The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
December 27, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 23-29

 

FRIDAY, NOVEMBER 29, 2002 

 

Functional Summaries on Food 

HealthScoutNews
Friday, November 29, 2002

FRIDAY, Nov. 29 (HealthScoutNews) -- Are you starving for information about functional foods?

Well, the International Food Information Council (IFIC) recently served up the first in a series of fact sheets on various food components and their potential health benefits. Functional foods refers to any food or food component that may provide a health benefit beyond basic nutrition.

The first fact sheet provides information on antioxidants, including health effects, research, Web links, and dietary sourcess.

Future fact sheets will cover functional foods such as soy protein, plant stanols and sterols, omega-3 fatty acids, and pre-and probiotics.

The IFIC is primarily supported by the food, beverage and agricultural industries.

More Information

Here's where to go to find the IFIC information about functional foods.

Very Heavy Pot Use Clouds Mental Function: Study

 

By Dana Frisch

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - People who smoked unusually large amounts of marijuana performed worse on tests of mental function than their peers who smoked less pot, even after a 30-day abstinence period, according to a new report.

Heavy users performed worse on 69% of the 35 tasks than light users, though their performances were not "clinically abnormal," the researchers found. The 22 participants were admitted to hospital during the course of the study and submitted to random urine tests to ensure they remained abstinent.

Lead author Dr. Karen Bolla characterized the study group as being "unusual" because of the large number of joints they smoked per week. Heavy users smoked on average 91 joints a week, or about 13 a day, while light smokers smoked an average of 11 marijuana cigarettes a week.

Bolla, who is an associate professor of neurology and psychiatry at Johns Hopkins University School of Medicine in Baltimore, Maryland, said the results cannot be generalized to social smokers or those who use pot for medicinal purposes, because they smoke far less marijuana. The potency might also differ, she said.

"What this study shows is that marijuana can be neurotoxic if you smoke a lot of it," Bolla told Reuters Health. She said this is particularly concerning since the average age of study participants was 22 years old, and the brain is still developing at that age. "You're putting a lot of foreign stuff in there that we don't really know what it does to a developing brain," she said.

The study, published in the November issue of the journal Neurology, found that the mental functions most severely impacted were memory, executive function (overall reasoning and functioning) and manual dexterity.

Bolla writes that these tasks in particular were affected because they are controlled by the hippocampus, prefrontal cortex and cerebellum. These brain areas are densely populated with cannabinoid receptors that attach to THC, the active ingredient in marijuana.

In mice, excessive marijuana use might damage parts of the brain and "knock out certain kinds of neurons," said Bolla. This can lead to receptors in the brain being over-stimulated or under-stimulated, changing their response to chemical messengers in the brain, similar to what might result from a brain injury.

Marijuana is the most widely used illicit drug in the US. An estimated 7 million people use marijuana weekly, according to 2000 data from the US Department of Health and Human Services (news - web sites).

This is only the second study to examine the residual effects of marijuana use after more than a couple of days of abstinence. Dr. Harrison Pope Jr., a professor of psychiatry at Harvard Medical School (news - web sites) and author of the other study, found no difference in performance on cognitive tests between heavy marijuana users and "control" subjects.

Pope said in an interview that his "hunch" was that the difference between his results and Bolla's were the "sheer intensity" of marijuana use among the participants in Bolla's study. Heavy users in Pope's study smoked on average 1 or 1.5 joints over the course of a day.

According to Pope, people who smoke a lot of marijuana and start earlier will do worse on tests of mental function. Whether the toxicity of the drug itself is responsible, or factors like being in school less and being unfamiliar with testing or being more impaired initially and turning to pot for that reason, is difficult to know, he added.

Source: Neurology 2002;59:1337-1343.

Ankle Sprains 

HealthScoutNews
Friday, November 29, 2002

(HealthScoutNews) -- Sprained ankles are usually more painful than they are serious.

Follow the American Academy of Family Physicians (news - web sites)' RICE approach to ease your discomfort:

  • Rest -- Depending on how serious your sprain is, you may have to rest your ankle, either partially or completely.
  • Ice -- Apply it to your ankle for up to three days after the injury. This can reduce swelling, pain, bruising and muscles spasms.
  • Compression -- Wrapping your ankle for a few days will help avoid swelling and bruising.
  • Elevation -- Raising your ankle to or above the level of your heart will keep the swelling in check and help reduce bruising. Try this for about 2 to 3 hours a day.

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Medical Marijuana Use Still Infrequent in US

 

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Four states in the US currently permit doctors to prescribe marijuana to their patients to help them with their ills, but a new report shows that only a fraction of the doctors and patients who reside in these states take advantage of this opportunity.

According to findings from the US General Accounting Office (news - web sites), in Hawaii, Alaska and Oregon--three of the states that permit the use of medical marijuana--only 0.05% of the patient population has requested the drug. Of those that have, the report notes, most were over 40 years old and, in the two states that included information about patients' gender, most were men.

California, the fourth state that permits the use of medical marijuana, did not have information on who uses the drug for medicinal purposes.

Hawaii and Oregon also submitted findings on physician prescribing patterns, and found that less than 1% of Hawaiian doctors and 3% of doctors in Oregon have requested their patients receive marijuana. Most doctors prescribed marijuana for patients with conditions that were extremely painful or marked by muscle spasms, such as multiple sclerosis.

The report notes that whether or not medical marijuana might muddle the ability of police to control the use of marijuana for non-medical purposes remains unclear. However, interviews with law enforcement officials from the four states suggest that allowing medicinal marijuana has not changed how they deal with recreational pot use.

Some officials noted, however, that it might become more difficult to prosecute cases involving marijuana if the defendant can claim the drug was needed for medical reasons.

The law that permits doctors to prescribe marijuana to their patients in these four states has always been in conflict with federal law, and last year the US Supreme Court unanimously upheld the federal ban on marijuana.

In response to the report, the US Department of Justice (news - web sites) cautions that issues such as how medical marijuana can facilitate drug trafficking and whether state and federal law enforcement agencies can cooperate over marijuana use remain unclear.

The justice department (news - web sites) adds that scientists continue to debate whether marijuana has medicinal value.

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Winter Skin

HealthScoutNews
Friday, November 29, 2002

(HealthScoutNews) -- Sometimes your skin signals winter's onset before your body feels its chill. The season's dry air and harsh winds can sap moisture from your skin, leaving it chapped and red with irritation.

Doctors at Duke University suggest these tips for maintaining healthy skin:

  • Continue to apply sunscreen to your face. Winter sun, especially if you're on the slopes, can leave you with serious sunburn.
  • You may need to cut back on certain skin products, such as alpha-hydroxy acids, as they may aggravate dry, irritated skin.
  • Avoid long, hot showers -- they drain skin of its natural oils. Instead, take a short, warm shower and moisturize your body while your skin is still damp.
  • Humidify indoor air.

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Diabetes Drug May Help with HIV Med Side Effects

 

By Keith Mulvihill

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - The results of a very small, preliminary study raise the possibility that a common diabetes drug could help treat the complications that can occur in patients taking certain anti-AIDS (news - web sites) drugs.

Patients taking highly active antiretroviral therapy (HAART) for HIV (news - web sites) infection can develop abnormal body fat distribution known as lipodystrophy, and tend also to become resistant to insulin, the body's key blood sugar-regulating hormone. Now that more and more people with HIV are living longer while on HAART, researchers have been concerned that these changes could signal an increased risk of heart disease.

It is not clear why or how lipodystrophy occurs, but experts suggest that it is somehow linked with the development of insulin resistance. There is currently no treatment for lipodystrophy.

Dr. Marie C. Gelato of the State University of New York at Stony Brook and her colleagues hypothesized that a diabetes drug that boosts insulin sensitivity, rosiglitazone (Avandia), might be helpful to HIV patients with insulin resistance and lipodystrophy.

To investigate, the researchers treated eight HIV-positive patients with Avandia for 6 to 12 weeks. Their findings were published in the October issue of the Journal of Acquired Immune Deficiency Syndromes.

"We felt that the drug would have two advantages," Gelato explained in an interview with Reuters Health. "We thought it would help improve their insulin resistance, which about 55% of patients with HIV and lipodystrophy have, and we thought that it would help restore some of the peripheral fat--fat located in the extremities as opposed to visceral fat found deeper in the body.

"What we saw is that (the drug) definitely improved the insulin resistance in many of the patients," she added. "And, we made an impact on the fat by getting an increase in peripheral fat and a decrease in visceral fat.

"It seems that with the drug, we may be able to improve insulin resistance and prevent patients from becoming diabetic. And secondly, we might be able to improve the fat loss," Gelato said.

Nonetheless, Gelato cautioned, "This is a very small study and it is very preliminary but we feel that it shows that the drug has potential.

