of the kidneys' ability to filter impurities out of the blood. The study started in 1995, with some patients followed for as long as 6.4 years.

The loss of kidney function was no different in the patients in whom blood pressure was reduced to 128 over 78 as compared to those whose pressure was reduced to 141 over 85, the researchers report. "Our results do not support additional reduction as a strategy to prevent" loss of kidney function, they write.

The study concentrated on kidney function because some previous trials indicated that more strenuous control of blood pressure is needed to prevent loss of kidney function, says Wright, a professor of medicine at Case Western.

"Once patients are controlled to levels that prevent cardiovascular disease, then further reduction to prevent kidney disease progression is not necessary," says Wright.

However, Dr. Michael A. Alderman, a professor of medicine and epidemiology at the Albert Einstein College of Medicine, who wrote an accompanying editorial, says the extra reduction in blood pressure appears to be worth it if the patients' overall health, rather than just their kidney function, is considered.

"Most patients like this die of heart attacks and stroke, and in fact the patients with lower blood pressure did have fewer cardiovascular events," Alderman says. Data in the published report show that "cardiovascular mortality and hospitalizations were 16 percent more likely among those assigned to the higher, rather than lower, blood pressure goal," he says.

The study also tested the effects of an ACE inhibitor, ramipril (marketed as Altace), against two other drugs for high blood pressure, the beta blocker metopropolol (marketed as Lopressor) and the calcium channel blocker amlodipine (marketed as Norvasc). Ramipril came out ahead, with patients assigned to that drug having a 22 percent risk reduction compared to those taking metopropolol and a 38 percent risk reduction compared to those taking amlodipine.

"Our results do support the recommendations that ACE inhibitors should be considered as first-line therapy over beta blockers and calcium channel blockers in these patients," the researchers say.

That finding is "no surprise," Alderman says, because it has been made in previous studies involving white patients. The new study does strike at the belief held by some that hypertensive kidney disease in blacks is somehow different from the same disease in whites, he says. "The concern that there is a biological difference between blacks and whites is not right," Alderman says.

What To Do

You can learn more about hypertensive kidney disease from the National Institute of Diabetes and Digestive and Kidney Diseases. For information on kidney disease in general, try the National Kidney Foundation.

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More Liquor Stores, More Cases of Domestic Abuse 

By Alison McCook

Reuters Health

Tuesday, November 19, 2002

PHILADELPHIA (Reuters Health) - Domestic violence in a neighborhood may rise as the number of liquor licenses in the area increases, new study findings suggest.

The current study backs up previous reports linking alcohol to domestic violence, study author Dr. Hsieng-Teh Su of the Mayo Clinic in Rochester, Minnesota and Johns Hopkins University in Baltimore, Maryland, told Reuters Health.

As such, she noted that reducing the incidence of domestic violence in one area may be as simple as spreading out the stores that are allowed to sell alcohol.

"I don't think you could say that liquor license, you know, alcohol, is the only factor in domestic violence," Su said. "But it's contributory. So as many factors as we can help to minimize, the better for violence and crime."

Su and her team presented their findings here last week during the 130th Annual Meeting of the American Public Health Association (news - web sites).

Approximately 800,000 incidents of domestic abuse are reported in the US each year, and experts estimate that only half of all cases are ever reported. Although many factors can contribute to domestic violence, previous studies in rodents have found that those given alcohol become more aggressive, and other research has shown that increasing the availability of alcohol in one area increases sales and consumption of the product.

In their study, Su and her colleagues compared the density of liquor stores in Baltimore County, Maryland, to the rate of reports of domestic violence--physical, sexual or psychological--in that same region. They found that, on average, 12.3 reports of domestic violence were recorded by police each year for every 1,000 people. The region contains 673 licensed liquor stores, or 1.3 stores for every 1,000 people.

Even after accounting for socioeconomic factors that could influence domestic violence, Su and her team discovered that a doubling of the density of liquor stores was associated with a 9% increase in the rate of reported domestic violence.

In an interview with Reuters Health, Su admitted that limiting the number of stores that can sell alcohol in one particular region may be difficult, but for areas where domestic violence is a particularly serious problem, this technique may be worth trying.

"Maybe one of the ways (to reduce domestic violence) is to restrict the availability of alcohol, I think," Su said. "But that's kind of hard so, we'll see."

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Doctors' Groups Issue Migraine Guidelines

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Tuesday, November 19, 2002

TUESDAY, Nov. 19 (HealthScoutNews) -- The nation's two largest groups of primary care physicians are issuing their first set of guidelines for the prevention and treatment of migraines.

The guidelines, formulated by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) and the American Academy of Family Physicians (news - web sites) (AAFP) and directed to physicians, recommend aspirin or ibuprofen as the first line of therapy.

Normally, migraine guidelines are put out by neurologists. When the ACP-ASIM conducted a survey in the mid 1990s of the topics its members would like to see guidelines on, headaches topped the list.

"It's a very common complaint in primary care," says Dr. Vincenza Snow, senior medical associate in ACP-ASIM's department of scientific policy. Primary care is where most migraine sufferers first encounter the health care system.

According to the new guidelines, published in today's issue of Annals of Internal Medicine, 28 million Americans suffer from these severe, recurring headaches, representing 18 percent of all women and 6.5 percent of all men. About half of these people have not been diagnosed or remain undertreated.

The guidelines were based on an extensive review of the existing medical literature by representatives from the fields of emergency medicine, internal medicine, neurology and other disciplines.

"These guidelines are really evidence-based, which means they were really crafted only after a really rigorous review of the medical literature," says Dr. Eric Wall, a family physician from Portland, Ore., who represented the American Academy of Family Physicians in the development of the guidelines. "We really had to hammer it out."

The guidelines may be more conservative than many people would like, Wall concedes, but this is only a reflection of the available literature.

"Some people will say it doesn't go far enough, that it doesn't address new treatments, new therapies," he says. "It is fairly conservative in its recommendations but, unfortunately, that really reflects the state of the science right now."

Conservative or not, here is what the multidisciplinary team has recommended:

·         The first line of therapy should be nonsteroidal anti-inflammatory drugs (NSAIDS), with the most reliable appearing to be the over-the-counter stalwarts aspirin and ibuprofen. There is no proof that acetaminophen on its own is effective for migraines. "People need to be taking the right kind of over-the-counter medications," says Snow. "Not all of them are good for migraine."

  • If these drugs don't work, patients and physicians should move on to drugs specifically developed for migraines, such as triptans or DHE nasal spray.
  • If patients have nausea or vomiting, non-oral remedies should be tried first. Nausea and vomiting should also be treated directly.
  • People who have repeated migraines should be evaluated for possible preventive therapy. Generally, good candidates for preventive measures are patients who have two or more migraines that last three or more days each month; fail to respond to migraine treatment; use medication more than twice a week; or have "uncommon" migraine conditions such as aura (visual sensations).
  • Migraine sufferers should be actively involved in formulating their own treatment plan, the guidelines says. And they should chart their headaches and identify and avoid triggers such as alcohol, chocolate, caffeine, foods containing additives (MSG, tyramine or nitrates), sleep loss, stress and perfumes.

What To Do

For more on migraines, visit the JAMA Migraine Information Center or the National Library of Medicine.

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AHA Responds to Atkins Study Reports

Reuters Health

Tuesday, November 19, 2002

NEW YORK (Reuters Health) - Concerned about the attention garnered by a small study of an Atkins-like low carbohydrate diet, the American Heart Association (news - web sites) issued a statement Tuesday emphasizing their guidelines, which recommend fruits, vegetables, whole grains, lean meat, fish, poultry and low fat dairy products as part of a healthy diet.

"Media reports about a small study funded by the Robert C. Atkins Foundation may have created the erroneous impression that the American Heart Association has revised its dietary guidelines," according to the statements. "This is not the case."

The Association said it was concerned because the study was "very small" including only 60 participants on a high fat, low carbohydrate diet. The study seemed to suggest that the diet was not harmful, and possibly helpful in terms of heart health.

"This is a short term study, following participants for just 6 months. There is no evidence provided by this study that the weight loss produced could be maintained long term," the AHA said.

"People should not change their eating patterns based on one very small, short-term study," said Dr. Robert Bonow, president of the AHA. "Instead, we hope that the public will continue to rely on the guidance of organizations such as the American Heart Association, which looks at all the very best evidence before formulating recommendations."

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Too Many College Kids Ignore Dangerous Allergies

By E. J. Mundell

Reuters Health

Tuesday, November 19, 2002

SAN ANTONIO (Reuters Health) - Most college students who experience a potentially life-threatening allergic food reaction fail to consult a doctor about the event, researchers report.

"A lot of people are having symptoms where they have some shortness of breath or rash, anything we'd consider to be a systemic manifestation of the allergic response. But many weren't seeing a physician for it and that's pretty scary," said researcher Dr. Andrew M. Singer of the University of Michigan in Ann Arbor. In fact, he said many affected college students may not even realize they suffer from a food allergy at all.

The findings were presented here Monday at the annual meeting of the American College of Allergy, Asthma & Immunology.

In their study, the Michigan investigators sent questionnaires to 1,700 dorm-living students. Over 15% said they had experienced what they thought might be an allergic reaction to a specific food. Of those reporting a reaction, 28% said they had suffered from vomiting or nausea after eating the suspect food, 25% said they broke out in hives, and a smaller percentage said they experienced more serious symptoms such as shortness of breath (12.5%) or swelling of the lips or tongue (9.4%).

More disturbing is that fact that just 41% of students who experienced these more serious symptoms reported the attack to a doctor.

In some cases, the individual may not recognize their symptoms as allergy, Singer explained. "Its actually not uncommon to see people who have symptoms but never realized it was an allergic symptom," he told Reuters Health.

"Just a few days ago we saw a patient who reported that almost his whole life, after eating almonds or cashews, his mouth went numb and got kind of itchy--but he never realized that it was an allergy. So a lot of people don't realize that the symptoms they experience are actually allergic in nature, and could potentially be life threatening," he added.

Other students may not want to bring attention to their allergies, or may simply forget about them. "When you're at home your parents know that you have to avoid shrimp, or you have a peanut allergy, but when you're on your own for the first time there are a thousand reasons why you may not want to," Singer said. "You're going to look uncool, you don't want people to know you have an allergy, you're studying, having a good time, and you're not considering your health."

Too many students who know they have serious allergies are also going without their "epi-pen"--an injectable "rescue" medicine that can save a life in the event of a severe allergic reaction. Of the 12 students in the study who had suffered a serious reaction in the past, just six carried epinephrine with them, and only one of those six had taught a friend how to use it should they become incapacitated.

"That's important," Singer said, "because if you have an allergic reaction and your symptoms are such that you have difficulty breathing or you pass out, you may not be able to give the injection to yourself. Someone around you needs to know how to use it and give it to you if you're found down and unresponsive."

He believes that parents, students and college healthcare providers need to take the threat of on-campus food allergy more seriously. Parents of students with food allergy should make sure that their child's allergy is "listed with someone in the dorm system, whether it be the resident assistant, the (college) health service."

And students with serious food allergy need to understand that the condition could kill them. "They need to let people around them know that they have food allergies--tell them 'Here's my Epi-pen, and here's how it's used. If you find me like this, this is when you need to use it."'

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US Report Backs 'Closed' Open Heart Surgery

Reuters

Tuesday, November 19, 2002

CHICAGO (Reuters) - Surgery to repair a defect in the heart that doesn't require a long incision splitting the breastbone but is instead performed through four small holes appears to work, researchers reported Tuesday.

The technique, which employs tiny camera-equipped robotic arms to work inside the closed chest, is expensive but will be a part of the surgical future, said the report from the Heart Institute at Columbia-Presbyterian Medical Center in New York City.

"We wanted to know if it was possible to operate inside the hearts of these patients without making any incisions," said Mehmet Oz, director of the institute. "Not only did we show that the operation is feasible, but we demonstrated it in more than a dozen patients."

The research marked the first time open heart surgery has been performed in the United States without opening the chest. It was reported at the annual scientific meeting of the American Heart Association (news - web sites).

The procedure was used to repair two conditions, atrial septal defect and patent foramen ovale, which are congenital defects that leave an opening between the heart's two upper chambers. The surgery involves plugging the hole with a patch or stitching the hole closed.

The surgery was done on 15 patients ranging in age from 22 to 68, the report said.

"Although the equipment is costly, this is definitely part of the future," said Michael Argenziano, lead author of the study. "Patients are going to insist on it despite the expense because it's cosmetically superior and allows for much faster recovery."

The robotic equipment used was the da Vinci Surgical System developed by Intuitive Surgical Inc., Sunnyvale, California.

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US Study Finds Equal Costs for Heart Techniques

Reuters

Tuesday, November 19, 2002

CHICAGO (Reuters) - Implanting a mechanical heart pump to treat severe congestive heart failure costs about the same as a heart transplant, at more than $200,000, a study said on Tuesday.

The finding, released at the American Heart Association (news - web sites)'s annual scientific meeting in Chicago, is important because Medicare, the federal health insurance plan for the elderly and disabled, has not decided whether to cover the cost of new implanted devices for patients who have severe heart failure.

Thoratec Corp., a California-based medical device company, earlier this month received US regulatory approval for its heart pump, called HeartMate, as a treatment for end-stage heart failure. Previously it was approved only as a bridge to a heart transplant.

The study said the new therapy, while expensive, costs about the same as heart and other organ transplants--procedures society has already determined should be underwritten.

"It's very competitive with other life-salvaging procedures that we undertake and that we pay for," Keith Grossman, chief executive of Thoratec, said in an interview.

An estimated 5 million Americans suffer from congestive heart failure, a condition in which the heart no longer pumps efficiently. Heart failure can cause severe shortness of breath and fatigue, as well as an accumulation of fluid in the lungs and tissues. Currently, the most common treatment is drug therapy.

The study, led by Mehmet Oz, director of the Cardiovascular Institute and vice chairman of surgery at Columbia-Presbyterian Medical Center in New York, found that the average cost of 68 procedures to implant a mechanical heart pump, called a left ventricular assist device, was $196,699. The device itself costs about $65,000, for a total of $261,699.

A heart transplant, for example, costs about $205,000, and a liver transplant about $250,000.

Oz said patients who developed device-related or general infections had longer hospital stays, raising the cost, and that infection rates can be reduced. Oz said the costs were less than he would have expected from such a new device.

"What we learned over the course of the trial is infection was the No. 1 adverse event," Thoratec's Grossman said.

"We also learned that it is probably the most controllable," he said, adding that new guidelines, surgical techniques and products are already reducing those rates.

The study was paid for by the National Institutes of Health (news - web sites) and Thoratec Corp.