"The next step is to start looking at a larger number of patients and to really home in on what this drug is doing at the level of the fat cells," she told Reuters Health.

"We need to try to understand how the drug is doing what it's doing, and hopefully get some insight into why the patient is developing the syndrome in the first place. We need to understand...the underlying defect in the cells."

The study was supported by research grants from the National Institutes of Health (news - web sites).

Source: Journal of Acquired Immune Deficiency Syndromes 2002;31:163-170.

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Treat the Cause, Kill the Symptom

HealthScoutNews
Friday, November 29, 2002

FRIDAY, Nov. 29 (HealthScoutNews) -- Targeting microscopic cells that cause inflammation in lung airways may be a more effective way of reducing severe asthma attacks than treating asthma symptoms, says a British study in tomorrow's issue of The Lancet journal.

Increased concentrations of microscopic cells called eosinophils cause inflammation in lung airways that results in asthma symptoms. These eosinophils are also present in a person's sputum several weeks before an asthma attack.

The researchers compared the effectiveness of reduction of eosinophilic inflammation to conventional asthma treatment, which relies on assessments of symptoms and simple measures of lung function.

The study included 74 people with moderate to severe asthma. They were selected at random to receive conventional treatment or normalization of the induced sputum eosinophil count.

The sputum eosinophil group received inhaled or oral corticosteriods in response to changes in their sputum eosinophil concentrations.

Over 12 months, the sputum eosinophil count was 63 per cent lower in people in the sputum management group than the people in the conventional asthma treatment group. The sputum management group had fewer severe asthma attacks (35) compared to the conventional treatment group (105).

The sputum management group had one person hospitalized for severe asthma, compared to six people in the conventional management group.

More Information

For more about asthma, go to the American Academy of Allergy Asthma and Immunology.

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UN Sees Synthetic Pills as Next Big Drug Problem

 

By Chris Johnson

Reuters

Friday, November 29, 2002

CHIANG SAEN (Reuters) - Use of designer drugs, such as methamphetamine pills, is spreading so fast it could soon dwarf the problem of traditional narcotics such as heroin and cocaine, the head of the UN drugs agency believes.

Antonio Maria Costa, global executive director of the Vienna-based United Nations (news - web sites) Office on Drugs and Crime, told Reuters these newer drugs could be produced cheaply and easily almost anywhere in the world, making them very difficult to control.

Small, attractive pills, they are easily trafficked by well-organized crime syndicates from production centers mostly in Southeast Asia to consumers in cities in the region and the West.

"I want to stress the significant danger of the spread of both the production and consumption of amphetamines around the world," Costa said in an interview in the heart of the notorious drugs-producing region of the Golden Triangle, where the borders of Thailand, Laos and Myanmar meet.

"In the period ahead, the use of synthetic drugs may become the most serious problem ever faced," he said.

Data on narcotics production and consumption are notoriously unreliable, but the United Nations keeps records of seizures across the world and these suggest an alarming increase in the use and abuse of synthetic drugs.

UN data show seizures of synthetic drugs, known by drugs agencies as "amphetamine-type stimulants" or ATS and made in secret laboratories from chemicals such as ephedrine, reached almost 40 tons in 2000 from just 5 tons in 1991.

'Poly-Consumption

New figures are not available but anecdotal evidence suggests output has risen many times over the last 2 years, especially in Myanmar, Thailand and China, which accounted for more than four-fifths of ATS production in 2000, according to the UN.

Many of the laboratories producing methamphetamines are in well-hidden factories just across the border from Thailand in military-run Myanmar, formerly known as Burma, drug agencies say.

Costa, in the Thai region of the Golden Triangle to visit an anti-drugs crop-substitution project, said there was evidence many countries were involved in production of synthetic drugs.

"The process is increasing everywhere in the world, because demand is increasing everywhere in the world. Everywhere in the world poly-consumption is emerging as a dangerous phenomenon with abusers using one narcotic in combination with another."

Usually the first of these drugs would be a traditional narcotic such as heroin or cocaine, and often the second would be a synthetic stimulant, he said.

Consumption of synthetic stimulants is rising rapidly in the United States, Europe and Japan, as well as in Southeast Asian markets such as the Philippines and Thailand where they are popular because they can cost less than $2 a pill.

Asked if he accepted Thai estimates that as many as one billion methamphetamine pills could come across the border into Thailand next year from Myanmar after an influx of as many as 700 million this year, he replied: "It is a plausible number, although it is very difficult to estimate the exact figures."

Despite the growing abuse of synthetics, governments could cope with the problem if they addressed it on several levels, discouraging consumption, clamping down on distribution and offering alternative sources of income for producers, he said.

"We are progressing in our war. The war is getting more serious. The stakes are getting bigger and we believe that the governments will eventually prevail.

"But we need inspiration, commitment and determination."

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Risk of Breast Cancer Drops After HRT Discontinued

 

By Alison McCook

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Taking hormones after menopause is associated with a slight increase in the risk of breast cancer (news - web sites), but new research suggests that women who took hormones in the past but no longer do so have no higher risk than women who never used the treatment.

"If you are a past user, it appears that once you discontinue use, the risk returns to normal levels," study author Dr. Linda K. Weiss of the National Cancer Institute (news - web sites) in Bethesda, Maryland, told Reuters Health.

Millions of women have relied on hormone replacement therapy for many years, but recent research has suggested that the benefits of the treatment--alleviating hot flashes and other symptoms of menopause and preventing osteoporosis--may be outweighed by its risks. Specifically, a recent report found that women who took a combination of estrogen and progestin for more than 5 years had a higher than average risk of breast cancer, heart attack, stroke and potentially life-threatening blood clots.

In the current study, published in the December issue of the journal Obstetrics & Gynecology, Weiss and her colleagues investigated the risk of breast cancer among past and present users of hormone replacement therapy (HRT). The study included 1,870 postmenopausal women who developed breast cancer and 1,953 of their peers who were cancer-free, all of whom were asked about their previous HRT use.

The investigators found that women who had been using HRT consisting of estrogen and progestin for more than 5 years at the time of the study were 54% more likely to be diagnosed with breast cancer while taking the medicine than those who never used the treatment. However, women who said they had used that type of HRT for at least 5 years in the past but had stopped at least 6 months ago were no more likely than those who never used the therapy to have breast cancer.

Weiss and her team also discovered that women who were currently using a form of HRT that contains only estrogen and had been doing so for at least 5 years did not appear more likely than others to have breast cancer. Estrogen-only users are typically women who have had their uterus removed, because the hormone is known to increase the risk of cancer of the uterine lining when not used in conjunction with progestin.

In all, these findings suggest that if you are a past user of estrogen and progestin HRT and did not yet develop breast cancer, "you probably don't need to be too alarmed that HRT, specifically, is going to cause breast cancer a few years down the line," Weiss said during an interview.

However, she noted that breast cancer remains a common disease among women and can stem from a variety of causes, such as family history. So just because a woman has stopped taking HRT and was currently breast cancer-free does not mean she should become lax, thinking she is immune from the disease, Weiss added.

"So they shouldn't stop going to their doctor, or getting screening," she said.

Source: Obstetrics & Gynecology 2002;100:1148-1158.

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Pregnant Women Should Get Group B Strep Test

 

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - All pregnant women should be routinely screened for Group B streptococcus, a major cause of illness and death among newborns, according to the American College of Obstetricians and Gynecologists (ACOG).

Group B streptococcus (GBS), or "strep," can cause serious infections, such as meningitis, in newborns. Infants can become infected with the bacterium during labor and delivery, so pregnant women are screened for GBS during the last few weeks of pregnancy. Women infected with strep may be treated with antibiotics to reduce the risk of passing on the infection.

"We now have strong evidence to make the case that routine screening for GBS is the superior method in preventing transmission of the bacteria from mother to child during delivery," Dr. Laura E. Riley of ACOG in Washington, DC, said in a prepared statement.

Previously, ACOG, the Centers for Disease Control and Prevention (news - web sites) and the American Academy of Pediatrics recommended that physicians adopt either culture-based analysis (swabbing the vagina and rectum for the presence of GBS) or risk-based analysis for the prevention of GBS transmission from mother to child, according to a report published in the December issue of the journal Obstetrics & Gynecology.

ACOG's current announcement stems from a recent review of data that found greater benefits of screening all pregnant women for the presence of GBS as opposed to just treating those believed to be at high risk for GBS infection.

"We have achieved great success in reducing the transmission of infectious diseases from mothers to newborns in recent years. By recommending universal GBS screening of all pregnant women, we look to further decrease perinatal morbidity and mortality rates in this country," added Riley.

Earlier this month, the US Food and Drug Administration (news - web sites) (FDA) cleared for marketing a new, faster GBS screening test for pregnant women, which takes an hour to produce results rather than the 18 to 48 hours needed for previously available tests.

This quicker turnaround time should help ensure that women who start labor early or have not received adequate prenatal care can still be tested and given antibiotics in time if necessary, the FDA noted.

Source: Obstetrics & Gynecology 2002;100:1405-1412.

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Feeling Stressed Out Weakens Immune System Response

 

By Charnicia E. Huggins

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - People who consider themselves to be stressed out and who are anxious or otherwise psychologically distressed may be less able to fight off the diseases they have been immunized against, study findings suggest.

Consequently, "it might be important to monitor antibody status following vaccination when vaccinating those who are likely to be experiencing high perceived stress and low levels of psychological well-being," lead study author Dr. Victoria Burns of the University of Birmingham in England told Reuters Health.

In fact, the perception of high stress seems to be more important than whether or not individuals have actually experienced highly stressful events, the report indicates.

Burns and her colleagues looked at 60 freshmen undergraduate students who had been vaccinated against meningitis C between 1 and 16 months before they were enrolled in the study.

Based on blood samples, nearly three quarters (73%) of the students had a protective level of antibodies to the disease, while the remaining students had a less protective level--meaning they had fewer antibodies against the pathogen, the investigators report in the November/December issue of Psychosomatic Medicine.

Students who experienced a parent's death or some other highly stressful life event were no more likely than other students to exhibit a lessened immune response. However, those who reported high levels of perceived stress were five times more likely to have fewer antibodies, the report indicates.

This was true even among students who said they had not actually experienced many highly stressful events.

For example, nearly 8 in 10 of the students who considered themselves to lead highly stressful lives, but actually reported experiencing only low levels of stressful events, had a low level of antibodies in comparison to 65% of students who perceived their life as stressful and had gone through highly stressful events.

"It appears to be the perception of stress and poor psychological well-being, rather than the actual stressful events that you experience, that appears to be detrimental to your meningitis C antibody status following vaccination," Burns said.

"These are your typical stressed-out people," she said, adding that they may be the most likely to have physiological and psychological responses to stress.

Further, students who had high levels of psychological stress had a fourfold increased risk of having lower antibody levels. This increased risk was especially true for students who were identified as high in anxiety/insomnia and social dysfunction, the researchers note.

In light of the findings, people who are vaccinated during periods of high stress, such as students around the time of final examinations or new military recruits about to be sent off to war, should be re-evaluated at some point to make sure they have the appropriate level of antibodies in their blood against the diseases they are immunized against, Burns said.

Doctors and other healthcare workers usually just "jab them and assume they're okay," she said.

Source: Psychosomatic Medicine 2002;64.

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Widely Used Test Wrongly Diagnoses Many as Demented

 

By Richard Woodman

Reuters Health

Friday, November 29, 2002

LONDON (Reuters Health) - A test that is widely used to screen elderly people for dementia may give a false positive result in 86% of cases, researchers warned on Friday.

The Mini-Mental State Examination (MMSE) is a short assessment tool used worldwide to assess cognitive function in relation to dementia, though doubts have been raised about its utility in primary care.

Professor Bob Woods and colleagues at the University of Wales in Bangor investigated the validity of the test in 709 patients aged over 75 undergoing annual health checks at nine general practices in North Wales between January 1998 and July 1999.

Their findings, reported in the British Journal of General Practice, showed that 286 of the 709 patients screened apparently had dementia--as defined by an MMSE score of 26 or under.

But further checks on 202 of these "dementia" patients using the well-validated GMS diagnostic system identified only 29 as truly having dementia.

"These results, with an 86% false-positive rate, raise concerns regarding the utility of the MMSE as a screening instrument for dementia in primary care," the researchers said.

"Simply adding the MMSE to existing assessments of people over 75 is unlikely to be helpful, leading to a high rate of older people apparently requiring further assessment and a high rate of false positives."

They noted that it was possible to reduce the false-positive rate to 59% using a more conservative MMSE score of 21 but said this was achieved at the expense of missing over half the true positives.

The authors recommended basing assessment on history and complaints of memory problems from patients and carers, not cognitive testing alone. "For example, recall of a name and address over 5 minutes is as reliable as a full MMSE and potentially less arduous."

Source: British Journal of General Practice 2002;52:1002-1003.

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Breast-Feeding May Boost Baby's Own Immune System

 

By Clementine Wallace

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - During breast-feeding, substances that protect against infection are passed from mother to child. Now a new study suggests that breast-feeding may also boost an infant's own immune response against infections later on in childhood.

"In the past 10 years, we have been realizing that breast-feeding brings much more than we thought," said Dr. Lars Hanson, from the University of Goteborg in Sweden. "Not only are some of the mother's defenses passed on to the child, but breast-feeding actually seems to activate something in the baby's own defense system."

Hanson, Dr. Sven-Arne Silfverdal, from the Orebro Medical Center Hospital in Sweden, and colleagues looked at children under age 6 who had been seriously ill with Haemophilus influenzae type b (Hib), a type of bacteria that can cause pneumonia, meningitis, and other potentially life-threatening infections. The children became ill in the late 1980s and early 1990s, before a Hib vaccine became available in Sweden.

The researchers found that youngsters 18 months or older who had been breast-fed exclusively for more than 13 weeks (average 19 weeks) had a stronger immune response to Hib than those breast-fed exclusively for less than 13 weeks (average 5 weeks). There was no difference in immune response in children under 18 months of age, according to the report published in the Pediatric Infectious Disease Journal.

Vaccination against Hib now exists in most countries, but the bacterium still poses a threat in poor countries with inadequate healthcare programs and vaccination, according to the report. Moreover, this report could be used as a model to study the protective benefits of breast-feeding against other types of diseases and infections, Hanson said.

"Convincing studies also demonstrate significant protection against diarrhea, respiratory tract infections, otitis media (ear infections), or urinary tract infection, for instance," he said.

In previous studies, Silfverdal's team also suggested that this immune system enhancement could last over the years, beyond the period of breast-feeding itself.

"We don't really understand how that might work, but the information is growing that longer periods of breast-feeding may afford more complete protection not only against certain diseases that may occur during breast-feeding, but also against disorders that surface long after breast-feeding is over," said Dr. Armond Goldman, from the University of Texas Medical Branch in Galveston, who was not involved in the study.

The point when a child no longer requires this immunological support via breast-feeding has not yet been established, according to Hanson, but "the more the better and the longer the better," he said.

Current recommendations suggest that exclusive breast-feeding should be continued for the first 4 to 6 months of life and up to a year if possible, according to Goldman, which is not always an easy recommendation to follow in the US.

"It's easy to say that people should be child-centered," he said, "but there are obvious socioeconomic factors that have to be taken into consideration and mothers also need an adequate environmental support to be able to breast-feed. Many factors come into play that make breast-feeding difficult."

Source: The Pediatric Infectious Disease Journal 2002;21:816-821.

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Mild Exercise Not Enough to Strengthen Bones

 

By Merritt McKinney

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Even mild physical activity, such as walking, gardening and working around the house, can help keep the heart healthy, but such activities do little to make bones stronger, according to a new study.

"Although some activity may be better than none at all for certain aspects of health, like heart health, milder forms of activity may not be sufficient to hold off or attenuate the age-related decline in bone with aging," said lead author Dr. Kerry J. Stewart of Johns Hopkins University School of Medicine in Baltimore, Maryland. "More vigorous exercise may be needed," he told Reuters Health.

Although mild activity and aerobic fitness did not seem to affect bone density in the study, having greater muscle strength and carrying extra pounds around the middle were related to stronger bones, according to a report on the findings that is published in November issue of the Journal of Internal Medicine.

Despite the apparent link between abdominal obesity and stronger bones, the study does not give the green light to pig out, Stewart cautioned.

"Although being fat may be good for bone density, gaining weight is not the answer because of the harmful effects of obesity on many other aspects of health," he said.

Stewart's team studied 38 men and 46 women who were generally healthy, although their blood pressure was at the high end of the normal range or mildly high. None of the participants exercised regularly.

In the study, neither overall aerobic fitness nor participation in mild physical activity had a significant effect on bone mineral density. But muscle strength as well as extra fat in the abdomen were associated with denser bones.

"We found that being more fat and having stronger muscle, which is common in fatter people, along with hormone replacement therapy, had the most influence on bone," Stewart said. "In particular, having more abdominal fat was most strongly linked to bone density."

The study did not look at how carrying around extra pounds may boost bone density, but Stewart suggested that the hormone leptin may be involved. Leptin levels tend to be higher in fatter people, he explained, and animal studies have shown that leptin increases the activity of bone cells.

Source: Journal of Internal Medicine 2002;252:1-8.