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For-Profit Dialysis May Be Deadlier for Patients

Reuters Health

Tuesday, November 19, 2002

WASHINGTON (Reuters Health) - For-profit kidney dialysis facilities cut corners that cause as many as 2,500 more deaths each year than non-profit centers, according to a report to be published Wednesday.

In a paper in The Journal of the American Medical Association (news - web sites), researchers from Canada's McMaster University and the University at Buffalo in New York said that because for-profit centers pay taxes and must find ways to earn money to satisfy shareholders, they squeeze operations, hiring less staff and making each dialysis session shorter than at non-profits. Nurse and technician wages account for about 70% of dialysis costs, according to the researchers.

"The higher death rates result when for-profit companies cut corners to make sure they produce the higher profit margin," lead author Dr. P.J. Devereaux of McMaster University said in a statement.

The study findings are important because the government, through Medicare, pays for patients with end-stage renal disease who must have dialysis to stay alive. Just more than 200,000 Americans receive dialysis, 75% through a for-profit center. There are about 3,000 for-profit centers, compared to 900 not-for-profit, according to the National Renal Administrators Association.

On average, one fifth of dialysis patients die each year. Devereaux and his colleagues estimated that the death rate was 8% higher in for-profit centers, meaning that 1,200 to 4,000 more might die at those facilities.

He and his colleagues reviewed about 700 already-published studies that looked at dialysis in both for-profit and non-profit centers. They took a closer look at eight studies, which covered data from 1973 to 1997. Six of the eight showed a statistically higher increase, and one showed a nonsignificant rise, in the death rate in for-profit facilities. One showed an insignificant decrease in mortality at for-profit centers.

The studies were limited in scope because they were a backwards look, and because none did a prospective, head-to-head comparison of non-profit and for-profit centers, Dr. Gordon Guyatt, a McMaster researcher, said at a press conference in Washington.

But, he said, it would never be possible to do a trial that assigns people to for-profit or non-profit care and then compares the results.

Guyatt said the findings are "highly plausible," and that the increased death rate might be an underestimate.

David Warnock, president-elect of the National Kidney Foundation (NKF), said that 1973-1997 data might not be relevant today. "There is no reason to doubt the validity of these findings relevant to that time period, but I am very uncomfortable applying these results to 2002, for several reasons," said Warnock, who is director of nephrology at the University of Alabama, Birmingham.

He said that all dialysis centers have been improving the quality of care over the last 5 years, largely because of guidelines imposed by the NKF.

"People have really taken those to heart and I think it's had a huge impact on the outcomes for dialysis patients," Warnock told Reuters Health.

Patients can ask dialysis centers for data on how well phosphate and anemia are controlled, and how often patients require temporary catheters, for instance.

Sidney Wolfe, director of Public Citizen's Health Research Group, said Medicare should use its clout "to impose much more control over the quality" of dialysis.

Public Citizen sponsored a briefing on the study.

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US Study Sees Better Carotid Artery Procedure

By Michael Conlon

Reuters

Tuesday, November 19, 2002

CHICAGO (Reuters) - A technique designed to capture bits of fatty deposit released when arteries leading to the brain are widened shows promise for reducing the risk of stroke that accompanies the procedure, researchers said on Tuesday.

The study--released at the annual scientific meeting of the American Heart Association (news - web sites)--compared two procedures for opening up the carotid arteries in the neck that supply blood to the brain.

One involved the surgical opening of the arteries and subsequent cleaning out of the deposits, the most common current method. The other employed a stent--a tiny tube made of wire-like mesh-that is sent on a wire through the arteries to open the neck vessel. The stents used here were equipped with an umbrella-like "basket" to catch dislodged pieces of the fatty material, also known as plaque.

The floating pieces of plaque can block blood vessels and lead to a stroke, the deadly and disabling outcome that the artery-clearing procedure is designed to prevent in the first place. The patients involved in the study were at high risk for problems if they had the surgical plaque removal, which in lower-risk patients carries a relatively minor risk of stroke.

The study was sponsored by Cordis Endovascular, a division of Cordis Corp., a Johnson & Johnson company. Its preliminary results found that of 307 high-risk patients on whom either the stent or the artery opening procedure were performed, death, stroke or heart attack occurred at a rate of 5.8% for the stent patients compared to 12.6% for the others--what the authors called a "statistically significant improvement" as recorded 30 days into the study.

'Very Encouraging’ Findings

"The interim findings for the ... study are very encouraging," said Dennis Donohoe, vice president of therapeutics and clinical research for Cordis. "It is critical that we identify a safe, effective alternative ... for the thousands of patients with carotid artery blockages who are at high risk for surgical treatment."

"We are extremely impressed with the performance of the (stent)," said Jay Yadav of the Cleveland Clinic Foundation, who was involved in the study. "While these results are preliminary, the 30-day data are a good barometer of long-term results. Most procedure-related adverse events in carotid artery intervention occur within this timeframe."

Brian Firth, a physician who is a vice president for medical affairs and health economics worldwide at Cordis, said in an interview that it is very clear something has to be done to trap the dislodged particles at the time the stenting procedure is done because the first 24 to 48 hours are critical to stopping clot formation.

He said the stent is deployed through a wire guided into the body through the groin, the common route for angioplasty artery-clearing procedures. In the case of the device being tested there is an umbrella-like basket that is opened when the stent is deployed. It can then be collapsed, with the dislodged plaque inside it, and pulled back through the arterial path and out of the body when the wire is removed at the end of the procedure.

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Sleep Apnea, Stuttering May Be Linked

Reuters

Tuesday, November 19, 2002

WASHINGTON (Reuters) - Stuttering and a serious form of snoring known as sleep apnea may be linked, and both conditions may be caused by brain damage sustained early in life, US researchers said on Monday.

A team at the University of California Los Angeles found that nearly 40% of sleep apnea patients they studied also stuttered as children.

Sleep apnea is a serious form of snoring in which a patient's breathing actually stops several times a night. It is linked with a high rate of heart death.

"For decades, we have blamed sleep apnea solely on a narrowed airway caused by enlarged tonsils, a small jaw or excess fat in the throat," Dr. Ronald Harper, a professor of neurobiology who led the study, said in a statement.

"Our findings show, however, that sleep apnea patients also suffer disordered wiring in brain regions that control muscles of the airway. These glitches may lead to the syndrome."

Writing in the American Journal of Respiratory and Critical Care Medicine, Harper and his colleagues said they used magnetic resonance imaging to compare the brains of 21 men diagnosed with sleep apnea with 21 men free of the disorder.

The MRIs revealed a dramatic loss of gray matter--brain cells--in the men with sleep apnea. The worst-hit areas were those involved in speech production, movement and emotion.

The amount of brain damage correlated directly to the severity of sleep apnea. The healthy men's brains were 2% to 18% larger in these areas than the men with sleep apnea.

"We propose that early damage to the brain's speech center triggers problems in the muscles that control the airway. This, in turn, eventually leads to sleep apnea," said Dr. Paul Macey, who also worked on the study.

"Because the sleep apnea patients possessed speech impairments from childhood and their brain's speech center revealed significant gray matter loss, this brain damage likely originated early in life."

The researchers said 38% of the sleep apnea patients reported a history of stuttering or speech impairment. Overall, 7% of the general population stutters.

"Speech impediments may prove an important diagnostic clue for assessing and treating sleep apnea," Macey added. "In the future, doctors may monitor certain brain structures and examine children for speech or movement problems that may predict a higher sleep apnea risk."

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New Compounds May Block Cancer Spread to Bone

By Merritt McKinney

Reuters Health

Tuesday, November 19, 2002

NEW YORK (Reuters Health) - Blocking the production of a molecule that promotes bone destruction may keep cancer from spreading to the bone, according to the results of a new animal study.

Dr. Wolfgang E. Gallwitz of OsteoScreen Ltd. in San Antonio, Texas, and colleagues identified compounds that prevented breast cancer (news - web sites) cells from spreading into bone in mice.

Gallwitz told Reuters Health that "one of the worst characteristics of cancer is its capacity to spread or metastasize." He noted that breast cancer is particularly prone to spreading to the bone and bone marrow. The Texas researcher explained that the spread of cancer into bone can be very painful, and can make bones fragile and more likely to fracture. Metastasis to bone may also lead to high levels of calcium in the blood, a condition called hypercalcemia.

Based on recent research, a peptide called parathyroid hormone-related peptide (PTHrP) seems to play a crucial role in a "vicious cycle" of metastasis to the bone. PTHrP promotes the breakdown of bone, and then cells called osteoclasts communicate with tumor cells, which leads to further bone loss and spread of the tumor. Laboratory experiments have shown that neutralizing PTHrP can block the growth of cancerous lesions in bone as well as reduce hypercalcemia.

Gallwitz and his colleagues were able to identify two compounds that neutralize PTHrP. In studies in mice, these compounds were able to "block the capacity of tumors to metastasize to bone and cause bone destruction," Gallwitz said. The compounds also reduced tumor formation in bone, he said, and they reduced calcium levels. A report on the findings is published in the November issue of the Journal of Clinical Investigation.

Gallwitz added that "an old anti-cancer drug called 6-thioguanine has the unique capability of inhibiting PTHrP production by breast cancer cells, and we plan to examine its potential as a therapy for patients at risk from breast cancer metastasis to bone in a clinical trial."

If the drug proves effective, it may be possible to use it in combination with drugs currently used to prevent cancer from spreading to bone. These drugs, known as bisphosphonates, were designed to counter the bone destruction of the brittle-bone disease osteoporosis, but they also can reduce the spread of cancer to bone. Bisphosphonates act in a completely different way than the compounds tested in the study, however.

PTHrP is often present in breast cancer, and it promotes bone destruction, so it is possible that the "reduction of PTHrP production or action could be of benefit in late stages of cancer," Dr. T. John Martin of St. Vincent's Institute of Medical Research in Melbourne, Australia, writes in an editorial that accompanies the study.

However, he points out that one study found that women with breast cancer whose tumors contained PTHrP were more likely to survive than women whose tumors lacked the peptide, so it is possible that the presence of PTHrP early in cancer might be linked to a less invasive type of cancer.

Source: Journal of Clinical Investigation 2002;110:1389-1401, 1559-1572.

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Study Shows Some Crib Deaths Are Heart-Related

Reuters

Tuesday, November 19, 2002

CHICAGO (Reuters) - A study suggests 5% of sudden infant death syndrome cases may be due to an electrical problem in which the heart recharges itself too slowly, researchers said on Tuesday.

About 3,000 infants die each year in the United States alone of SIDS, defined as the sudden and unexplained death of an infant less than 1 year old. Previous research has also suggested sleeping on the stomach, nervous system problems related to breathing, abnormal metabolism in the liver and flaws in the heart's electrical channels could be among the causes.

The American Academy of Pediatrics recommends infants be placed on their backs to sleep instead of on their stomachs, and studies have indicated that change has reduced the incidence of SIDS.

The study released Tuesday at the American Heart Association (news - web sites) meeting in Chicago found that in one out of 20 cases of SIDS, the baby has a problem similar to a heart condition called long Q-T syndrome that sometimes causes sudden death in young people and adults.

With long Q-T syndrome, the heart electrically recharges itself too slowly or in a disorganized way, ahead of the next heartbeat, and can sometimes cause the heart to stop pumping. An estimated one in 5,000 people may suffer from the syndrome.

The researchers, led by Michael Ackerman, an assistant professor at the Mayo Clinic, performed a genetic autopsy on every unexplained infant death investigated in Arkansas from September 1997 to August 1999. There were 93 cases.

"Long Q-T syndrome is sometimes called the perfect killer, because it leaves no clues," Ackerman said in a news release issued by the heart association. "Neither does SIDS."

"SIDS will probably turn out to have 20 different underlying causes," he added. "If we can figure out what they are, we can screen for them and hopefully one day, prevent future cases."

Ackerman urged medical examiners to collect and store tissue in sudden infant deaths in a way that allows researchers to carry out a molecular autopsy, in order to continue to study the possible causes of SIDS.

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Many U.S. Adults Not Controlling Blood Pressure

Reuters Health

Tuesday, November 19, 2002

NEW YORK (Reuters Health) - At least one half of older adults with high blood pressure do not have their pressure controlled to levels that would limit their risk of heart disease and stroke, according to a large national study.

The risk of heart disease, the leading cause of death in the US, increases when blood pressure exceeds 140/90 millimeters (mm) of mercury (Hg). Control is achieved when the top number or systolic pressure falls below 140 mm/Hg. Failing to control this number may account for up to 22% of heart attacks and 34% of strokes that occur each year in older adults, the researchers explain.

"The expected public health benefit of more aggressive treatment of systolic hypertension (high blood pressure) is likely to be large," Dr. Bruce M. Psaty from the University of Washington in Seattle and colleagues write in the November 11th issue of the Archives of Internal Medicine (news - web sites).

Their study included information on nearly 6,000 US adults aged 65 and older who had their blood pressure measured annually. High blood pressure was reported to the patient and the patient's doctor.

While the rate of blood pressure treatment and control increased over the following decade, about 50% of people with high blood pressure remained untreated despite the yearly reports. And low-dose diuretics and beta-blockers, safe medications recommended as initial treatments for high blood pressure, were not used as often as they could have been.

Overall, however, the average number of blood pressure-lowering medications used by each person rose, the report indicates.

"More widespread use of low-dose diuretics is likely to be an important public health intervention to prevent the devastating complications of hypertension, including stroke, (heart attack) and heart failure," Psaty and colleagues conclude.

Diuretics flush excess water from the body, thereby helping the heart work more efficiently. The medication has been shown to lower the risk of stroke, congestive heart failure, coronary disease and death in individuals who retain fluid, and is safe and effective for older adults.

Source: Archives of Internal Medicine 2002;162:2325-2332.

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MONDAY, NOVEMBER 18, 2002

Many Schools Bar Allergy, Asthma Meds, Group Says

By E. J. Mundell

Reuters Health

Monday, November 18, 2002

SAN ANTONIO (Reuters Health) - Overzealous "zero-tolerance" anti-drug rules are preventing many American schoolchildren with asthma or serious allergies from carrying medications that could save their lives, according to representatives of the nonprofit advocacy group Allergy & Asthma Network Mothers of Asthmatics (AANMA).

For vulnerable children, medications such as asthma inhalers or auto-injectable epinephrine (used in the case of severe anaphylactic shock brought on by allergy) can mean the difference between life and death. AANMA President Nancy Sander says her group is pressuring Congress to pass legislation that would guarantee children across the US the right to carry these and other essential medications on their person, instead of leaving them at the school health clinic, as is now sometimes the case.