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THURSDAY, NOVEMBER 28, 2002

 

Playing With Fire Is a Deadly Game 

HealthScoutNews
Thursday, November 28, 2002

THURSDAY, Nov. 28 (HealthScoutNews) -- Child's play can be deadly.

Children playing with fire cause hundreds of fire deaths and injuries each year in the United States. Preschoolers are most likely to play with matches and lighters that lead to fires and are most likely to die in such fires, says the National Fire Protection Association (NFPA).

Most people killed in child-playing fires are under age 6, and child-playing fires are the leading cause of fire death among preschool children.

In 1998, children playing with fire caused 67,490 fires reported to U.S. fire departments, resulting in 232 civilian deaths, 1,805 civilian injuries, and $234.7 million in direct property damage, the NFPA says.

About 3 out of every 4 child-playing fires and at least 4 out of 5 injuries or deaths involve matches and lighters -- with lighters causing the larger share, the NFPA says. But children also start fires when they play with stoves, candles, fireworks and lighted tobacco products.

Here are some NFPA child fire safety tips for parents and caregivers:

         Buy only child-resistant lighters. But remember that they're not child-proof.

  • Store all matches and lighters out of the reach and sight of children. Put them in a high location, preferably in a locked cabinet.
  • Never leave young children unattended.
  • Never use matches or lighters as a source of amusement for children. They may want to imitate you.
  • If you think your child is playing with fire or is unduly fascinated with fire, call your local fire department, school, or community counseling agency to help you get in touch with experts who can help your child.
  • Teach young children that they should tell an adult if they find matches or lighters. School-age children should be taught to bring matches or lighters they find to an adult.
  • Children should be taught to stop, drop and roll if their clothes catch on fire. Teach children that when there is a fire, they shouldn't hide, but should get out of the house immediately.

More Information

To learn more about fire safety, go to the NFPA.

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Genes Help Explain Why Low-Cal Diet Extends Life

 

By Amy Norton

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Research has shown that a low-calorie lifestyle can extend the lives of species ranging from yeast to mammals, and now scientists have evidence that two genes may be the major orchestrators of this effect.

Their work with fruit flies found that calorie restriction and particular mutations in a gene called rpd3 appear to work together to lengthen the insects' lives. Both dieting flies and those with mutant rpd3 showed increased activity in a gene called Sir2, already thought to be a major player in the link between low-cal living and longer life.

Scientists hope that by unraveling the cellular mechanisms by which dieting stretches the life span, they can eventually find a way to "mimic" some of the health benefits of calorie cutting--without the obstacle of having to actually eat less.

But, "the emphasis is on the word 'eventually,"' said study author Stewart Frankel, of Yale University School of Medicine in New Haven, Connecticut.

He told Reuters Health that he and his colleagues at the University of Connecticut believe that rpd3 and Sir2 are the "master switches" of the mechanism by which calorie restriction affects longevity, but there's still a lot to learn about the molecules that carry out the genes' orders.

"We have the coaches, but we need to know who the players are," Frankel explained.

He and his colleagues report their findings in the November 29th issue of Science.

A number of studies have shown that cutting calories extends the life span of yeast, worms, insects and mammals. More importantly, Frankel pointed out, research in monkeys and rodents suggests that it's not only a longer life, but also a healthier one.

As for how calorie restriction might accomplish this, research in yeast and worms has indicated that revved up Sir2 activity is an important factor. In addition, a dip in rpd3 activity has been implicated in bestowing long life to yeast, a single-cell organism.

The new study extends that finding to a more-complex life form, and it also suggests that the drop in rpd3 activity may be particularly crucial, according to Frankel. The findings suggest that low-cal diets lead to decreased rpd3 activity, which is then followed by a boost in Sir2 activity.

Frankel explained that it would easier to design a drug that could lower rpd3 activity, as opposed to one that would jumpstart Sir2.

But a drug that would specifically mimic the life-prolonging effects of calorie cutting would be hard to study in humans, according to Frankel. It would be far easier, he said, to test for a drug that mimics the benefits of calorie cutting upon the diseases of old age.

Source: Science 2002;298:1745.

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It's All in the Name, Baby

HealthScoutNews
Thursday, November 28, 2002

THURSDAY, Nov. 28 (HealthScoutNews) -- Babies use their own name and at least one other familiar name -- usually connected with their mothers -- in order to recognize adjoining words when someone is talking to them in fluent speech, says a Brown University study.

The study found that infants who are six months old can recognize words. That's the youngest documented age for that ability.

Previous studies had found that infants recognized words at seven-and-a-half months and their own names at six months.

For the study, which included 24 infants, each of the infants sat on their mothers' laps facing a three-sided booth. Lights were positioned at eye level on the three sides of the booth. At the start of each trail, the light directly in front of the infant blinked in order to attract the infant's attention.

That was followed by the blinking of one of the lights on either side of the booth. When the infant turned to look at that light on the side of the booth, a recording with a few spoken sentences played. When the baby looked away from the light, the recording stopped.

There were two sets of recordings. One included the baby's name and one included another baby's name. In both recordings, the name was linked to a specific noun or verb.

For example: Sam's bike could go very fast; Sam's bike has big, black wheels; the girl rode on Sam's bike; Jon's cup was bright and shiny; Jon's cup was filled with milk; a clown drank from Jon's cup.

Continuing with these examples, the researchers then tested Sam and Jon on their recognition of bike and cup. They found that Sam recognized bike, but not cup. Jon recognized cup, but not bike.

That same kind of recognition happened when the researchers used words such as mommy or mama and paired them with other words.

The researcher say infants first need to recognize a word's sound pattern in order to figure out what it means. Highly familiar words, such as their own name or one they associate with their mother, provide infants with an "anchor," the researchers say.

The study was presented recently at the annual Boston University Conference on Language Development.

More Information

The American Speech-Language-Hearing Association has more about speech and language development.

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Moderate Drinkers Take Less Sick Leave: Study

 

By Keith Mulvihill

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Not only may moderate drinking promote heart health, new study findings from Finland have found that people who consume alcohol a few times each week may actually miss less work.

Modest drinking of any type of alcohol has been linked to better health, particularly cardiovascular health, and wine has stood out as especially beneficial. Some researchers speculate that certain properties of wine, such as its antioxidant content, may give the beverage an added benefit above and beyond its alcohol content. However, studies have also suggested that wine drinkers may just have healthier lifestyles overall.

The new findings suggest that moderate alcohol consumption may reduce health problems other than those associated with cardiovascular illness, the researchers report.

"We found that lifelong abstainers, former drinkers and heavy drinkers had higher rates of sick leaves than moderate drinkers," the study's lead author, Dr. Jussi Vahtera of the Finnish Institute of Occupational Health, told Reuters Health.

"The elevated risk in non-drinkers was not due to differences in lifestyle or psychological or social factors," the researcher added.

In the study, absence from work due to sickness was based on a physician's examination, explained Vahtera.

"Typically, abstainers have slightly higher mortality than moderate drinkers while heavy drinkers have a much higher rate than the former two groups," said Vahtera. "But no clear pattern was discovered in earlier studies on the relationship between alcohol intake and other health outcomes, such as sickness absence."

In the current investigation, the team of researchers evaluated the relationship between consumption of alcohol and the amount of sick leave a person took from their job. In all, the medical records of more than 6,000 men and women were reviewed.

The rate of medically certified sickness absence was 1.2 times higher for non-drinkers, former drinkers and heavy drinkers compared to lighter drinkers, the authors report in the November issue of the American Journal of Epidemiology.

"The high rate of sickness absences among heavy drinkers may be due to a greater incidence of alcohol-induced diseases, a more severe course of these or other diseases, poorer treatment or compliance to treatment, and inferior functional capacity due to excessive alcohol consumption," Vahtera noted.

"The higher rate of sickness absences among non-drinkers than among moderate drinkers may result from a lack of the protective effects of alcohol intake," the researcher added.

"Our findings suggest that light alcohol intake may reduce not only cardiovascular disease but also other health problems," Vahtera concluded.

Source: American Journal of Epidemiology 2002;156:969-976.

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Fire Escape 

HealthScoutNews
Thursday, November 28, 2002

(HealthScoutNews) -- If a fire broke out in your home, would your family know what to do? Having an escape plan can save your lives.

According to Shriners Hospitals for Children, a home fire escape plan should include the following:

  • A floor plan with two exits from each room. Windows can serve as emergency exits.
  • A designated meeting place at a safe distance outside the home.
  • Practice sessions for getting out of the home through various exits.
  • Smoke detectors installed wherever needed.

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Body Burns Some Fats Better After Exercise

 

By Anne Harding

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - A workout can help burn the fat you eat, and keep it from adhering to your hips, even hours after you've left the gym, the results of a small new study suggest.