"You would not tell a child who needs a wheelchair to leave his wheelchair in a clinic," Sander told Reuters Health. "You would not tell a child who needs glasses to leave his glasses in the clinic. But this is a life-threatening condition, where children do die every single school year."

In fact, the state of Georgia recently passed the Kellen Edwin Bolden Act, named after an asthmatic child who was barred by local school policy from carrying his asthma inhaler with him while on campus. Bolden died after suffering a severe asthmatic attack while boarding a school bus.

Passage of the act now means that children in Georgia cannot be barred by individual school boards from carrying prescribed, lifesaving medications.

But children in many states lack these protections. In their nationwide survey, presented here Saturday at the annual meeting of the American College of Allergy, Asthma & Immunology, Sander and Magnetti report that just 17 states have enacted laws explicitly protecting the right of schoolchildren to keep prescribed lifesaving drugs on their person while at school.

Other states protect the rights of children with life-threatening allergies to carry auto-injectable epinephrine, but do not extend those protections to asthmatic children, who rely on their inhalers. And while Tennessee and Wyoming have general policies allowing schoolchildren to carry necessary drugs, these policies do not extend to epinephrine.

In most cases where children are barred from carrying essential drugs on their person, schools mandate that these medications be kept at the school heath clinic, instead.

"But these clinics are in many cases not staffed by RNs," Sanders pointed out. "They may be staffed by the school secretary or a parent volunteer--who may or may not have as much experience in administrating that medication as the child does himself."

Policies like these usually spring from overzealous efforts on the part of parents and school administrators to reduce kids' use of illicit drugs, Sander explained.

"It's 'zero-tolerance' for drugs," she said. "There's also a fear that's been expressed--and it's not a rational fear--of 'What would happen if a child dropped his inhaler on the playground and another child finds it and uses it--the child may get high."'

Those fears are unfounded, according to Sander. "It's not fun to use an inhaler in the first place. And it's not going to harm a child who finds it and may try it--even if they could figure out how to use it."

Right now, school policies governing kids' access to their medications vary widely from district to district and from state to state. "We're hoping to create (federal) legislation that would protect the rights of all children with asthma and anaphylactic conditions to carry prescribed, lifesaving medications," Sander said. "Once we get that policy for the entire United States, then what we will launch is a campaign that would let families know that they have the right to ask for this."

The issue is a serious one, she said. "Kids have died. They've died on the way to the clinic after being sent there by themselves. They've died back in the classroom, after going to the clinic and asking for help and being told 'you look good to me.' There are legal battles that have been fought and won on behalf of children who died, because the school did not respond to their asthma emergency in an appropriate manner and did not allow the child to carry their inhaler on their person."

For more information on the campaign, visit Allergy & Asthma Network Mothers of Asthmatics' Web site at www.breatherville.org.

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Savvy Food Shopping

HealthScoutNews

Monday, November 18, 2002

(HealthScoutNews) -- Because of a growing concern about food-borne diseases, the U.S. Food and Drug Administration (news - web sites) suggests you stack your shopping cart and grocery bags with care.

Here are some steps you should follow:

  • Separate raw meat, poultry, seafood, and eggs from ready-to-eat foods.
  • Place raw foods inside plastic bags to contain the juices.
  • Go home straight after your grocery shop and refrigerate perishables right away.
  • In hot weather, load groceries into your air-conditioned car rather than the trunk.

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Popular Buckwheat Pillows May Trigger Allergy

By E. J. Mundell

Reuters Health

Monday, November 18, 2002

SAN ANTONIO (Reuters Health) - Though often touted as hypoallergenic, pillows containing buckwheat husks may be anything but a dream for some users.

"It's entirely possible that the buckwheat pillows themselves are causing people to have asthma or allergic rhinitis," said Dr. Stephen Fritz of the University of Michigan Medical Center in Ann Arbor. He presented a case study here Sunday at the annual meeting of the American College of Allergy, Asthma & Immunology, describing a patient who developed buckwheat allergy symptoms after pillow use.

Sales of the pillows--usually a cotton casing filled with thousands of dried brown buckwheat husks--have skyrocketed in the past few years. Manufacturers claim that the pillows conform better to the neck and head compared with standard feather pillows, providing users with better sleep and marked reductions in neck or back pain.

However, some users may not be quite so satisfied. Fritz and his colleague Dr. Bernard Gold describe the case of a 24-year-old man who came to them with worsening symptoms of both asthma and allergic rhinitis (runny, stuffy nose). After testing negative for allergies to a whole host of common triggers such as cat, dog, mold and dust mites, Fritz prescribed strong anti-asthma and allergy medications, which did little good.

Only when the patient mentioned that he had bought buckwheat pillows for himself and his girlfriend was he tested for buckwheat allergy. Testing positive, he got rid of the pillows "and his symptoms resolved in a couple days, which is quite phenomenal," Fritz told Reuters Health.

The Michigan researcher believes that allergists in the US may not be aware of the growing popularity of buckwheat pillows, or that buckwheat contains potent allergens. "Bakers can get occupational allergy from (inhaling) buckwheat flour," he explained. "We suspect that that was what was happening with our patient--there were buckwheat flour particles attached to the husks inside the pillow. He was inhaling them into his nose and respiratory system, his upper and lower airways."

Any manufacturer's claim that their buckwheat pillow is hypoallergenic needs to be taken with a grain of salt, Fritz added. "Many of them do claim that they are hypoallergenic, usually from the standpoint that they don't contain feathers, because some people are actually allergic to feathers." But users could still develop a reaction to buckwheat, he warned.

"I'm not saying they are not beneficial--I think some patients get a great deal of benefit from them," Fritz said. "But if they develop asthma or allergic rhinitis, they should go see their allergist about getting skin tested for buckwheat allergy."

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Herbal Menopause Remedy Ineffective

By David Caruso

Associated Press Writer

The Associated Press

Monday, November 18, 2002

PHILADELPHIA (AP) - Except for an herbal remedy developed by American Indians, most of the exotic berries, teas, herbs and oils frequently taken by women to ease menopause symptoms have been ineffective in clinical trials, according to a study.

Alternative treatments for hot flashes, vaginal dryness and other menopause symptoms have gotten additional attention since July, when researchers found evidence linking estrogen-progestin hormone supplements with breast cancer (news - web sites) and heart disease.

Researchers at Columbia University and George Washington University examined the results of 29 independent studies on alternative treatments for hot flashes and found that only the herb black cohosh appeared to work.

Three of four trials found the herb had a benefit, according to the review in Tuesday's issue of the Annals of Internal Medicine.

Black cohosh, a member of the buttercup family, is among the most popular of alternative treatments for menopause. Most clinical studies involved a concentrated brand called Remifemin, manufactured by GlaxoSmithKline.

Other popular herbal treatments, including ginseng, red clover, dong quai and oil of evening primrose, were found to have no discernible effect on such symptoms as hot flashes, vaginal dryness, sleeplessness and other ills blamed on menopause. Researchers said studies have also found few documented benefits from acupuncture, vitamin E, relaxation techniques and progesterone creams.

The study said a few alternative treatments showed promise. Women who ate soybean dietary supplements reported hot flashes that were less intense, though in many cases the benefits disappeared after a few weeks.

Study authors Fredi Kronenberg and Adriane Fugh-Berman noted, however, that most of the trials examining the benefits of alternative treatments were small and inconclusive. Few looked at the benefits or harm of using herbal remedies for many months or years.

"Product advertising hype far exceeds scientific knowledge," they wrote.

Dr. Margery Gass, director of the University Hospital Menopause and Osteoporosis Center in Cincinnati and president of the North American Menopause Society, said the review points to a need for further study.

"We're seeing pharmaceutical companies get interested in these products. We are seeing the government get interested," she said. "It would be wonderful if we could see some bigger clinical trials before people start spending millions of dollars on nontraditional therapies."

On the Net:

Annals of Internal Medicine: http://www.annals.org

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US Study Finds Offspring of Centenarians Healthier

Reuters

Monday, November 18, 2002

CHICAGO (Reuters) - Whether it's the genes or the lifestyle, living to an old age appears to confer benefits to one's children.

Researchers said on Monday that the children of people who live to be 100 have strikingly lower problems with heart disease and other health troubles than those whose parents die in their 70s.

"Exceptional longevity runs in families but at this point it's difficult to predict how much of this effect is genetic and how much is related to environment and lifestyle," said Dellara Terry of the Boston University Medical Center.

"Our research suggests that children of centenarians have some cardiovascular health advantages over the rest of us but Americans can still improve their health and age more successfully by not smoking, maintaining a healthy weight and exercising regularly," she said in a report released at the annual scientific meeting of the American Heart Association (news - web sites).

The study was based on a look at 176 offspring of centenarians. They had a 26% incidence of high blood pressure and a 13% incidence of heart disease compared to 52% and 27% respectively for those in the group whose parents did not live as long.

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The Inherited Benefit of Old Age

HealthScoutNews

Monday, November 18, 2002

MONDAY, Nov. 18 (HealthScoutNews) -- If you've seen one of your parents blow out 100 candles on their birthday cake, you may have your own cause for celebration.

Adults who had a parent live to be at least 100 have much lower incidence of heart disease and fewer major heart risk factors in old age than adults whose parents died in their 70s, says an American study being presented today at the American Heart Association (news - web sites)'s scientific sessions meeting in Chicago.

The study compared 176 adult children of centenarians (called c-children) to a control group of 166 adult children who had at least one parent die at age 73. That's the average life expectancy for someone who survives past age 20.

The average age of the c-children in the study was 71.1 years, and the average age in the control group was 69.7 years.

The average age at death was 102.4 years for the centenarian parents of the c-children. The average age of death of the second parent was 77 years in both the c-children group and the control group.

One of the c-children had two parents who lived to age 100, but a single individual is too small a sample to draw any conclusions about being the offspring of two centenarians, the researchers say.

The study found that c-children had lower rates of high blood pressure (26 percent versus 52 percent), heart disease (13 percent versus 27 percent), and diabetes (5 percent versus 11 percent) than the control group.

The c-children also weighed less. Female c-children had an average weight of 146 pounds, compared to an average of 158 pounds for control group females. Male c-children had an average weight of 184 pounds, while control group males had an average weight of 202 pounds.

C-children also had lower body mass indexes than the control group.

However, the study found no significant difference between the two groups when it came to the prevalence of other age-related diseases such as cancer, stroke, dementia, osteoporosis, cataracts, glaucoma, macular degeneration, depression, Parkinson's disease (news - web sites) and thyroid disease.

More information

The American Heart Association has more about heart disease.

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Tiny Water-Borne Bugs Could Be Allergen

By E. J. Mundell

Reuters Health

Monday, November 18, 2002

SAN ANTONIO (Reuters Health) - Microscopic aquatic animals known as copepods, one of the most widespread and abundant life forms on Earth, could be a source of gastrointestinal and other allergies, researchers report.

In fact, nearly half of patients already allergic to other substances also tested positive to proteins extracted from a species of copepod, according to Dr. Steve Kagen of the Kagen Allergy Clinic in Appleton, Wisconsin.

Copepods (Latin for "oar feet") are related to much larger crustaceans, such as crabs or shrimp, and are found wherever there is water--from the deep ocean and freshwater streams to the moist undersides of leaves and grass. Ranging in size from microscopic to barely visible, they feed on algae, bacteria and other organisms, and taken together comprise one of the largest sources of protein on the planet.

Because other small animals--such as dust mites or cockroaches--can shed proteins known to trigger allergy, Kagen wondered if the lowly copepod might do the same. After extracting suspected protein allergens from two species of copepod, he and his colleagues used a highly sensitive antibody test to see if any of 75 patients already allergic to other substances were allergic to copepod protein, too.

The result? Thirty-three of the patients--44%--showed evidence of antibodies suggesting prior reactions to copepod. To help rule out "cross-reactivity"--the possibility that other allergens might have triggered the antibody response--Kagen also ran tests for common allergens such as ragweed, birch, grass, midge, shrimp and dust mites. They found no evidence of cross-reactivity.

All of us have ingested--and will continue to ingest--proteins shed by copepods, Kagen said. "If you go swimming in a lake and you swallow some water, you just swallowed some copepods," he told Reuters Health. And even in tap water sourced from municipal water supplies, "the copepod itself may not get through, because there are sand filters and other techniques that are being used, but the proteins themselves will come through," he said.

Of course, developing antibodies to an allergen does not mean a patient will develop noticeable symptoms of allergy. But because copepod proteins ingested through swimming or drinking water will most certainly come into direct contact with the gastrointestinal system, Kagen believes they could be an as yet unidentified trigger for Crohn's disease or ulcerative colitis--serious chronic illnesses whose causes are not always clear.

Kagen's team is currently investigating the prevalence of copepod allergy in patients with these conditions, known collectively as inflammatory bowel disease, and so far every one of the Crohn's patients in his practice have tested positive for copepod allergy.

"What we're going to do next is isolate the copepod proteins, sequence them if we can, clone the genes, so we can really find out what these proteins are," Kagen said. In the meantime, he hopes to alert allergists to the fact that these tiny, ubiquitous creatures could be a cause of hitherto-unexplained allergic illness.

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Hospice Care Is Being Started Later

The Associated Press

Monday, November 18, 2002

WASHINGTON (AP) - Terminally ill patients are spending fewer of their last days in hospice care, advocates of better care for the dying said in a report Monday.

Last Acts, a coalition of health and aging groups, looked at the availability of good end-of-life care. One central measure is hospice care, which provides dying patients with such services as pain relief and assistance in putting their affairs in order. It usually is offered in patients' own homes, and Medicare pays for it.

More people are turning to hospice care, the report said. Enrollment jumped from about 1,000 a year in 1975, when hospice care began, to 700,000 in 2000.

But they are entering hospice care ever closer to the time of death. Patients spent an average of 70 days in hospice care in 1983, but that dropped to 36 days by the late 1990s, the report said. In 1998, 28 percent of hospice patients were enrolled for one week or less before they died.

Hospice care varies widely by state. In 2000, hospice was most popular in Arizona, where between one-third and half of patients over age 65 used it during their last year of life. It was least popular in Alaska and Maine, where less than 10 percent of the dying elderly used it.

Medicare pays for hospice for patients considered likely to die within six months, and Last Acts cited studies suggesting patients must participate for at least 60 days to get the maximum benefit.

In 2001, the report said, hospice stays for patients of any age were longest — a median of 30 to 45 days — in Alabama, Louisiana, Mississippi, New Mexico, North Carolina and South Carolina.

It's not known why hospice time is dropping, although recent studies have found it is harder to predict remaining life expectancy with certain diseases. Some cancers, for instance, progress steadily while other diseases, such as heart failure, may wax and wane.

Members of Congress two years ago called the decline in hospice lengths of stay troubling. They urged Medicare to remind doctors that if a patient lives longer than the six months initially expected, recertifying that he or she remains close to death ensures that payment continues.

Medicare officials issue periodic reminders explaining that, but it still causes confusion, said Judith Peres, co-author of the report.

Percentage by state of Medicare-eligible patients who used a hospice during their last year of life, according to 2000 figures, and 2001 figures measuring median number of days patients of any age spent in a hospice.

State Hospice use Median stay

Ala. 23.5 42.9

Alaska 4.9 n/a

Ariz. 42 27.7

Ark. 18.8 26

Calif. 24.2 23.6

Colo. 36.8 22.5

Conn. 19.4 21.5

Del. 24.4 n/a

D.C. 13.8 n/a

Fla. 35.3 18.2

Ga. 24.2 25.4

Hawaii 19.1 26.6

Idaho 20.8 25.1

Ill. 25 18.8

Ind. 18.8 26.7

Iowa 23.1 27.9

Kan. 22.5 25.4

Ky. 20.8 27.5

La. 19.7 33.2

Maine 9.1 27.4

Md. 20.5 20.5

Mass. 18.3 18.1

Mich. 28.2 26.2

Minn. 21.8 23.2

Miss. 17.6 37

Mo. 22 24.1

Mont. 17.5 25.2

Neb. 20 25.4

Nev. 28.8 n/a

N.H. 17.9 20.8

N.J. 18.7 21.1

N.M. 29.6 35.2

N.Y. 15.8 18.9

N.C. 18.9 32.2

N.D. 18.1 20.9

Ohio 26.9 17.5

Okla. 28.4 25.9

Ore. 31.1 23.9

Pa. 21.2 24.3

R.I. 18.3 13.7

S.C. 19.3 34.1

S.D. 12.8 26.8

Tenn. 15.4 23.6

Texas 28.4 25

Utah 24.9 19.3

Vt. 14.9 27

Va. 18.1 24.9

Wash. 24.1 23.6

W.Va. 16.6 29.4

Wis. 19.5 18

Wyo. 14.5 15.2

Source: Dartmouth Atlas of Health Care and National Hospice and Palliative Care Organization.

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Study: Older Patients Benefit from Statin Use

Reuters

Monday, November 18, 2002

CHICAGO (Reuters) - Elderly patients who use cholesterol-lowering drugs may enjoy the same benefits as their younger counterparts, researchers reported on Monday, based on results of a landmark trial.

Researchers found a 15% combined reduction in the risk of heart attack and stroke among a group of patients over the age of 70, but most of that benefit came from the reduction of heart attack risk.

The trial involved 5,804 patients aged 70 to 82 in three European centers, including 3,239 patients with blood vessel disease and 2,565 patients who were at high risk of contracting the disease because of smoking, high blood pressure and diabetes.

Patients were given Bristol-Myers Squibb Co.'s pravastatin, sold under the name of Pravachol, which lowers cholesterol by blocking the enzyme that makes cholesterol. It found that pravastatin, a member of the "statin" class of drugs, significantly reduces coronary events by 19% and deaths linked with coronary events by 24%.

The study, presented at a meeting of the American Heart Association (news - web sites), provided the first scientific evidence of the effectiveness of such drugs in treating heart disease in older patients.

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Secondhand Smoke Bad for Kids

HealthScoutNews

Monday, November 18, 2002

MONDAY, Nov. 18 (HealthScoutNews) -- If you're a parent who smokes, here's another good reason for you to quit the habit: Your secondhand smoke can damage your child's blood vessels.

Children subjected to cigarette smoke from one parent had up to 50 percent higher levels of a biological marker of oxidative stress in their blood, says an Austrian study being presented today at the American Heart Association (news - web sites)'s scientific sessions meeting in Chicago.

A growing body of evidence indicates that secondhand smoke breaks down antioxidant defenses, leading to problems with the endothelial-dependent function of arterial walls. Endothelial dysfunction is an early feature of atherosclerosis, which can lead to heart disease and stroke.

The Austrian researchers measured levels of a biological compound called 8-epi-PGF2alpha in the blood and urine of 158 children, aged 3 to 15. This compound forms when free radicals attack arachidonic acid, a chemical responsible for blood vessel dilation, prevention of blood clots and inflammation reaction.

Children exposed to secondhand smoke from less than 20 cigarettes a day from one parent had 35 percent to 50 percent more of the compound in their blood and 20 percent to 30 percent more of the compound in their urine than children not exposed to any parental secondhand smoke.

The more exposure to secondhand smoke, the higher the compound levels were in children. If both parents together smoked more than 40 cigarettes a day, the compound levels in children were as much as 130 percent higher in blood and 65 percent higher in urine than in children not exposed to secondhand smoke.

The study also found that mothers who smoked had a much greater impact on their children than fathers who smoked. The researchers say that may be because mothers may have closer contact with their children at home.

The study authors say these findings are important considering that nearly half of all children in the United States and Western Europe are exposed to secondhand smoke in some way.

More information

Here's where to find out more about secondhand smoke and children.

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Cells Engineered Into Blood Vessels, Pacemakers

Reuters

Monday, November 18, 2002

CHICAGO (Reuters) - Scientists are morphing tissue cells into working blood vessels and engineering them to act as artificial pacemakers, according to findings presented at a major medical meeting on Sunday.

The techniques involve manipulating cells from one organ, say a muscle, to form different tissue types, for example a heart cell. Researchers hope the technology, when perfected, will aid in repairing broken vessels and cells in sick patients.

In one study, researchers took cells from 11 heart disease patients, manipulated them in a culture and implanted them into animals with broken arteries.

"When we are doing it in you, it will be your skin cells and your own tissue," said Todd McAllister, chief executive officer of Cytograft Tissue Engineering in Novato, California.

Blood clots didn't form nor did the vessels pop, which encourages scientists that they will be able to begin research in humans within a year and a half.

Patients with heart and leg bypass surgeries and on dialysis could benefit from such procedures.

The findings were among those presented at the American Heart Association (news - web sites)'s annual scientific meeting in Chicago, Illinois.

In a separate trial, scientists extracted muscle cells from rats, manipulated them with chemicals and injected them back into rat hearts.

There, the cells appeared to work as a pacemaker would--connecting with heart cells to make electrical currents--for more than a year after implantation.

Scientists hope eventually to use the technology to help patients with heart block, a potentially fatal condition in which the electric pathway is broken down.

"Everything at this point shows that the pathway is there," said Douglas Cowan, a biologist who led the study at Children's Hospital in Boston.

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Blood Thinner May Cut Death Risk

By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, November 18, 2002

CHICAGO (AP) - Long-term use of the blood thinner Plavix can significantly reduce the risk of death and bad side effects in angioplasty patients, a study found.

The promising results suggest there would be at least 24,000 fewer deaths, heart attacks and strokes combined annually if every U.S. patient who undergoes angioplasty were treated for one year with Plavix, the researchers said.

"We saw a big benefit," said Dr. Eric Topol of Cleveland Clinic. He helped conduct the research and also works as a consultant for Bristol-Myers Squibb Co. and Sanofi-Synthelabo, which market the drug and paid for the study.

Dr. Robert Bonow, president of the American Heart Association (news - web sites), called the results significant and said if confirmed in other studies, they could lead to changes in current practice.

"It's a big deal," Bonow said.

The study appears in this week's Journal of the American Medical Association (news - web sites) and also was presented at Monday's session of the AHA's scientific meeting in Chicago.

Plavix, also known as clopidogrel, helps keep blood components called platelets from sticking together and forming clots. The pills are commonly used with aspirin for about one month after an angioplasty.

The study involved 2,116 heart patients aged 62 on average, most of whom underwent a non-emergency angioplasty to open a blocked artery and had a stent implanted to keep the artery from reclosing. Patients were mostly male and white.

Patients took Plavix and aspirin for 28 days after the procedure, which is standard practice. After that, half continued with the combination for a year, and half received a placebo instead, plus aspirin.

After a year, there were 89 deaths, heart attacks and strokes combined in the Plavix patients compared with 122 in the placebo group. That equals a 27 percent risk reduction for the Plavix patients.

The results suggest that with at least 800,000 patients undergoing angioplasties annually, there would be about 24,000 fewer deaths, heart attacks and strokes if they all received the Plavix-aspirin treatment for a year, Topol said.

Plavix is currently recommended for just a month after angioplasty and stenting because that is thought to be the riskiest period for blood clots, Bonow said. Stents are small mesh-like tubes often made of metal and designed to keep an unclogged artery propped open. Exposing blood to the foreign object increases the risk of clots that could cause a heart attack, but tissue gradually grows over the stent and lowers that risk.

The study suggests that using Plavix beyond that initial risky period benefits more than just the stented artery — perhaps also other clogged arteries, Bonow said.

A study published earlier this year in the New England Journal of Medicine (news - web sites) suggested that long-term use of Plavix would not be cost-effective because it is much more expensive than aspirin.

Topol said Plavix costs about $80 a month, "which is not trivial," but argued that the benefits found in the study would make the extra cost worth it.

On the Net:

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

American Heart Association: http://www.americanheart.org

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Drug Cuts Women's Stroke Risk-Study

By Julie Steenhuysen

Reuters

Monday, November 18, 2002

CHICAGO (Reuters) - The use of Evista, Eli Lilly and Co.'s drug to treat post-menopausal osteoporosis, cut the risk of stroke by nearly two-thirds in women at high risk for heart disease, researchers said on Sunday.

The data, presented at the American Heart Association (news - web sites)'s annual Scientific Sessions conference in Chicago, showed that Evista was linked with a 62% reduction in the risk of all strokes--fatal and non-fatal--in post-menopausal women at high risk for heart disease.

The research comes in the wake of recent findings by a Women's Health Initiative study that showed Wyeth's hormone replacement therapy Prempro, which is often prescribed for post-menopausal osteoporosis, increased the risk of stroke by 41%.

The WHI study's results, released in July, triggered a huge debate over how doctors treat post-menopausal women.

Lilly's Evista findings were part of a four-year study of 7,705 post-menopausal women with osteoporosis. It found that of the 1,035 women in the group who were at high risk of heart disease, Evista cut the risk of non-fatal strokes by 68%.

"These data are particularly interesting in light of recent findings from the WHI trial examining hormone therapy," said Dr. Elizabeth Barrett-Connor, professor of family and preventative medicine at the University of California, San Diego, who presented the results. "While raloxifene and hormone therapy are both prescribed for osteoporosis, the WHI data showed that combined estrogen-progestin hormone therapy actually increased the risk of stroke."

A Time For ‘Smart’ Estrogen

Dr. Cheryl Keech, clinical research physician at Lilly, said the Evista results suggest a place for "smart" estrogen therapy that can target specific receptors within a cell.

"The one thing WHI has shown us is you have to do randomized controlled trials," Keech told Reuters.

Known by the chemical name of raloxifene HCI, Evista is a selective estrogen receptor modulator used for both the prevention and treatment of osteoporosis.

Along with the decreased risk of stroke in the subgroup of women at high risk for heart disease, Evista showed no increased risk of stroke among the total 7,705-patient population. Evista also did not increase blood pressure, a risk factor for stroke.

Lilly said it is studying Evista to determine its ability to reduce the risks of serious heart-related events and breast cancer (news - web sites) in post-menopausal women in a number of clinical trials.

In an ongoing 10,000-patient study of Evista in preventing heart disease, Lilly aims to determine whether Evista can have positive benefits without the problems of hormone replacement therapy.

"We don't see any harm and we see both benefits in stroke and coronary," she said, adding that the observations need to be proven in a prospective trial.

The company plans to use the data from that trial as part of a submission to the US Food and Drug Administration (news - web sites) to use Evista as a treatment to prevent heart disease. Early results of that study will be available in 2005.

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Treatment Guidelines Call for ACE Inhibitors

HealthScoutNews

Monday, November 18, 2002

MONDAY, Nov. 18 (HealthScoutNews) -- Increased use of ACE inhibitor drugs could reduce heart attacks and strokes and save the lives of people with chronic chest pain caused by stable angina (news - web sites).

That finding is behind new treatment guidelines from the American College of Cardiology and the American Heart Association (news - web sites).

ACE (angiotensin-converting enzyme) inhibitors are a class of drugs used to treat high blood pressure.

Stable angina refers to chest discomfort that does not change for weeks or months and usually occurs during exertion or when a person is emotionally upset.

The new guidelines recommend that ACE inhibitors should be routinely offered to people who have had a heart attack or those with coronary artery disease that's been documented with angiography, if those people also have diabetes or diminished function in their heart's left ventricle.

Dr. Robert O. Bonow, president of the American Heart Association, says the new ACE inhibitor guidelines should significantly reduce the rates of heart attack, stroke and death.

He says the ACE inhibitors benefit these people by lowering blood pressure, dilating blood vessels, slowing plaque growth in arteries, and preventing blood clots.

The new guidelines are based on findings from the Heart Outcome Prevention Evaluation (HOPE) trial, which compared the ACE inhibitor ramipril against a placebo in more than 9,000 people with vascular disease.

More information

You can check out the new guidelines at the American College of Cardiology.

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Dutch Board to Study Risks of Antidepressant Drug

By Andrew Conaway

Reuters Health

Monday, November 18, 2002

AMSTERDAM (Reuters Health) - The Netherlands Medicine Assessments Board announced that it will begin investigating the antidepressant drug nefazodone after receiving reports of serious side effects from its use.

Since it became available in the Netherlands in 1994, the Medicine Assessment Board has received 26 reports of serious liver failure and some deaths related to the drug worldwide.

In the Netherlands there has been one reported case of liver failure, but no deaths have been attributed to the drug, according to a spokesman for the board, known as the College ter Beoordeling van Geneesmiddelen (CBG), in The Hague (news - web sites).

Nefazodone, or nefazodon as it is known in the Netherlands, is manufactured by the UK-based pharmaceutical company Bristol-Myers Squibb and is marketed here under the brand name Dutonin. The drug is sold in the US as Serzone.

The drug has already been withdrawn from the Swedish market voluntarily by the manufacturer, according to Dr. Pim van der Giesen of the CBG.

He added that the board had also considered pulling the drug from the market, but that they had not decided to do so at this time, and no additional advisories will be sent out to doctors. But he noted that the drug already carries advisories and strong warnings on its use.

The Web site for the National Institutes of Health (news - web sites) in the United States (www.nih.gov) warns that nefazodone may cause "serious disease or damage in your liver" if it is taken by anybody with liver problems.

A spokeswoman for Bristol-Myers Squibb in the Netherlands, Aglae Weyers, confirmed that the drug is under investigation.

"We will cooperate fully with the CBG," said Weyers, "and will provide all relevant details as needed concerning side effects of the drug."