But this doesn't work for every type of fat, the researchers found; while previous exercise helped people burn monounsaturated fat from a subsequent meal, it had no effect on how the body used saturated fat. Monounsaturated fat is found in plant foods like olive oil, while saturated fats come mainly from animal foods.

The study "again demonstrates that all fats aren't created equal, and there are differences in metabolism and, from other studies, health outcomes," Dr. Dale Schoeller of the University of Wisconsin-Madison's Department of Nutritional Sciences, one of the study's authors, told Reuters Health. The findings are published in the latest issue of Medicine & Science in Sports & Exercise.

To investigate whether people might process fat from a meal differently after they had exercised, Schoeller and his colleagues conducted a study of seven healthy, moderately active women whose average age was 26. The women each underwent three different 2-day tests. In one, women stuck to scheduled sleep and meal times. In the second and third visits, the sleep and meal schedules were the same, but the women exercised lightly or heavily on a special stationary bike for 2 hours. They were also given a snack the night before to compensate for the calories used when they exercised the following day.

A half hour after they finished exercising or resting, at 10:30 AM, the women were given meals containing oleate, a monounsaturated fat, and palmitate, a saturated fat. Then the researchers collected breath samples hourly up until 10 PM to measure how the women's bodies were using the fat.

After the heavy exercise, the women oxidized, or burned, significantly more oleate than after light exercise or rest. And a light workout burned more oleate after a meal than resting did. But metabolism of the saturated fat was the same whether or not the women exercised.

When fat is burned, it doesn't have the chance to be stored in the body as excess fat tissue. Studies in animals, Schoeller noted, have shown that the body uses monounsaturated fats differently than saturated fats after semi-starvation or fasting. But this is the first research, he believes, that shows differences in post-exercise fat metabolism after a meal.

The findings offer "one more reason to stay away from saturated fats," he noted, which are more readily stored by the body as excess pounds. So people hoping to stay at a healthy weight, he adds, should substitute monounsaturated fats for saturated fats and, of course, exercise.

Source: Medicine & Science in Sports & Exercise 2002;34:1757-1765.

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Head Injuries 

HealthScoutNews
Thursday, November 28, 2002

(HealthScoutNews) -- Children's heads are frequently in the front line for injuries. Fortunately, most knocks to kids' heads result in scalp injuries and don't cause internal damage. Any heavy blow to the head may require immediate medical attention.

The American Academy of Pediatrics advises you to call 911 for any of these symptoms:

  • Loss of consciousness or drowsiness.
  • Persistent headache or vomiting.
  • Clumsiness or inability to move any body part.
  • Oozing of blood or watery fluid from ears or nose.
  • Seizures.
  • Abnormal speech or behavior.

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Zinc Supplement Overdose Can Have Toxic Effects

 

By Alan Mozes

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Prolonged consumption of large doses of over-the-counter mineral and vitamin supplements--such as the increasingly popular mineral zinc--can cause major health complications, California researchers warn.

The researchers highlight the case of a high school basketball player who suffered from extreme fatigue after taking large amounts of zinc on a daily basis to treat a chronic skin condition for more than a year and a half.

"In general, these supplements are safe if the doses that are written on the bottles are followed," noted Dr. Mark B. Salzman of Kaiser Permanente West Los Angeles Medical Center, the study's lead author. "(But) this was a 17-year-old teenager who felt that since the usual dose was not working, more is better."

In the current issue of the Journal of Pediatric Hematology/Oncology, Salzman and his colleagues report that the patient had initially been advised by a dermatologist to take zinc supplements as an acne treatment. However, when the teen saw no quick improvement in his skin he decided to up the dosage from 50 milligrams (mg) per day to 300 mg per day.

After repeatedly witnessing the teen tire easily when playing basketball, the patient's mother became concerned that he might have a heart condition and brought her son in for a series of medical evaluations.

The doctors discovered that the boy had an abnormally low red blood cell count, or anemia. An inadequate supply of red blood cells results in a drop in the delivery of oxygen throughout the body, leading to fatigue, weakness, dizziness and even heart attack or stroke in some cases.

In addition, the tests revealed that the teen suffered from neutropenia, a condition in which the amount of neutrophils in the blood is abnormally low. Neutrophils, a type of white blood cell, serve as the body's main cellular defense against infection and play a critical role in healing.

Two weeks after he stopped taking zinc, the teen's blood levels of the mineral remained two to three times greater than normal. Salzman and his team concluded that an overdose of zinc accounted for the blood complications. The patient was given no medication for treatment, and 4 months after he had stopped taking zinc he had almost fully recovered.

The researchers observed, however, that even after 6 months, the patient's zinc levels remained at slightly above normal levels, and note that zinc elimination is an extremely slow process. In more severe cases of elevated zinc levels, they note, a patient may be given copper supplements, since normal absorption of copper by the body can be blocked by excessive zinc consumption.

The authors caution that as the market in vitamin and mineral products is virtually unregulated, the toxic effects of overdosing may become increasingly common. They added that zinc, in particular, has grown recently in popularity as a remedy for the common cold. They urged doctors to be on the lookout for overuse of zinc or any other minerals when taking medical histories.

"This may be an isolated case, but I would think it happens regularly since so may people take supplements," Salzman told Reuters Health. "The public needs to know that over-the-counter medications and supplements can have serious adverse effects when larger than recommended doses are taken without the advice of a health professional."

Source: Journal of Pediatric Hematology/Oncology 2002;24:582-584.

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Study: 'Safer' Cigarettes May Be All Smoke

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews
Thursday, November 28, 2002

WEDNESDAY, Nov. 27 (HealthScoutNews) -- They're sold by big tobacco companies and go by names like Advance, Eclipse and Accord.

They're marketed as safer cigarettes that can lessen the risks of smoking by releasing fewer cancer-causing substances.

But two new studies show these so-called safer cigarettes may not be safer at all -- and may even lead to increased addiction.

In the first study, researchers invited 20 smokers in the lab and, over three days, had them puff on their own brand of cigarettes, then an Advance cigarette, now sold by Brown & Williamson Tobacco Corp., and also an unlit cigarette for comparison.

Advance cigarettes are marketed as a safer cigarette because they supposedly contain less of a type of cancer-causing substance called nitrosamines, said Thomas Eissenberg, an associate professor of psychology at Virginia Commonwealth University and lead author of both studies.

The Advance study, which did not look at nitrosamine levels, found the cigarette produced 11 percent less carbon monoxide. Carbon monoxide has been linked to cardiovascular disease in smokers, Eissenberg said.

But Advance also delivered 25 percent more nicotine into the blood than the smokers' own brands. Nicotine is the addictive substance in cigarettes.

"We don't know for sure if it causes increased dependence, but certainly many smokers would like to know if they're being exposed to more nicotine," Eissenberg said.

A spokesman for Brown & Williamson responded that the researchers had looked at an early version of Advance cigarette made by a different company.

"The nicotine levels they are reporting are not correct," spokesman Marc Smith said. "They are looking at a product that is not on the market today. The product being sold today has much lower nicotine levels ..." He did not say what the nicotine levels were.

The study appears in the December issue of the journal Tobacco Control.

In a second study, published in the December issue of Harm Reduction, Eissenberg and his colleagues conducted a similar experiment with Accord cigarettes, made by Philip Morris Co. Inc., and Eclipse, made by R.J. Reynolds Tobacco Co..

Both cigarettes heat rather than burn tobacco, presumably reducing carcinogen levels.

Researchers didn't look at carcinogen levels, but they did look at nicotine, carbon monoxide and the effects on smokers' heart rate.

On the plus side, they found Accord delivered significantly less nicotine and boosted smokers' heart rate and carbon monoxide levels less than traditional cigarettes.

But Accord didn't do as well as traditional cigarettes in suppressing cravings or reducing such withdrawal symptoms as anxiety, restlessness and irritability, they found.

If Accord fails to give smokers the same satisfaction they get from smoking their regular brand, they may simply smoke more, which would defeat the purpose of safer cigarettes, Eissenberg said.

Eclipse, on the other hand, increased heart rate and suppressed withdrawal symptoms about as well as conventional cigarettes. However, Eclipse delivered about 30 percent more carbon monoxide than regular cigarettes, Eissenberg said.

"Based on our evaluation, all three alternative cigarettes appear to reduce some toxins that are associated with smoking-related diseases," Eissenberg said. "But our testing also revealed that Eclipse and Advance may increase levels of dangerous substances produced by these cigarettes that smokers should be aware of."

A spokeswoman for R.J. Reynolds said the 30 percent increase in carbon monoxide (CO) cited in the study is not correct.