She declined to comment further, citing the ongoing investigation.

Van der Giesen added that other European nations were aware of the Dutch investigation.

"There are others in the EU member states who are watching with great interest what we are doing," he said in a telephone interview with Reuters Health. "I think there will be a lot of interest in this investigation."

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Kids' Acupuncture Gaining Interest

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, November 18, 2002

WASHINGTON (AP) - Four-year-old Eliza Brady held very still as Dr. Yuan-Chi Lin slowly stuck hair-thin needles into her legs. After six months of these acupuncture treatments, the painful intestinal inflammation that plagued Eliza for two years was finally better.

Coincidence or the ancient Chinese therapy? No one knows for sure, because inflammatory diseases can wax and wane.

But scientists are just starting to study acupuncture in young children — unusual in U.S. kids despite its popularity among adults. And some say if tots could put aside the fear of needles, it might prove as helpful for them as it does for certain adult conditions.

"It's not easy to do for kids. You really need to spend time and effort to explain it to the patient and the family," says Lin, a Harvard Medical School (news - web sites) anesthesiologist who often needles the parents first, saying children are less afraid if mom doesn't flinch from what some describe as the mosquito-bite sensation.

Lin's pain clinic at Children's Hospital in Boston just finished a study of yearlong acupuncture in 243 children, one of the largest pediatric studies yet. The children reported less pain and missed school due to headaches, abdominal pain and other common conditions than before they tried acupuncture, he told a recent meeting of the American Society of Anesthesiology.

He's preparing another, more scientifically stringent, study — giving half the children real acupuncture and half a sham version.

Adult acupuncture has gained in popularity in recent decades, particularly after the National Institutes of Health (news - web sites) in 1997 declared it can help relieve certain conditions, such as surgical pain and the nausea and vomiting that accompanies chemotherapy.

Oriental medicine practitioners say needles placed at certain points, along with other practices such as the use of herbs, can heal by correcting flows from the body's energy channels.

While many Western scientists are skeptical that acupuncture has as many bodywide effects as Oriental medicine practitioners believe, they have found evidence that it may affect body chemicals related both to pain sensitivity and other functions. Now the NIH is funding half a dozen studies to see if acupuncture significantly helps certain non-pain disorders, such as high blood pressure.

You can't assume what works in adults will work in children — it must be tested, cautions Dr. Brian Berman, the University of Maryland's director of complementary medicine.

Yet pediatric acupuncture research is in its infancy, says Richard Nahin of the NIH's National Center for Complementary and Alternative Medicine. There have been a handful of pilot studies, on conditions including attention deficit disorder and cerebral palsy, but Nahin says the strongest evidence so far backs acupuncture to relieve chemotherapy-induced nausea and vomiting. The NIH now is studying child cancer patients.

Parents' interest is rising, says Lin, who estimates a third of pediatric pain centers have begun offering child acupuncture.

"I had nothing to lose and everything to gain," says Eliza's mother, Susan Luchetti.

The Weston, Mass., mother balked when her daughter's gastroenterologist said Eliza's Crohn's disease-like intestinal inflammation was worsening despite mild medication and recommended stronger steroid treatment. Instead, Eliza tried acupuncture, which is common in Asia for certain gastrointestinal problems. After years of blood tests, the much smaller acupuncture needles didn't frighten her.

Remarkably, blood and stool tests showed inflammation receding as Eliza felt better. Nobody knows if it was just a routine remission and six months later, Eliza, now 5, still takes mild medication. But Luchetti would try acupuncture again if she worsens.

Where can parents find child acupuncture?

There are 15,000 licensed acupuncturists, non-physicians who learn acupuncture and Oriental medicine techniques at nationally accredited schools. Also, a small but growing number of mainstream physicians like Lin mix acupuncture with conventional treatments.

Few specialize in children, and state laws governing who is qualified to practice acupuncture in general vary widely. People can find information on acupuncturists at the National Certification Commission for Acupuncture and Oriental Medicine — http://www.nccaom.org — or the American Academy of Medical Acupuncture — http://www.medicalacupuncture.org.

But "it is absolutely imperative" for a pediatrician to ensure no otherwise treatable disease is causing a child's symptoms before trying acupuncture, cautions Dr. Santhanam Suresh of Children's Memorial Hospital in Chicago.

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

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Study Backs Longer Post-Angioplasty Therapy

Reuters

Monday, November 18, 2002

CHICAGO (Reuters) - Patients who have undergone angioplasty or similar artery-opening procedures cut their risk of death by taking aspirin and a clot-reducing drug for 12 months afterward instead of the currently recommended four weeks, researchers said on Monday.

The finding was based on a look at 2,116 patients who underwent the procedure at 99 medical centers in North America between June of 1999 and April 2001.

The anti-clotting prescription drug involved in the study was clopidogrel, sold in the United States as Plavex by Bristol-Myers Squibb in partnership with Sanofi-Synthelabo of France, both of which sponsored the study.

"Our major finding is that continuation of dual antiplatelet therapy with clopidogrel and aspirin for at least one year, instead of the current standard of two to four weeks, leads to a statistically and clinically significant reduction in major thrombotic events," including death, heart attack and stroke, researchers at the University of North Carolina in Chapel Hill said.

They said the study also indicated that patients would receive a "substantial benefit" if the therapy is begun from three to 24 hours before the medical procedure is done.

"Furthermore, the long-term combination of aspirin and clopidogrel was relatively safe and the efficacy extended to a large population of patients who undergo elective percutaneous coronary revascularization (such as angioplasty)" the authors concluded.

The study was published in this week's Journal of the American Medical Association (news - web sites) and released at the annual scientific meeting of the American Heart Association (news - web sites).

Dr. Steven R. Steinhubl, associate professor of medicine at the University of North Carolina at Chapel Hill, told meeting attendees that if these results were extended to the 1.5 million people who will have angioplasty this year, 50,000 heart attacks and deaths could be prevented.

He noted that patients tolerate Plavix well, perhaps even better than they tolerate long-term aspirin therapy.

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New Drug Found to Fight Anthrax

HealthScoutNews

Monday, November 18, 2002

MONDAY, Nov. 18 (HealthScoutNews) -- A drug developed at the Louisiana State University (LSU) Health Science Center may block the development of lethal toxins produced by infectious bacteria such as anthrax, says a study in the December issue of Infection and Immunity.

The drug, called D6R, is a potent, stable small molecule that blocks the action of an enzyme called furin.

In anthrax, the lethal factor toxin has to bind to another part of the anthrax toxin, called the PA molecule, before the lethal factor toxin can enter and kill a healthy cell.

Before that binding can happen, the PA molecule has to be made smaller. That's where furin comes into play. Furin is a protein-cutting enzyme that sits on the outside of cells. Furin cuts the PA molecule and makes it small enough to bind with the lethal factor toxin.

Without a cut PA molecule, the lethal factor toxin can't bind and enter and kill a cell.

The new D6R drug developed by the LSU researchers suppresses furin activity.

The LSU researchers tested the effectiveness of D6R against toxin from the bacteria Pseudomonas aeruginosa, in cell cultures and in live mice.

This Pseudomonas bacteria causes urinary tract, respiratory and soft tissue infections, among others. The bacteria is also known for its resistance to antibiotics.

In their tests, the LSU scientists found a 50 percent survival rate for live cells 48 hours after being given D6R and Pseudomonas toxin at the same time. There was also about a 50 percent survival rate at seven days for mice who were given D6R for two days before they were administered the Pseudomonas toxin.

The survival rate for mice given D6R and the toxin at the same time was 25 percent.

Future research will test the effectiveness of D6R against anthrax toxin in cells, rats and mice.

More information

Here's where you can learn more about bacterial infections.

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Unstable Chromosomes Could Kick Off Colon Cancer

By Merritt McKinney

Reuters Health

Monday, November 18, 2002

NEW YORK (Reuters Health) - A mutation in a gene called APC is believed to be present in most cases of colorectal cancer, but new research raises the possibility that a defective APC gene may not be the first step on the road to cancer.

According to a mathematical model created by Dr. Christoph Lengauer of Johns Hopkins University in Baltimore, Maryland and colleagues, it is possible that unstable chromosomes may trigger changes in the APC gene that lead to cancer.

In an interview with Reuters Health, Lengauer stressed that the idea is only a possibility and still needs to be proven. What comes first, APC mutations or chromosomal instability, is a bit a "chicken or the egg" question, he said. Unlike that age-old question, though, determining whether changes in APC or unstable chromosomes come first could have important implications for cancer therapy, according to Lengauer. Documenting the first step in colorectal cancer, he said, will give scientists a target for developing new treatments to destroy cancer in its earliest stages, before it has a chance to spread.

In the interview, Lengauer explained that about 85% of the time, the APC gene is defective in colorectal cancer. This gene helps regulate the growth of cells, so if it is not working properly, cancer cells can grow unchecked. Most cases of colorectal cancer also involve another type of chromosomal defect, Lengauer said, in which the rate at which chromosomes are lost and gained is increased. The Johns Hopkins researcher noted, however, that it has been uncertain whether this chromosomal instability is a result of an APC mutation or itself triggers such a genetic defect.

The question still awaits a conclusive answer, but it is possible that chromosomal instability could come first, Lengauer's team asserts in a report in the online early edition of the journal Proceedings of the National Academy of Sciences (news - web sites). The authors developed a mathematical model suggesting that genetic mutations that cause chromosomal instability could develop before APC mutation occurs.

To develop new therapies for colorectal cancer, it is important to know what the earliest steps in the cancer process are, Lengauer said. If changes in APC come first, then it might be possible to develop a drug to prevent those changes, he said. Alternately, a drug that keeps chromosomes stable might stave off cancer if chromosomal instability is the initial step in colorectal cancer, according to Lengauer.

The model does not prove that chromosomal instability is the first step, but it does give researchers a starting point, he said. To see if unstable chromosomes are indeed the "driving force" behind colorectal cancer, Lengauer and his colleagues plan to look for chromosomal instability in the earliest forms of precancerous growths called adenomas. Finding chromosomal instability in these growths would support the idea that chromosomal instability is the instigator of colorectal cancer, he said.

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.202617399.

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Cholesterol Drugs May Aid Elderly

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Monday, November 18, 2002

CHICAGO (AP) - Cholesterol-lowering drugs, already a mainstay of heart care for the middle-aged, also prevent heart attacks in elderly people, a large study concludes.

The drugs, called statins, are widely prescribed to people with even modestly elevated cholesterol levels, and the new results are likely to enlarge their use even more.

Many studies so far have looked at people in their 50s and 60s. The new research was intended to see if the drugs improve the quality of life of people in their 70s and beyond, even though their life expectancy is relatively short.

The results show that statins reduced their risk of heart attacks and stroke by 15 percent during three years of treatment. However, the study, known by the acronym PROSPER, found no effect on Alzheimer's disease (news - web sites), as many hope these drugs would.

"We believe that PROSPER is good news for senior citizens," said Dr. James Shepherd of the University of Glasgow. "The results remind us that treatment that currently applies to middle-aged individuals is equally applied to the elderly in our population."

Shepherd presented the findings at the annual scientific meeting in Chicago of the American Heart Association (news - web sites). It is also being published in the journal Lancet and was financed by Bristol-Myers Squibb, which makes Pravachol, the drug tested.

The study involved 5,804 people between the ages of 70 and 82 in Britain, Ireland and the Netherlands. All were considered at increased risk because of coronary artery disease because of other conditions, including diabetes, high blood pressure or smoking.

Among the findings:

_ The drug reduced LDL, the bad cholesterol, by 34 percent.

_ Deaths from coronary disease fell 24 percent in those getting the statin.

_ Strokes were not affected by the treatment. However, longer treatment might still show a benefit.

The study also found that people on statins had a 24 percent increase in new cancer diagnoses. However, the researchers dismissed this as a fluke, saying no other study found a link between statins and cancer, and there is no reason to think the medicines could trigger the disease so quickly.

Dr. Augustus Grant of Duke University said, "At the present time, people in this age group are not being treated with statins as much as they need, and this study says they should."

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

On the Net:

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

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Some Over-The-Counter Drugs Can Ease Migraines

Reuters Health

Monday, November 18, 2002

NEW YORK (Reuters Health) - Inexpensive over-the-counter pain relievers may effectively treat migraines if taken as soon as symptoms appear, according to a joint statement by two national medical organizations.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen should be used as the first line of treatment against migraines--severe headaches marked by throbbing pain, nausea, sensitivity to light and noise and vomiting. The pain can last anywhere from a couple of hours to several days.

If pain persists, patients could try prescription drugs known as triptans, a class of migraine drugs that are stronger and more effective than NSAIDs, but also more expensive. They also carry a higher risk of side effects, including mild tingling; warm sensations in the head, neck, chest and limbs; dizziness; chest pain and shortness of breath.

While triptans may cause chest symptoms, they do not raise the risk of heart attack.

DHE nasal spray may also be effective for severe attacks, according to the guidelines from the American College of Physicians-American Society of Internal Medicine and the American Academy of Family Physicians (news - web sites). Opioids, however, have not been shown to reduce headache pain and may lead to dependence.

The recommendations, published in the November 19th issue of the Annals of Internal Medicine, may help to guide the roughly 28 million Americans who suffer from the chronic headaches. Many patients, especially those with family members who also get migraines, believe that they simply have to suffer through the attacks, Dr. Vincenza Snow, one of the authors of the paper, told Reuters Health in an interview.

"There are over-the-counter medications with proven efficacy with migraines," she said. "Patients do not have to suffer."

For some patients, preventing migraines may be more effective than treating symptoms. Studies suggest that medication to prevent migraines can be used if patients get at least two migraines a month, suffer from severe symptoms for at least 3 days a month, use medication to treat their headache more than twice a week, and do not get relief from treatment medication.

Anti-inflammatory drugs such as naproxen (Aleve) and some beta-blockers, a class of drugs used to treat high blood pressure, have been shown to prevent migraines. Antidepressants such as amitriptyline (Elavil) may also work.

Regardless of the type of medication used, treatment should be tailored to each patient and based on the frequency and severity of attacks, other symptoms, and the patient's tolerance for specific medications, as well as other individual factors, according to the guidelines.

"Patients need to be a little patient that (treatment) is somewhat trial and error," said Snow. "A patient may not respond to the same medication with every attack."

Patients should also remember to avoid common triggers such as alcohol, caffeine, chocolate and stress, and steer clear of multiple medications, which can actually cause headaches.

Source: Annals of Internal Medicine 2002;137:840-849.

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Coffee Jitters? Don't Blame the Caffeine

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Monday, November 18, 2002

MONDAY, Nov. 18 (HealthScoutNews) -- There's good news for regular coffee drinkers who are in good health: It's probably not going to raise your blood pressure.

However, there's not-so-good news for those who don't have a coffee habit: Drink it, and even decaf can boost your blood pressure.

These findings come from a Swiss study, reported in today's online issue of Circulation. They add to the growing, often controversial, body of research about the effect of coffee on your health.

Dr. Roberto Corti, a cardiologist at University Hospital Zurich in Zurich, Switzerland, and his team evaluated 15 healthy people: six regular coffee drinkers and nine "non-habitual" drinkers who avoid coffee and caffeinated colas.

They gave each a triple espresso, a decaf triple espresso, an intravenous dose of caffeine and an intravenous dose of saline. They measured their blood pressure and sympathetic nervous system activity before and after. The sympathetic nervous system plays an important role in blood pressure regulation and its overactivation has been linked with high blood pressure.

The non-habitual coffee drinkers showed an increase in sympathetic nervous system activity and blood pressure after IV coffee, coffee and even decaf. Their systolic blood pressure (the top number of the reading) increased about 12 millimeters of mercury and their diastolic (the bottom number) increased about 7 millimeters an hour after the consumption or administration of the coffee.

Regular coffee drinkers also had an increase in their sympathetic nervous system activity, but their blood pressure did not increase, probably due to tolerance, the researchers say, but perhaps not to caffeine.

As the results with the non-habitual drinkers who got a rise in blood pressure even with the decaf coffee suggest, it might not be the caffeine that's to blame for activating the cardiovascular system, the researchers say.

"The only conclusion you can derive from our study is that caffeine is not the only [substance] responsible for the cardiovascular effects of coffee," Corti says. There's not a possibility that the decaf coffee really contained caffeine, since the researchers also measured blood levels of caffeine and found no increase in people after they drank or were administered the decaf preparations.

"Two findings were very surprising," Corti says. "The first, that habitual coffee drinkers don't have an increase in blood pressure despite activation of the sympathetic nervous system, and the second that in non-habitual coffee drinkers both 'regular' coffee and decaffeinated coffee led to an activation of the sympathetic nervous system and [a rise in] blood pressure."

Corti plans to continue his research, next evaluating what happens when people drink coffee under stressed conditions rather than at rest, as in his study. He also hopes to identify the ingredient responsible for the cardiovascular activation, perhaps paving the way for the development of new forms of coffee that would be lacking the undesirable stimulants.

Another expert, Dr. Robert H. Eckel, calls the study interesting.

"The idea that coffee may contain an ingredient we don't know about [that impacts its cardiovascular effect] is of interest," says Eckel, a professor of medicine at the University of Colorado Health Sciences Center in Denver and chairman of the American Heart Association (news - web sites)'s Council on Nutrition, Physical Activity and Metabolism.

The fact that regular coffee drinkers didn't get a boost in pressure makes sense, he says: "Tolerance to coffee is real."

However, Eckel suggests the researchers should also look at people older than those in the current study, who range from age 27 to 38, and that they should evaluate a bigger sample.

Until more research is in, Corti says healthy coffee drinkers without a family history of high blood pressure are probably not increasing the likelihood of cardiovascular disease by continuing to drink coffee.

"In others words, healthy people that have a regular coffee intake should not be concerned," Corti says.

On the other hand, he adds, "occasional coffee drinking seems to have an important cardiovascular stimulatory effect and can acutely increase blood pressure."

"At this point in time, I would not change the recommendations" for coffee drinkers, Eckel adds. While certain people, such as those with high blood pressure and ulcers, are usually advised to stay away from coffee, for healthy people the beverage is probably acceptable, he says.

What To Do

For more information on blood pressure and keeping it under control, see Blood Pressure.com or National Heart, Lung, and Blood Institute.

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Hormone Therapy, Alcohol Use Studied

By Michael Rubinkam

Associated Press Writer

The Associated Press

Monday, November 18, 2002

PHILADELPHIA (AP) - Women who drink alcohol and take hormones are at almost double the risk of breast cancer (news - web sites), researchers with a large ongoing study say.

Previous studies have shown that women who have more than a drink a day raise their risk of breast cancer, and that hormone replacement therapy also increases the cancer risk.

The Nurses' Health Study assessed the risk of the two factors combined. Researchers said the good news is that alcohol and estrogen together do not greatly magnify the danger through interaction. Some scientists were concerned that might be the case.

Instead, what they found is that a postmenopausal woman who has a lifetime breast cancer risk of 4 percent could increase the risk to 8 percent if she drinks and takes hormones.

"The public health message is that the two will substantially increase your risk of breast cancer and you might want to be particularly vigilant about having both of these risk factors," said study co-author Dr. JoAnn Manson of Brigham and Women's Hospital.

The research, published in Tuesday's Annals of Internal Medicine, was based on 44,187 participants in the Nurses' Health Study from 1976-96 and tracked more than 120,000 female nurses overall for a variety of research studies.

During the study years of 1980-94, 1,722 women developed breast cancer. Women who took hormones for at least five years but drank no alcohol increased their risk of breast cancer by about 30 percent, as did women who did not take hormones but consumed more than one drink a day.

For women who took hormones and drank alcohol, the risk nearly doubled.

Even so, the increased risk is "not big enough to say it'll kill you if you drink," said Dr. Norman Lasser of the University of Medicine and Dentistry of New Jersey, who is not affiliated with the Nurses' Health Study.

Study co-author Dr. Wendy Chen, of Brigham and Women's Hospital and the Dana-Farber Cancer Institute, said it's not necessary to stop drinking altogether. For those women who still take hormones, a good compromise would be to consume no more than one drink a day, she said. That way, women can still get the cardiovascular benefits of moderate alcohol use while eliminating the increased breast-cancer risk.

Government scientists raised the red flag on hormone-replacement therapy in July after they announced that long-term use of estrogen-progestin pills significantly increased the risk of breast cancer, strokes and heart attacks. Scores of women have since quit taking the hormone combination.

Researchers with the Women's Health Initiative study are still assessing whether the use of estrogen by itself — prescribed for women who have had hysterectomies — is safer than combination therapy. Most of the women in the Nurses' Health Study had hysterectomies and took estrogen-only pills.

"People are always having to assess how much risk they are willing to tolerate and whether the short-term gain you get (from hormones) is worth it," said Lasser, a co-author of the Women's Health Initiative study.

On the Net:

Annals of Internal Medicine: http://www.annals.org/

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Marrow Transplant Grows New Vessels in Legs

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Monday, November 18, 2002

MONDAY, Nov. 18 (HealthScoutNews) -- Doctors have prevented amputations in people with poor circulation in their legs by injecting the patients' own bone marrow into their limbs.

A Japanese research team says the marrow injections helped new blood vessels form in the affected limbs, which had clogged arteries. The team reported the feat today at the American Heart Association (news - web sites)'s scientific sessions meeting in Chicago.

The team believes it is the first to try the technique, says Dr. Hiroya Masaki of Kansai Medical University in Moriguchi, Japan. It is not only effective but appears very safe. "There are no serious side effects or complications from the technique," he says.

In peripheral artery disease (PAD), deposits build up along the walls of the arteries and reduce blood circulation, especially to the legs and feet. Due to the risk of blood clots, those with PAD have a higher risk of death from stroke and heart attack.

The condition can be painful and, in later stages, it can lead to a lack of blood flow or even gangrene, which triggers the need for amputation of a limb.

Current treatments include medication to prevent blood from clotting or angioplasty, in which a deflated balloon is passed into the narrowed vessel and then inflated to open it up. Surgery can also be done to bypass the diseased vessel portion or to cut out the fatty deposits.

The Japanese researchers tried another approach. They aspirated bone marrow cells from the person's hip bone. They implanted either a patient's own bone marrow cells or saline (as a control treatment) into the calf muscles of 45 patients with peripheral artery disease. Twenty had reduced blood flow in both legs and 25 had it in one leg.

Those who got the bone marrow cell transplants had a "striking" increase in new formation of collateral vessels, as shown on angiography (exam of the blood vessels by X-ray after injecting an opaque substance) and thus improved blood flow, the researchers found.

New vessels were documented in 27 limbs among those who received the bone marrow transplants. New capillary vessel formation was much less in those who got the saline injections.

"Bone marrow cells contain endothelial stem cells and also release growth factors," says Dr. Hiroaki Matsubara of Kansai Medical University, who presented the data today. "The endothelial cells attach to existing capillary cells" and enhance their growth, he says. New capillaries then sprout and provide collateral circulation. Endothelial cells are delicate cells that line arteries.

"It's interesting that they used the person's own bone marrow cells," says Dr. Richard Nesto, chairman of cardiovascular medicine at Lahey Clinic Medical Center in Boston and a spokesman for the American Heart Association.

Over the past several years, Nesto says, there have been many studies using growth factors to encourage blood vessel growth. The Japanese study, however, "is the first I've seen where they inject directly into the muscle itself. Usually they inject into the artery supplying the [smaller] blood vessels."

The technique seems safe and effective, Nesto says. Once perfected, he adds, it would seem feasible the treatment could be a simple outpatient procedure.

What To Do

For more information on peripheral artery disease, try the American Heart Association or the University of California at Davis.

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Fat Lurks Behind Slim Asian Frames

By Alisa Tang

Associated Press Writer

The Associated Press

Monday, November 18, 2002

BANGKOK, Thailand (AP) - Prapai Lertphiphat is an average Thai woman: short and slender, a picture of perfect health.

But in Asia, appearances can be deceptive. The 44-year-old hospital clerk is suffering from the classic disease of overweight people: hypertension, or high blood pressure.

Prapai is not alone in her plight.

After a series of independent surveys in 10 Asian countries, researchers have come up with an alarming conclusion: There are millions of people like Prapai in the region, showing symptoms of obesity despite their small frames and apparent lack of excess fat.

It is not that Asians have suddenly become unhealthy. It's just that health experts had all along been applying a global standard, known as body mass index, to measure obesity that was unsuited to Asians.

To help doctors prevent obesity-related ailments, the World Health Organization (news - web sites) established in 1997 a body mass index standard, calculated by dividing a person's weight in pounds by height in inches, dividing again by height in inches and multiplying by 703. A normal weight is a BMI of less than 25; overweight is under 30 and obesity is over 30.

But the 10-country research showed that Asians had more fat content compared to Caucasians, which meant that a BMI of 25 was way above overweight for Asians.

In response, a group of WHO experts in July recommended an Asian optimal BMI of 23. Anything over it should be considered overweight and a health risk, they said.

In other words, an Asian and Caucasian may be the same weight and height, but the Asian is at greater risk for fat-related illnesses such as heart disease and diabetes. The countries surveyed were Hong Kong, India, Thailand, Malaysia, Fiji, Indonesia, Singapore, mainland China, Korea, and the Philippines.

Researchers in Hong Kong found that as people surpassed a BMI of 23, there was a very sharp rise in the risk of heart disease.

Studies in India found that city dwellers have an average BMI of 24.5, and have diabetes rates four times higher than their rural counterparts, hypertension 2 1/2 times higher, and heart disease twice as high.

Prapai has a BMI of 23.5 because she weighs 121 pounds and is 5 feet tall. Her small frame belies her medical problems, which have forced her into a salt-free diet and a daily regime of antihypertension pills.

"Mornings when I forget to take my medicine, I get headaches and lose my balance while standing," Prapai said.

In Singapore, 22-year-old Tan Choon Ping, a recent college graduate, was told by his doctor to lose about 4 1/2 pounds from his 181-pound weight.

Standing 6 feet tall, he has a BMI of 24.8 — perfect for a Caucasian but potentially harmful in an Asian.

"I was utterly mortified when my doctor told me I was overweight," Tan said. "I nearly throttled her."

Scientists are yet to figure out why Asians have more fat than Caucasians. But they cite a range of theories including evolution, maternal nutrition or simply lack of exercise.

Fat researcher Jeffrey Friedman, a Howard Hughes Medical Institute investigator at Rockefeller University in New York, said populations that store more body fat may have been naturally selected through generations of famine.

In ancient times, people in areas prone to famine — such as China or India — developed a biological mechanism to store more fat to survive. When subsequent generations prospered and had access to food, they accumulated excess fat, Friedman said.

"Having more fat is good in certain environments because ... it helps one survive the famine," he said.

Another reason Asians are fatter might be maternal nutrition, Dr. K.S. Reddy, a WHO expert who studied the data from the 10 countries, said from New Delhi.

He said that if a fetus doesn't get sufficient nutrition, it adapts its metabolism to consume nutrition conservatively. When the baby is born, its metabolism may not be able to keep up with the greater availability of food, leading to excess fat, he said.

Also, Asians tend to exercise little compared to Westerners, which sets them up for heart diseases later in life.

In China, more than 60 percent of people do not do any physical exercise, according to a survey conducted by a Chinese government sports research organization. It said less than 8 percent of China's 1.2 billion people exercise with "average intensity" compared to 41 percent of Britons and 20 percent of Americans.

Exercising is also low in priority among people who are more concerned about earning a livelihood. But among wealthier Asians, the treadmill trend is catching on.

"People who are better off tend to do more exercise," said Yang Xirang, professor of sports physiology at the Beijing Sports University.

In wealthy Hong Kong and other major Chinese cities going through an economic boom, gyms are the latest fad.

Hong Kong's South China Morning Post newspaper recently reported that Beijingers are spending up to a third of their monthly salary on gym memberships.

But in countries like India and Malaysia, people still wear flab around their waists as a badge of prosperity.

Malaysian Health Minister Chua Jui Meng warned at a conference recently that 25 percent of Malaysia's 23 million people are overweight.

"We do know there has been a shift towards an overeating population, eating more than the body requires," he said.

Nothing wrong with that, counter the Asians.

"So what's wrong with my paunch," asked Indian businessman Lalit Gupta, patting his belly. "Business is booming ... and you might as well eat well and live well," he said, sitting in his grocery shop in New Delhi's Yusuf Sarai market.

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Spinal Tap May Help Alzheimer's Diagnosis

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, November 18, 2002

MONDAY, Nov. 18 (HealthScoutNews) -- Two proteins present in brain and spinal fluid of people with mild memory trouble may flag those destined to develop Alzheimer's disease (news - web sites).

The proteins, called tau and beta-amyloid 42, are elevated and suppressed, respectively, in the cerebrospinal fluid of people whose wobbly cognition turns out to be the initial stages of Alzheimer's, German scientists have found. Although the degenerative disease has no cure, early treatment can help delay its progression by six months or so. Scientists, therefore, are eager to uncover harbingers of the dementia before it becomes full-blown.

The latest findings appear this month in the Archives of Neurology.