"The CO claim mentioned in the study is contrary to what we have found during our extensive investigations. Under FTC machine-smoking puffing conditions, the 'tar' and nicotine yields for Eclipse are in the range of ultra-low-'tar' cigarettes, while the CO yield is in the low-'tar' range," said Carole Crosslin.

The company's extensive studies, she added, "have found that, on average, there is about a 10 percent increase in COhB in smokers switching to Eclipse from their usual brand."

However, Patrick Reynolds, founder of the Foundation for a Smokefree America, called the research an important step in debunking claims of safe cigarettes.

"There is an array of tobacco products on the market all claiming to varying degrees to be safer," said Reynolds, the grandson of R.J. Reynolds and the son of a man who died of smoking-related disease. "It will be decades before we have the medical data and studies in about whether these products are substantially safer."

Even if a product delivers less carbon monoxide or carcinogens, he added, it is still unknown what amount causes an individual smoker to get cancer or heart disease.

"Whether the products are one percent safer or 15 percent safer, we really don't have any clue," Reynolds said. "The big danger is that many smokers may believes these products are far safer than they really are and will justify their continued smoking based on that."

What To Do

The Foundation for a Smokefree America and Action on Smoking and Health have information on kicking the habit.

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Treatment Clues for Blacks with Kidney Disease

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Bringing blood pressure below currently recommended levels appears to offer no additional benefit to African Americans with kidney disease, new study findings suggest.

But the study did find that one type of blood-pressure drug, an ACE inhibitor, was more effective than beta-blockers or calcium channel blockers for preventing additional decline in kidney function.

High blood pressure is a leading cause of kidney disease in African Americans, and research has shown that kidney function declines faster in African Americans with kidney disease compared to whites with the same blood pressure, Dr. Jackson T. Wright, Jr., of Case Western Reserve University in Cleveland, Ohio and colleagues note in the November 20th issue of The Journal of the American Medical Association (news - web sites).

While ACE inhibitors have been shown to slow the progression of kidney disease, the researchers point out, few African Americans have been included in this research.

Chronic high blood pressure is known to damage small blood vessels throughout the body and, over time, hampers blood flow, which can lead to kidney disease.

To investigate whether more aggressive treatment of high blood pressure could help slow kidney disease progression, and determine if some drugs were better than others in doing so, Wright and colleagues evaluated various treatment strategies in 1,094 African-American patients between the ages of 18 and 70. All had been diagnosed with high blood pressure-related kidney disease.

Participants were either assigned to lower their blood pressure to currently recommended levels or to even lower levels. In addition, patients received one of three different blood pressure-reducing medications: the ACE inhibitor ramipril, the beta-blocker metoprolol, or the calcium channel blocker amlodipine.

The researchers monitored the progression of kidney disease among all of the patients by measuring the rate at which their kidneys were able to filter blood. Patient progress was followed for between 3 and 6.4 years.

Lowering blood pressure even further than currently recommended levels had no additional benefit in terms of kidney disease progression, the researchers found. But patients treated with ramipril had a 22% and a 38% reduction in kidney disease complications compared to patients taking metoprolol and amlodipine, respectively, the investigators found.

"We conclude that although blood pressure reduction to levels below current guidelines for cardiovascular risk reduction are achievable, our results do not support additional reductions as a strategy to prevent progression of (hypertensive-related kidney disease)," the authors write.

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

Source: The Journal of the American Medical Association 2002;288:2421-2431.

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Wonder What's in Your Food Other Than Food?

HealthScoutNews
Thursday, November 28, 2002

WEDNESDAY, Nov. 27 (HealthScoutNews) -- Chemical preservatives are used to keep food fresh and slow the growth of bacteria, molds and yeasts.

But which preservatives do what, and how do they actually work? An article in the current issue of Chemical and Engineering News offers some answers.

Chemical preservatives fall under three general groups: antimicrobials that block the growth of bacteria, molds or yeasts; antioxidants that slow oxidation of fats and lipids that cause food to become rancid; and a third group that combats enzymes that cause ripening of fruits and vegetables after they're harvested.

Sulfites are a group of preservatives found in many foods, including vinegar, fruit juices and dried fruits. Sulfites block the growth of microbes by interrupting their normal cell function. Some people are allergic to sulfites.

Bakery products are kept fresh by antimicrobials called propionates, which occur naturally in apples, strawberries, grains and cheese. These propionates combat bread molds and the spores of bacterium that cause a condition called "rope," which makes bread inedible.

Benzoates, found naturally in cranberries, fight fungi.

Nitrates and nitrites preserve meat and counter deadly botulism bacteria. They give a fresh pink color to cured meat, which would turn brown without nitrates or nitrites.

Antioxidant preservatives halt the chemical breakdown of food caused by exposure to air. Unsaturated fatty acids in oils and lipids are particularly prone to oxidization, which can cause them to become rancid.

Ascorbic acid and citric acid attack enzymes that cause fruits and vegetables to over-ripen after they're picked.

More Information

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

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Migraines Don't Boost Kids' Learning-Problem Risk

By Natalie Engler

Reuters Health

Friday, November 29, 2002 

NEW YORK (Reuters Health) - German researchers have found, in a small study, that children with migraines process information just as well as their migraine-free siblings, suggesting that the recurring headaches do not put kids at risk for learning delays

The research adds to the debate over whether migraine headaches--characterized by throbbing pain, nausea and light- and noise-sensitivity--contribute to impaired mental function in adults.

Dr. Fritz Haverkamp of the Department of Pediatrics at the University of Bonn in Germany and his colleagues evaluated the mental performance of 37 children with migraines and compared it with that of 17 of their healthy siblings using a standardized intelligence test. The test, the Kaufman-Assessment Battery for Children (K-ABC), defines intelligence as a child's ability to arrange elements into a successive series and to integrate and synthesize information at the same time.

The researchers found that, on average, the two groups of children received similar scores and performed within the normal range for kids their age, which ranged between 6 and 12 years.

Their findings appear in a recent issue of the journal Headache.

"In short, the main message for parents of children with migraine or for their pediatricians should be that there is no principal risk for cognitive development," Haverkamp told Reuters Health in an interview.

He added that children whose migraines are accompanied by "transient cognitive disturbances," such as short-term amnesia, are also not at risk for learning problems.

Source: Headache 2002;42:776-779.

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Botox May Relieve Cluster Headaches

By Merritt McKinney

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Injections of Botox, the wrinkle-smoothing toxin, may provide relief to some people with cluster headaches that do not respond to conventional treatment, according to a Chicago headache specialist.

Seven out of 10 people with cluster headache experienced at least some relief after receiving Botox injections, Dr. Lawrence Robbins of the Robbins Headache Clinic in Northbrook, Illinois, and Rush Medical College in Chicago, Illinois reports in a recent issue of the American Journal of Pain Management.

Although Robbins points out that larger studies are needed to confirm the benefits of Botox for cluster headaches, he said that the treatment may be helpful for some patients.

"Botox is only occasionally useful for cluster headache, but, for those who obtain relief, it is very welcome," Robbins told Reuters Health. He noted that cluster headaches can be severe, and the patients in the study had not responded well to other sorts of treatments.

Cluster headaches--which are more common in men--cause sudden, severe pain, often centered in one eye. Though the headaches tend to be short, they run in cycles, which may cause several headaches in one day or every few days. Most people with cluster headaches experience pain-free periods of several weeks or more between each headache cycle. About 10% of sufferers, however, experience chronic cycles, which can last a year or more.

Several medications, including the blood-pressure drug verapamil, lithium and cortisone, are used to prevent cluster headaches, and other drugs, including ones used to treat normal migraine headaches, can relieve the pain once a cycle starts. Many people who experience cluster headaches do not get much relief from conventional therapies, though.

According to several reports, Botox, which is the brand name for a purified form of the botulinum toxin, has reportedly been useful in relieving migraine headache, so Robbins set out to test it in people with cluster headache who did not respond well to conventional treatment. The study included eight men and two women aged 28 to 63 who received at least one Botox injection in the face or temple.

Among the seven patients with chronic headaches, one experienced "dramatic" relief that lasted for 3 months, while another three experienced moderate relief, according to the report. The treatment had no effect in three patients. In the case of patients with episodic cluster headaches, relief was complete in one and moderate in another. In the third patient, relief was complete after the first round of injections, but a year later, after a second set of injections, symptoms improved only moderately.

In the report, Robbins notes that larger studies that include "control" groups of people who do not receive Botox are needed to confirm the benefits of the treatment.

In the meantime, he told Reuters Health that even though Botox did not help everyone in the study, it did significantly improve the quality of life of several patients. One drawback of Botox, however, is its high cost, Robbins said.

The Chicago physician said that Botox is safe, although he noted that the long-term safety of its use as a headache treatment has not been tested. So far, he said, "we have had very few side effects from Botox, so that the worst that happens is nothing at all." In the study, one patient experienced a droopy eyelid for 12 days, and another had a burning sensation in both eyes that cleared up after 6 days.

Source: American Journal of Pain Management 2002;12:136-139.

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Diabetes Cases Go Up After Measles Outbreak: Report

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - The city of Philadelphia experienced a jump in type 1 diabetes in children in 1993, roughly 2 years after a measles epidemic hit the area, according to a new report.

The link between measles and type 1 diabetes is not proven, although the researchers suggest that some children may have developed diabetes after coming down with the measles.

In an interview with Reuters Health, Dr. Terri H. Lipman, of the University of Pennsylvania in Philadelphia, said that it is "very important" to note that the study does not prove that the measles cases were to blame for the jump in diabetes cases. In some studies, measles have been shown to trigger an autoimmune reaction similar to what occurs in type 1 diabetes, but other studies have not shown this effect.

"Nothing has been proven," she said. "The evidence is not clear."

Type 1 diabetes is sometimes called juvenile diabetes because it usually strikes at a younger age than the more common type 2 diabetes. In type 1 diabetes, the immune system launches a misguided attack against insulin-producing cells and patients must take daily insulin injections.

Though diet and lifestyle play a major role in type 2 diabetes, which is on the rise, the factors that affect a person's chances of developing type 1 diabetes are less certain.

In a report in the November issue of the journal Diabetes Care, Lipman's team summarizes the new cases of type 1 diabetes that occurred in children in Philadelphia from 1990 to 1994. During that time, 209 Philadelphia children were diagnosed with type 1 diabetes.

The "most interesting finding," the researchers note, is a jump in type 1 diabetes cases that occurred in 1993. There were 32 new cases of type 1 diabetes reported between January and June in 1993, compared with 12 cases in the first 6 months of 1992, and 18 cases in that time period in 1991.

In a review of Philadelphia health records, the researchers discovered that the city experienced a measles outbreak in late 1990 through the first half of 1991.

Lipman and her colleagues point out that several factors have been associated with changes in the rate of new cases of type 1 diabetes, including viruses, vaccinations and infants' diets. But the authors note that determining exact causes is difficult. For example, it is hard to know how much time lags between exposure to a possible risk factor and development of diabetes.

"The important thing," according to Lipman, "is that we need to have very careful ways to look at diabetes incidence." The formation of more diabetes registries like the one in the study would go a long way in helping researchers understand the causes of diabetes, she said.

Lipman also said, "The public should know that the incidence of diabetes is definitely increasing in black children." That more and more African-American children are developing type 2 diabetes, the form of the disease that is often related to obesity, has been known, but this study provides additional evidence that there is also a rise in type 1 diabetes, Lipman said.

Source: Diabetes Care 2002;25:1969-1975.

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Mini-Strokes Shouldn't Be Thought Harmless: Study

By Charnicia E. Huggins

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Many health professionals and lay individuals alike incorrectly view transient ischemic attacks, or mini-strokes, as relatively harmless and less serious than strokes, a team of researchers assert in a new report.

But they recommend that the term transient ischemic attack (TIA) be redefined to make the public and medical community more aware of its serious implications.

"TIAs are underrecognized, underreported, and undertreated," Dr. David G. Sherman of the University of Texas Health Science Center in San Antonio and his colleagues write in the November 21st issue of The New England Journal of Medicine (news - web sites).

They are "perhaps the most important harbinger of stroke in the immediate future, and people do tend to ignore them," Sherman added in an interview with Reuters Health. "There's a sense of urgency that needs to be conveyed."

A TIA is a sudden loss of function or sensation "that lasts for less than 24 hours," according to its classic definition. Common symptoms of the condition include dizziness, loss of vision, difficulty speaking and paralysis of the face, arm or leg.

The 24-hour time frame included in the definition is the key factor that distinguishes TIAs from strokes; however, that time limit "is outdated, confusing, and potentially misleading," the researchers write. Most TIA symptoms last for only several minutes or one hour at most, the report indicates.

Further, this 24-hour criterion carries with it the assumption that if symptoms of brain damage disappear quickly--within one day--that damage is not permanent, the report indicates. Due to advances in various scientific techniques, however, scientists now know that TIAs may indeed lead to permanent brain injury in some patients, particularly those who experience longer-lasting attacks.

The problem is that, in the past, symptoms have not been taken seriously enough, according to Sherman.

For example, many stroke patients recall having previously experienced numbness or weakness that they ignored at the time because the symptoms did not seem to last long, he said. Yet it is during the first 24 to 48 hours after one's TIA symptoms have disappeared that patients are at greatest risk of suffering a stroke, he explained.

To communicate that risk to patients, Sherman and his team propose that the new definition describe TIA as "a brief episode...with clinical symptoms typically lasting less than one hour"--a more true-to-life time frame than the current 24-hour criterion. Their new definition also states that the TIA episode should be "without evidence of acute infarction," so as to easily distinguish it from stroke.

Overall, the researchers want patients to be aware that while a case of arm numbness first thing in the morning may be the result of their having slept on their arm the previous evening, it is "also possible that they had a TIA and may have a stroke in the next day or so," Sherman said.

Patients must also exercise "a little bit of individual judgment," he added. For example, if someone experiences symptoms that are strongly suggestive of TIA, they should go to an emergency room immediately, but if the symptoms are less alarming, they should check with their doctor first, he said.

Source: The New England Journal of Medicine 2002;347:1713-1716.

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Cholesterol Drugs May Slow Valve Disorder

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - A widely prescribed class of cholesterol-lowering drugs may slow the progression of a heart-valve disorder, according to the results of a new study.

If the findings are confirmed, the drugs, known as statins, could turn out to be the first drug treatment for the valve disorder, which is currently treated with surgery.

Aortic stenosis causes the valve to the aorta, which is the body's largest artery, to become narrower and narrower. Eventually, this stenosis can block the flow of blood from the heart to the aorta, leading to complications including heart failure. Surgery to insert a new valve can correct the condition, but treatment is controversial, with some physicians recommending a wait-and-see approach.

Some experts suspect that high cholesterol levels contribute to the progression of aortic stenosis just as they hasten the clogging of arteries, but research on the connection between cholesterol and aortic stenosis has been mixed.

In the new study, Dr. Maurice Enriquez-Sarano and colleagues at the Mayo Clinic in Rochester, Minnesota, looked at 156 people with aortic stenosis who were followed for roughly 4 years.

Although cholesterol was not linked to aortic stenosis, the valve condition progressed more slowly in people who were taking cholesterol-lowering statin medications.

The study does not prove that statins were the reason aortic stenosis progressed less rapidly, but Enriquez-Sarano and his colleagues conclude that the results justify a clinical trial of the treatment.

Though statins were designed to lower cholesterol, the researchers suspect that other effects of the drugs, possibly their anti-inflammatory actions, may account for the slowing of aortic stenosis. This study is not the first time that statins have been suspected of providing benefits besides reducing the risk of heart attack and stroke. The drugs are being studied for the treatment of other diseases, including Alzheimer's disease (news - web sites) and multiple sclerosis.

The study seems "to offer the promise that a safe and effective medical therapy for aortic stenosis is not just wishful thinking," Dr. Alan S. Pearlman, of the University of Washington School of Medicine in Seattle, writes in an editorial that accompanies the study.

Pearlman points out that studying the effect of statins on aortic stenosis will not be easy, given that many patients with the condition have other cardiovascular risk factors, such as high cholesterol and high blood pressure, that may make it difficult to assign them to a placebo rather than a statin. Despite this problem, such studies are necessary, according to Pearlman, because aortic stenosis "is too prevalent, and its consequences too important, to ignore."

Source: Journal of the American College of Cardiology 2002;40:1723-1730, 1731.

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Sparkling Water May Help Indigestion, Constipation

By Merritt McKinney

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Sparkling water may do more than tickle your tongue. A new report suggests that carbonated water may ease indigestion and constipation, although the study's authors are not sure whether the benefits stem from sparkling water's bubbles or the extra minerals it contains.

Carbonated water has been touted as a tummy tonic for centuries, but the effect of sparkling water on the gastrointestinal tract is not well studied.

In the new study, Dr. Rosario Cuomo of Federico II University in Naples, Italy and colleagues compared the effects of carbonated water and tap water in 21 people who suffered from constipation and a type of indigestion called dyspepsia. For about 2 weeks, participants in the study drank either tap water or carbonated water.

In comments to Reuters Health, Cuomo explained that the type of indigestion that affected the participants is very common, and is not caused by any specific disorder or disease. People with this type of indigestion, known as functional dyspepsia, often feel full sooner than they should.