Alzheimer's disease, which is thought to be caused by a buildup of toxic beta-amyloid in the brain, affects an estimated 4 million Americans. The number of patients is expected to quadruple over the next 50 years as the population ages.

A handful of scientists believe that draining cerebrospinal fluid may stall the advance of Alzheimer's by shunting away harmful proteins from the brain. That approach is still experimental and hasn't been proven to work, experts said.

The latest work, led by researchers at the Technische Universitat in Munich, followed 28 men and women with mild cognitive impairment, or MCI. These people have some recall problems but do fine on cognitive tests, can perform tasks of daily living, and don't have dementia.

Over an 18-month period, a dozen of the volunteers went on to develop dementia, 10 with likely Alzheimer's disease. Of the rest, 16 were still considered to have mild impairment, although six had gotten worse and 10 had remained stable.

Patients who ended up with dementia were about six years older, on average, than those whose MCI didn't get that bad.

Those whose MCI worsened, or who developed dementia, had higher than normal tau for their age, the researchers found. Yet levels of the protein weren't elevated in people whose MCI remained steady throughout the study. For beta-amyloid, the finding was reversed, with lower than expected concentrations of the protein in their cerebrospinal fluid.

Researchers found another predictor that didn't require a spinal tap to detect. People who had trouble remembering words on a standard test at the start of the study were more likely to see their memory problems worsen, or turn, into dementia, 18 months later.

Dr. Roger Rosenberg, a brain specialist at the University of Texas Southwestern Medical Center and the editor of the Archives of Neurology, said the findings imply that progressive mild cognitive impairment "is indeed pre-Alzheimer's, rather than a separate disease." What's more, the two wayward proteins appear to act as markers of the condition.

In those with dementia, levels of these proteins typically diverge from normal in the 60s, Rosenberg said. But the bad chemistry of Alzheimer's is probably present at least a decade before its symptoms arrive.

Dr. Gerald Silverberg, a Stanford University neurologist, said the German research "fits with what everyone would expect."

Tau is released by brain cells that are killed by protein plaques and tangles and the inflammation that characterizes Alzheimer's, so higher concentrations of the molecule in cerebrospinal fluid are the echoes of dying neurons. The reason beta-amyloid levels drop in the fluid, Silverberg said, is because more of the substance stays in the brain to do damage.

Silverberg is now leading a small study to see whether removing tau and beta-amyloid from brain and spinal fluid can slow the progression of Alzheimer's disease. Preliminary evidence suggests that cognitive test scores stabilized in the group undergoing the treatment while levels of the two proteins fell, he said. Longer follow-up is needed to see whether the therapy is safe and effective.

In an unrelated study also published this month in the journal, Maryland researchers found that the average 65-year-old with Alzheimer's lives about eight years after the diagnosis is made, while those diagnosed at 90 survive only three years with the disease. The study found that people are typically diagnosed with Alzheimer's 2.8 years after first showing symptoms of the brain ailment.

What To Do

For more on the degenerative brain disorder, try the Alzheimer's Association. You can also try the University of California at Irvine.

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Tissue May Help Fix Damaged Hearts

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Monday, November 18, 2002

CHICAGO (AP) - New research suggests doctors may someday fix hopelessly damaged hearts with bits of tissue from other parts of the body.

Preliminary studies conducted in the United States and Europe raise the possibility that cells taken from bone marrow or muscles can be used to revive seemingly dead patches of heart muscle.

"If this proves efficacious, we will improve the quality of life of our patients and their survival. This will replace heart transplants," said Dr. Nabil Dib of the Arizona Heart Institute.

The inability of the heart to pump forcefully enough, a condition called heart failure, is a large and growing health problem afflicting an estimated 5 million people in the United States alone.

Two years ago, a French doctor described a novel alternative: He put millions of immature muscle cells into the badly damaged heart of a 72-year-old man. His heart began to pump more powerfully, although it was unclear whether the benefit came from the new cells or from coronary bypass surgery he received at the same time.

That physician, Dr. Philippe Manasche of Bichat Hospital in Paris, has now repeated the approach on 10 patients, and similar experiments are being conducted by teams in the United States, Germany, England and Poland.

Preliminary but encouraging data on these experiments were reported Sunday at the annual scientific meeting in Chicago of the American Heart Association (news - web sites). Doctors said the shifted cells can live inside the heart's dead scar tissue and show at least some signs of contracting like the original heart muscle.

"This is quite exciting and definitely new," said Dr. Timothy Gardner of the University of Pennsylvania, who is not involved in the studies.

For now, all that researchers can say for sure is that the transferred cells take root and flourish in dead areas of the heart. Whether they make the heart pump more forcefully remains to be proved, although researchers say they see encouraging evidence that this may happen.

"The results so far support the hypothesis that these cells will do some good. It gives us a reason to go on," said Dr. Francis Pagani of the University of Michigan.

Pagani is working with Dib, whose team tested the approach on 16 patients getting either coronary bypasses or temporary pumps to keep them alive until they could have heart transplants.

Ordinarily, the heart pushes out more than half of its blood with each beat. Dib's patients had such bad heart failure that their hearts pumped just 23 percent. After the bypasses and cell injections, this improved to 36 percent, although it was impossible say how much, if any, of the new strength resulted from the extra cells.

Like Manasche, Dib's team begins with immature muscle cells, called myoblasts, obtained from the patients' own thighs. These are grown in test tubes until millions are available. Then they are injected into parts of the heart that died during heart attacks.

"We clearly showed living tissue in the injected scar," Dib said.

Dr. Tomasz Siminiak of the University School of Medical Science in Poznan, Poland, tested the same approach on 10 patients. Improved contraction was seen in scarred areas of the heart within a month of the procedure.

Both Manasche and Siminiak found that patients needed drugs to prevent potentially lethal heart rhythm disturbances in the months following the injections, although this hazard appeared to go away with time.

Drs. Manuel Galinanes of the University of Leicester in Britain and Christof Stamm of Rostock University in Germany are using primitive bone marrow cells instead of thigh muscle cells, and both say their results are similar.

Using heart scans, Galinanes found no change in the way the scarred tissue moved after receiving solely bypass surgery or marrow cell injections. However, he said, "when the two treatments were applied in combination, we saw a very, very significant improvement."

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

On the Net:

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

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A Fish a Day Keeps Heart Woes at Bay

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, November 18, 2002

MONDAY, Nov. 18 (HealthScoutNews) -- The American Heart Association (news - web sites) is boosting its recommendations about omega-3 fatty acids, telling people with known heart disease that getting enough of them, either in the diet or by taking supplements, can be life-saving.

People with documented heart disease are best off if they get 1 gram a day of two omega-3 fatty acids, eicosapentaenoic and docosehexaenoic acids, which are plentiful in such fish as mackerel, lake trout, herring, sardines, albacore, tuna and salmon, say new guidelines published today in the association's journal Circulation.

A third, less-potent kind, alpha-linoleic acid, found in such plants as soybeans, canola, walnuts and flaxseed, is also recommended.

The association's last guidelines, published in 2000, recommended at least two servings of oily fish each week both for healthy people and those with known heart disease.

The recommendation for people without heart disease remains unchanged.

But studies showing that omega-3 fatty acid consumption reduces cardiac deaths led to the change for people with known heart disease, says William S. Harris, professor of medicine at the University of Missouri, and a member of the committee that drew up the revised guidelines.

"New trials have been reported that finally broke the camel's back," Harris says. "The last report showed that giving 0.85 grams of omega-3 fatty acids to people who survived heart attacks caused a 20 percent reduction in overall mortality over three-and-a-half years. One of the big contributors to that reduction was a 45 percent decrease in sudden cardiac deaths."

The best way to get the recommended intake of the fatty acids for those with known heart disease is by eating oily fish every day, Harris says. People who find such fish distasteful can turn to dietary supplements -- but only after they talk to their physicians about the supplements they plan to take, he says.

"There's still a concern about the quality of product that's out there," Harris says. "There are no standard measures of omega-3 fatty acid content in supplements. Many of them are very good, but we can't make recommendations about specific products, so we're dumping the issue to the physicians."

Some people --those with elevated blood triglyceride levels, for instance -- may need 2 to 4 grams a day of the omega-3 fatty acids, the guidelines say. But anyone taking at least 3 grams daily should do so only under a doctor's supervision, because high intakes might cause excessive bleeding.

The two servings a week of oily fish recommended for people without heart disease works out to "in the neighborhood of 300 to 400 milligrams a day," Harris says. The epidemiological evidence for that recommendation is not as strong as might be desired, he adds, but there is a feeling that it will do most people good.

There are exceptions to the two-serving recommendation. Children, pregnant women and nursing mothers are advised to avoid fish that the U.S. Food and Drug Administration (news - web sites) has listed as posing potential mercury hazards: king mackerel, tilefish, swordfish and shark.

Fish oil researchers like Harris -- he has been at it for more than 20 years -- are still studying the mechanisms by which omega-3 fatty acids reduce coronary risk. But studies have shown they reduce the likelihood of blood clots, lower blood pressure, decrease blood levels of harmful fats and interfere with the growth of artery-blocking plaque deposits.

What To Do

More information about fish oil is offered by the American Heart Association. And the association offers this site on diet and nutrition.

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Court Refuses Organ Harvesting Case

The Associated Press

Monday, November 18, 2002

WASHINGTON (AP) - The Supreme Court refused Monday to block a lawsuit accusing the Los Angeles County Coroner's Office of wrongly removing the corneas of dead children without first getting permission.

The coroner's office was sued by the parents of two boys whose corneas were harvested and sold to an eye bank for several hundred dollars in 1997. The parents' attorney has sought class-action status for the lawsuit, and said the class could include the families of up to 7,000 deceased.

Controversy over the practice prompted the California Legislature to pass a law requiring consent for the harvesting. An earlier state law had allowed the cornea takings without permission if coroners had no knowledge of objections.

County attorneys told the Supreme Court that if the decision was not overturned, staff at hospitals and coroners' offices will be afraid to harvest tissue or organs because of lawsuits.

"The lifesaving and life-enhancing benefits from organ and tissue donation will necessarily be jeopardized," attorney Cheryl A. Orr wrote in a brief.

Bill Colovos, the attorney for the parents, said relatives of the deceased have a right to dispose of a body the way they want.

The case is Sathyavaglswaran v. Newman, 02-423.

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Springtime Ragweed Allergy Is Real, Study Finds

By E. J. Mundell

Reuters Health

Monday, November 18, 2002

SAN ANTONIO (Reuters Health) - For millions suffering from allergy to ragweed pollen, late summer and fall are the "misery months," when the plant sheds its sneeze-inducing spores into the air.

So how to explain a re-emergence of symptoms in the spring, long after the pollen season has passed? While some doctors may dismiss those symptoms, a new study suggests patients are not imagining things.

"Ragweed pollens can survive mild winters and are present in springtime air samples," report Dr. Ramasamy Muthiah and Dr. Steve Kagen of the Kagen Allergy Clinic in Appleton, Wisconsin. Muthiah presented the findings here Saturday at the annual meeting of the American College of Asthma, Allergy & Immunology.

Experts estimate that at least one in every five allergy patients experiences reactions to pollen shed by ragweed, which is ubiquitous in temperate climates. Muthiah knew that the pollen could survive in soil for centuries--perhaps it could survive a Wisconsin winter, too.

Testing that theory, in early spring of 2002 Muthiah and Kagen used a high-tech air sampler to search for ragweed pollen floating in the skies over Wisconsin. Examining their "aerobiological" samples under a microscope, the investigators detected moderate levels of ragweed pollen, peaking on March 22nd.

"We think that, last year's winter being mild in our area, probably these pollens survived the winter, and they are coming back," Muthiah told Reuters Health. "It's a surprise, a new finding. They are not coming from the plant itself. They are just lying there on the ground and during heavy windy days, they are coming back (into the air)."

The phenomenon seems unique to ragweed. Over the past 10 years, Muthiah has tested the survival ability of other airborne allergens, such as tree pollens, and he said "usually we don't see any carryover from season to season."

The take-home message for allergists? "If ragweed-allergic patients complain in the spring that they have ragweed allergy problem, they aren't lying--they're probably experiencing allergic symptoms," Muthiah concludes. He said further testing at other geographic sites is needed to confirm that the survival of airborne ragweed pollen occurs at equal rates elsewhere.

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SUNDAY, NOVEMBER 17, 2002

Emergency Angioplasty Alone Works

HealthScoutNews

Sunday, November 17, 2002

SUNDAY, Nov. 17 (HealthScoutNews) -- People who receive emergency angioplasty for heart attacks have the same survival rates whether or not there's cardiac surgery backup.

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

The American study is the largest to date showing the benefit of immediate angioplasty in people with heart attacks.

Researchers examined data on 30,358 people from more than 700 hospitals contained in the National Registry of Myocardial Infarction. It's one of the largest observational studies on heart attack and includes data on more than 1.8 million American heart attack patients.

In this new study, the researchers looked at the results for 1,935 people with heart attack who were taken to 97 hospitals that performed angioplasty or diagnostic catheterization but didn't have cardiac surgical units. They compared that to 28,603 people with heart attack who received angioplasty at 562 hospitals with cardiac surgical units.

The study found the in-hospital death rates were 3.2 percent at hospitals with diagnostic catheterization but no cardiac surgery, 4.4 percent at hospitals with angioplasty but no cardiac surgery, and 5 percent at hospitals with angioplasty and on-site cardiac surgery.

In the last group, patient death rates ranged from 4.8 percent for people treated in-house to 6.5 percent for people transferred from another facility.

The study also found a significant difference in the time that elapsed between the heart attack victims' arrival at hospital and when they received angioplasty.

If a person was transferred from one facility to another, the average wait for angioplasty was 198 minutes. That compares to 107 minutes in hospitals performing angioplasty with or without on-site cardiac surgery and 96 minutes at hospitals performing diagnostic catheterization without cardiac surgical units.

The authors say the findings show that hospitals with diagnostic laboratories that meet American Heart Association/American College of Cardiology criteria for doing emergency angioplasty without on-site cardiac surgical units should do the lifesaving procedures instead of transferring heart attack patients to hospitals with cardiac surgery units.

More information

The Mayo Clinic has more about angioplasty.

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Marrow, Muscle Grafts Revive Broken Hearts

 

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Sunday, November 17, 2002

SUNDAY, Nov. 17 (HealthScoutNews) -- Injecting bone marrow into the scarred pumps of heart attack patients can reverse the damage and make the contracting muscle run better, a new study has found.

The study by British researchers adds to mounting evidence that muscle-generating cells in bone marrow can rejuvenate hearts deadened by infarctions, or loss of blood to the tissue. Previously, scientists had considered that damage irreversible.

"It has been the belief in general that you are born with a fixed number of [heart muscle cells], and that when they die they die forever," says Dr. Manuel Galinañes, a heart surgeon at the University of Leicester and leader of the research effort. "This has been challenged."

Scientists have demonstrated in animals that heart muscle can recover from attacks, and the latest work brings those findings to people. Galinañes presented the results today at a meeting in Chicago of the American Heart Association (news - web sites).

The researchers injected bone marrow into the hearts of 12 men and two women undergoing non-emergency bypass procedures to open blood flow to constricted areas. Each injection contained 32 million cells, drawn from the patients themselves to avoid rejection problems, which went into a total of 34 scarry patches of heart muscle afflicted by infarction.

Using a measure called wall motion -- which reflects the ability of the heart to contract -- Galinañes's group found that exercise test scores improved significantly in as little as six weeks. They continued to improve over 10 weeks of observation.

However, the researchers found that the only areas with better muscle activity were those that received both injections and new blood flow from the bypass. "It makes a lot of sense," Galinañes says. "When you seed a garden but you don't water the garden, or you do the reverse, you have no consequences."

In an unrelated study, also presented today at the heart meeting, Arizona scientists found grafts of skeletal muscle from the arms and legs could also revive scarred heart tissue. As in the British work, the Arizona patients -- who were undergoing either bypass or getting an implant to help their failing heart -- received their own cells, obviating the possibility of an immune reaction against the graft.

The procedure, in which doctors transplanted anywhere from 10 million to 300 million cells, led to nearly an average improvement in pumping power of nearly 60 percent in 16 heart attack patients.

Dr. Nabil Dib, director of cardiovascular research at the Arizona Heart Institute and leader of the study, says it's not clear how much of that was due to the grafts and how much to the other operations. However, he says, "clearly those [transplanted] cells do not deteriorate the heart function."

Imaging tests performed earlier this week show that after six months of follow-up the new cells are alive and settled into the heart, he adds.

Dib's group also did not see signs that the grafts caused irregular heartbeats, a potential side effect. The next step will be to see if the procedure indeed boosts pumping capacity.

What To Do

For more on heart attacks, try the American Heart Association or the Heart Information Network.

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Research Offers New Hope for Heart Bypass Patients

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Sunday, November 17, 2002

SUNDAY, Nov. 17 (HealthScoutNews) -- Two new engineering feats may one day brighten the prospects for cardiac bypass patients and other heart patients.

Both studies were reported today at the American Heart Association (news - web sites)'s annual meeting in Chicago.

In the first study, researchers used tissue engineering to build blood vessels from human skin cell tissue, then implanted them into laboratory animals, where they worked well for up to two weeks.

If the results are borne out in human trials, (which the scientists hope to begin by the start of 2004), this could be good news for people who need to undergo heart and leg bypass operations, among other procedures.

Past attempts at this type of engineering had had to use scaffolds made of synthetic materials, which ran the risk of being rejected by the body. The process used in the new study required no such scaffold.

"The technology that we're working on is the capability to grow blood vessels exclusively from your own cells, and that's what separates us from any other technology," says Todd McAllister, co-author of the study and president and CEO of Cytograft Tissue Engineering in Novato, Calif., which developed the technique. "Others depend on the presence of a scaffold."

McAllister and his colleagues took skin cells from 11 patients aged 54 to 84, all of whom had advanced cardiovascular disease and who were undergoing coronary artery bypass operations. The cells were harvested and expanded, then grown into a sheet of cells.

"That sheet is like carbon fiber or some cloth material from which you can assemble more complex three-dimensional structures," McAllister explains. "We roll the sheet around a temporary support and essentially make a jelly roll of tissue. It then goes through the maturation phase where it fuses together to form a homogenous tissue." The process takes about 12 to 14 weeks.

The newly formed vessels were implanted as a leg artery graft in four study animals, and were removed at three, seven or 14 days, depending on the animal. Three of the four grafted vessels survived past the third day, without developing any blood clots. The vessels were also strong and resilient, smaller than had been achieved in the past, and came from an array of patients, meaning that the same procedure could work for different people, McAllister says.

But there's still a long way to go before the technique can be used on humans.

Dr. Jacob Shani, director of cardiology at Maimonides Medical Center in Brooklyn, N.Y., who was not involved in the McAllister research, says, "The concepts that we are talking about [in the new study] are not new. People have tried, and are still trying, to grow tissue from stem cells. But obviously we're not there yet. It's exciting, but I wouldn't book the procedure yet."

The procedure developed by McAllister's company doesn't involve stem cells, but actual human cells.

"The problem starts when you compare it to what's already available," Shani continues. "We have blood vessels from our bodies, veins we use in bypass and these are readily available in most patients. You cut from one place and put it in another. You have to bring something that will beat it because the cost is obviously far greater."

Although promising, 14 days is a very short time period and, Shani points out, "you're talking about an animal model that doesn't have all of the other complexities that human beings have. The concept is very exciting, but it has to pass the test in human beings."

In the second study, skeletal muscle cells that were implanted into the hearts of lab animals were actually able to connect with existing cells and start passing electrical signals. Though extremely preliminary, the findings may one day provide an alternative for pacemakers.

Myoblasts, or immature skeletal muscle cells, make the same protein that heart muscle cells use to connect with each other and transmit electrical signals. In the study, researchers extracted myoblasts from rats and used them to create three-dimensional strips of tissue that were then surgically implanted into rat hearts.

"We had a theoretical weakness which is that, normally in skeletal muscles, when these cells differentiate, they stop expressing the proteins that are important for electronically and mechanically coupling to each other," says Doug Cowan, lead author of the study and an assistant professor of anesthesiology at Harvard University School of Medicine.

"We didn't know if they were going to behave differently, but they did express the proteins that are necessary for continued mechanical and electrical coupling which was one hurdle. The other was, once transplanted, could they survive. And ultimately they did work."

The idea was originally conceived for children, who have an especially difficult time with pacemakers.

"We're a long, long way away from humans," Cowan says. "We were just sort of testing whether this idea would even be feasible. The results so far have been pretty promising."

Shani, of Maimonides Medical Center, says the researchers behind the second study "were able to achieve connections, which is interesting. It is a wonderful concept.

"Again, it works in the lab. We have to see how it works in humans. But, if indeed, you can establish an electrical connection and then avoid the need for a pacemaker, that will be a phenomenal thing," Shani adds.

What To Do

For more on heart bypass surgery, visit the National Library of Medicine. And check the American Heart Association for more research from Scientific Sessions 2002.

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SATURDAY, NOVEMBER 16, 2002

Drug-Resistant Germs: Food for Thought

By Holly VanScoy and Adam Marcus
HealthScoutNews Reporters

HealthScoutNews

Saturday, November 16, 2002

SATURDAY, Nov. 16 (HealthScoutNews) -- In the campaign to educate people about the danger of over-prescribing antibiotics, victories seem to be coming in small doses.

U.S. pediatricians are prescribing fewer antibiotics for common childhood respiratory infections than they were just a decade ago, a recent study says. This suggests that messages about drug-resistant germs are working.

At the same time, there's growing concern among some scientists and members of the medical community that people are ingesting too many antibiotics on a regular basis because of their widespread use in the food supply.

According to a recent report in the Journal of the American Medical Association (news - web sites), the number of antibiotic prescriptions for children under the age of 15 fell from 46 million in 1989 to 30 million in 2000. And the rate of prescriptions per 1,000 doctor visits dropped by nearly 30 percent during the same period.

Despite the drop, the rate is "still probably too high," says Linda F. McCaig, a statistician at the National Center for Health Statistics and lead author of the study.

For instance, the study found that many doctors continue to prescribe antibiotics such as penicillin and erythromycin for the common cold, a viral condition that doesn't respond to bacteria-killing drugs, McCaig says.

And experts estimate that as many as half of all prescriptions for childhood respiratory ailments are unnecessary.

OK, so you and your doctor agree that, from now on, no more antibiotics for trivial ailments. You won't ask for them and she won't prescribe them unless and until they're needed.

That should take care of your personal antibiotic resistance concerns -- unless you plan to eat food.

The Union of Concerned Scientists estimates that 70 percent of the antibiotics being used in the United States today are fed to healthy pigs, cows and chickens to promote growth and prevent disease. Of the 19 classes of antibiotics approved for use in animals, seven are commonly prescribed for human infections -- including Cipro, Bactrim and ampicillin.

As a result, there's a growing number of common food-borne bacteria strains -- such as listeria and E. coli -- that are becoming resistant to antibiotics.

"This is a blind risk," says Dr. Linda Tollefson, deputy director of the Center for Veterinary Medicine, part of the U.S. Food and Drug Administration (news - web sites). "People are getting resistant pathogens through food, and they don't even know it's happening. They are not in the hospital for some necessary treatment where they pick up a resistant pathogen. The risk that we're talking about is a crapshoot. It comes from eating food. And most people eat food."

Several types of drug-resistant bacteria are believed responsible for recent reports of drug-resistant infection.

For instance, an E. coli strain resistant to Bactrim led to an outbreak of urinary tract infections among women on college campuses across the United States last year. Although urinary tract infections aren't normally epidemic, the widespread incidence of the same bacteria led investigators to believe the source was food-borne, Tollefson says.

Then there's the Campylobacter bug, the most common bacterial cause of diarrheal illness in the United States. It infects 2 million Americans each year, usually through contact with raw chicken. Approximately 15 percent of the germ found in a random sample of Americans was of a strain resistant to the antibiotic Cipro. It was the same strain of the germ found in at least 10,000 cases of drug-resistant infection reported in 2001, Tollefson says.

In addition, one strain of the salmonella bacteria -- commonly transmitted to humans through foods such as chicken -- that causes typhoid fever is now resistant to tetracycline, ampicillin, streptomycin, sulfonamides and choloramphenicol, she says.

The list is long and growing, but since you obviously can't stop eating, what should you do?

Proper food handling and cooking can prevent some infections caused by food-borne bacteria. Hands, utensils and all surfaces that come into contact with raw meat or eggs should be washed thoroughly with soap and water. And all food from animal sources should be thoroughly cooked or pasteurized before being eaten, health experts say.

Vegetarians aren't off the hook either. Vegetables and fruits are not immune from exposure to food-borne bacteria, and should be washed thoroughly as well.

Ron Phillips, a spokesman for the Animal Health Institute, contends that the "use of antibiotics in animals is not the 'major driver' behind the resistance issue. What's amazing is that we've been using antibiotics in animals for 50 years, and, although we're still using the same compounds we began with, they are still effective."

Phillips and Tollefson took part in a public meeting sponsored by the Center for Veterinary Medicine last month that was aimed at completing a new categorization system for antibiotics used in animal production. The system is designed to discourage the use of antibiotics in animals that are important human food sources.

Even if adopted, the system would provide only guidance, not regulation.

"This is a long process," says Tollefson, adding that the decision to ban the use of such antibiotics is unlikely to lie with the U.S. Food and Drug Administration.

"I think it's taken several years to convince the food production industry the problem is real and that they have a role to play, but we don't have any means to make that societal judgment," she says. "That would have to be done by Congress."

So, while you're waiting for Congress to act, wash your knives, cutting boards, hands and tomatoes carefully.

What To Do

To learn more about antibiotic resistance and food-borne illness, visit the U.S. Centers for Disease Control and Prevention.

For an overview of drug-resistant bugs, check the U.S. Food and Drug Administration. For a primer on the proper use of antibiotics, see the American Medical Association.

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Fighting Fat in Kids

HealthScoutNews

Saturday, November 16, 2002

SATURDAY, Nov. 16 (HealthScoutNews) -- Can exercise and nutritious snacks in the after-school hours help counter high obesity rates in American children?

That's the focus of a new study by researchers at the Medical College of Georgia (MCG). The study, called the MCG FitKid Project, received a $3.3 million grant from the U.S. National Institutes of Health (news - web sites).

The FitKid Project will assess the effects of changes made to the after-school activities of 300 third graders in nine Richmond County schools for three years. Each day after school, the children will do some warm-up drills and then receive sports skill instruction, such as learning how to dribble a basketball.

Following that, the children will do 30 to 40 minutes of aerobic activity in the form of games. Then they'll do strength training using calisthenics and resistance exercises.

When they get hungry, the children will choose from a U.S. Department of Agriculture (news - web sites) list of healthy snacks.

The results of the study group will be compared to a control group of 300 third graders in nine other schools who'll keep doing what they normally do after school.

Third graders were chosen for this study because that tends to be the age when physical activity starts to decline and weight starts to increase.

More information

The U.S. Surgeon General has more information about the growing problem of overweight and obese children.

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A New Look at Lyme Disease

HealthScoutNews

Saturday, November 16, 2002

SATURDAY, Nov. 16 (HealthScoutNews) -- Many cases of Lyme disease are misdiagnosed or go undiagnosed.

So says the International Lyme and Associated Diseases Society (ILADS).

The U.S. Centers for Disease Control and Prevention (news - web sites) (CDC) estimates there are 19,000 new cases of Lyme disease in the United States each year. However, ILADS doctors say the number of new infections may be more than 200,000.

Lyme disease was first recognized in 1977 in Connecticut. Since then, tens of thousands of people with Lyme disease have been misdiagnosed with fibromyalgia, chronic fatigue and multiple sclerosis, ILADS says.

By the time they're correctly diagnosed, some people with Lyme disease are in the chronic stage and treatment is much more difficult. Lyme disease can cause health complications ranging from seizures to retinitis to sudden cardiac death.

Many doctors don't know how to recognize Lyme disease and have to rely on outdated diagnosis and treatment information, ILADS says.

To address the problem, ILADS recently introduced new detection and treatment guidelines for Lyme disease.

Doctors are often told to look for a red bull's eye rash caused by a tick infected with Lyme disease. However, ILADS experts say less than half those with Lyme disease develop a rash and fewer than half ever recall getting a tick bite.

ILADS says doctors need to look for a wider range of complaints that may indicate Lyme disease. These include fever, joint pain or arthritis, facial palsy, headaches, dizziness, sudden weight change, fatigue, mood swings, memory loss, depression and disorientation.

An enzyme-linked immunosorbent (ELISA) test is used by most doctors to detect Lyme disease. However, ILADS says doctors need to do a variety of tests to assess Lyme antigens and antibodies and to detect Lyme DNA.

The new ILADS guidelines also call for more aggressive treatment of Lyme disease in both early and late stages. Current recommendations for early Lyme disease call for a two to three weeks of treatment with oral antibiotics.

ILADS says that's not sufficient and recommends six to eight weeks of oral antibiotics to treat early stage cases of Lyme disease. People with chronic Lyme disease may need to take antibiotics even longer and may also need to take them intravenously.

More information

You can learn more at the Lyme Disease Network.