At the end of the study period, symptoms of indigestion had significantly improved in the sparkling-water group, the authors report in the European Journal of Gastroenterology and Hepatology. Similarly, people who drank carbonated water were less constipated at the end of the study period. In contrast, indigestion and constipation did not change in people drinking tap water.

Exactly how carbonated water may improve constipation and indigestion is uncertain. It could be the bubbles, but the carbonated water in the study also contained more minerals than the tap water.

Participants who drank sparkling water tended to not feel full too soon. In addition, their gallbladders emptied more quickly than at the start of the study, which could have helped relieve indigestion. However, even though constipation improved, drinking carbonated water did not have a significant effect on how quickly waste moved through the colon.

"We can conclude that a correct intake of water with a moderate carbon dioxide content can improve some gastrointestinal functions and particularly the symptoms of patients with dyspepsia and constipation," Cuomo told Reuters Health. She cautioned, however, that "water intake must be associated with correct dietary habits that include many foods rich in fibers, such as fruits and vegetables."

She added, "In many cases, the resolution of the dyspeptic symptoms and constipation can be achieved only with the help of a physician, who should correctly evaluate the symptoms and prescribe the most suitable therapy."

The study was partially funded by Co.Ge.Di S.p.A. in Pisa, Italy, which produces mineral water.

Source: European Journal of Gastroenterology and Hepatology 2002;14:991-999.

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Acne Cream May Help Smooth Aging Skin

By Alison McCook

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - A cream commonly used to treat acne and psoriasis may also help people smooth out the wrinkles and sun damage that come with age, new study findings suggest.

Dr. Tania J. Phillips of Boston University School of Medicine in Massachusetts and her colleagues found that people who used tazarotene cream for 24 weeks experienced more reductions in their wrinkles and skin flaws stemming from sun damage than did people given an inactive cream. After 24 weeks, all participants began to use tazarotene once a day for an additional 28 weeks, and experienced further improvements in their skin appearance, which did not appear to taper off at the end of the period, the authors note.

"At the end of the year, patients were still continuing to improve," Phillips told Reuters Health.

However, Phillips cautioned that patients should never believe that a product will protect their skin more than good, sensible habits. "Avoiding sun and using sunscreen" are essential parts of keeping skin healthy, she said.

Some of the researchers who participated in this study are employees of Allergan, the company that makes tazarotene. Allergan also funded this investigation.

Tazarotene is a type of retinoid, a derivative of vitamin A, that appears to promote the growth of collagen in the skin, helping to smooth out skin damage. Many other retinoids are currently available, Phillips said--some even over the counter. Tazarotene is currently available from doctors to treat acne and psoriasis, she added.

Phillips added that the side effects people often experience from tazarotene include redness, dry skin or peeling in places where they have applied the cream. However, she noted, these symptoms often disappear once the skin becomes used to the product.

During the study, Phillips and her team assigned 563 patients to receive either tazarotene or an inactive cream during the first 24 weeks of the study. None of the patients knew which product they had received during this initial period. Then all patients were given tazarotene to use for the rest of the year.

Dr. John Voorhees of the University of Michigan Medical School in Ann Arbor, who reviewed the research for Reuters Health, said that he does not usually use tazarotene to help repair aging skin. However, based on his experience with other retinoids, he said he would have been surprised to see that the drug did not work.

"Based on everything I know, if (the report) had said it didn't work, I wouldn't believe that," he told Reuters Health.

He added that he believed that patients who use the drug continue to improve over time, but noted that, in his experience, patients who use retinoids tend to experience a plateau in their improvements after approximately 9 months. "There comes a point when people don't get much better," he said.

At that point, once people no longer appear to be improving, Voorhees explained that they often have to use the cream again a few times each week, in order to maintain their previous progress.

Source: Archives of Dermatology (news - web sites) 2002;138:1486-1493.

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Pregnancy Safe for Some Women with Heart Disorder

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Pregnancy may not be as risky as once thought for women with a rare inherited disorder in which the heart cannot pump blood properly, researchers report.

About 1% of women with the disease, known as hypertrophic cardiomyopathy (HCM), die during pregnancy, and these women have more severe forms of the condition, the investigators found. While the risk of death is still higher than that of healthy women, it is lower than previous studies have suggested.

These reports included mostly women with a severe form of the disease. But In recent years, advancements in medical technology and genetic screening have led more women to be diagnosed with the disorder. Many of these women have no symptoms and may have remained undiagnosed in the past, the researchers explain in the November 20th issue of the Journal of the American College of Cardiology.

"Pregnancy is safe for most patients with HCM," according to Dr. Camillo Autore from Universita La Sapienza in Rome, Italy, and colleagues. "Therefore, in the overall HCM population, many young women who have a low-risk clinical profile should be reassured about pregnancy."

HCM is caused by a genetic mutation that causes the heart muscles to thicken, eventually limiting the organ's ability to pump blood and putting patients at risk of heart failure or sudden death from cardiac arrest.

In the study, the researchers tracked nearly 200 women who had either been diagnosed with HCM, or who had a close relative attending a heart clinic in Italy.

Over the 16-year study, two women died during pregnancy or within a few days of delivering. Both women were at high risk and "strongly advised against becoming pregnant," according to the report.

Although the findings may reassure women with HCM, the study shows that patients remain at risk of worsening cardiac symptoms, such as shortness of breath and fatigue, Autore's team found.

Patients were also more likely to deliver by cesarean section, although this finding may reflect caution among physicians, the researchers suggest.

Source: Journal of the American College of Cardiology 2002;40:1864-1869.

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Few U.S. Women Stay Highly Active as They Age: Study

By Amy Norton

Reuters Health

Friday, November 29, 2002

NEW YORK (Reuters Health) - Many US women are failing to get regular, vigorous exercise, and the numbers only get worse with age, according to new study findings.

Data from the large, national study show that few women stick with activities like jogging and aerobics throughout their lives, and the steepest drop-off in such vigorous types of exercise kicks in after age 50. The pattern appears consistent across racial and ethnic groups, researchers report in the November 15th issue of the American Journal of Epidemiology.

Dr. Kelly R. Evenson of the University of North Carolina-Chapel Hill and her colleagues analyzed data on nearly 72,000 women ages 55 to 79 participating in the US Women's Health Initiative, a national study begun in 1992.

The women were asked how often they engaged in vigorous activities like jogging, swimming laps and aerobics each week. They also reported whether they got regular, vigorous exercise at ages 18, 35 and 50.

The researchers found that few of the women currently exercised vigorously three or more times a week--ranging from just over 13% of black women to about 16% of Asian/Pacific Islander women. And, for all races and ethnicities, the percentage of women who fit this exercise group declined with age--with the steepest fall coming after age 50.

What's more, the researchers report, very few women got regular, vigorous exercise throughout their lives. Between 3% and 7%, depending on race, reported such activity levels for all four ages studied.

In general, health experts advise adults to get at least 30 minutes of moderate exercise on most, and preferably all, days of the week. The current study did not look at how much moderate activity women were getting, Evenson noted--in part because the researchers were asking women to remember their exercise levels from years ago, and vigorous activity may be "better recalled."

Exactly why vigorous activity declined with age is not clear, according to Evenson and her colleagues. Women who said they were in "excellent" health were more likely to be highly active in their 50s and beyond, but still only about one quarter reported regular, vigorous exercise. Women who were average-weight, of higher income and education, and didn't smoke were also more likely to report such high activity levels.

Because the biggest drop-off in vigorous activity occurred after age 50, Evenson told Reuters Health, this point in life "may be a critical time to target and tailor interventions" that encourage women to stay active.

Source: American Journal of Epidemiology 2002;156:945-953.

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WEDNESDAY, NOVEMBER 27, 2002 

Invasive Cervical Cancer Strikes Hispanics Hardest

 

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews

Wednesday, November 27, 2002

WEDNESDAY, Nov. 27 (HealthScoutNews) -- Hispanic women are almost twice as likely as whites to be diagnosed with aggressive cervical cancer, a statistic that health experts say underscores the need for better screening programs and earlier detection efforts among minorities.

A new report looking at rates of cervical cancer in the United States between 1992 and 1999 found that the disease is becoming less common in all women. But Hispanics were twice as likely as other women to be diagnosed with the potentially deadly disease at any age. Overall, there were 16.9 cases per 100,000 Hispanic women, compared with 8.9 per 100,000 among other women, during the seven-year period.

"The problem is that they are not getting screened as [often as] the other women," said Dr. Sidibe Kassim, an epidemiologist at the Centers for Disease Control and Prevention (news - web sites) and a co-author of the report appearing in this week's Morbidity and Mortality Weekly Report. Kassim said the CDC needs to develop "culturally appropriate" messages promoting screening -- including the Pap test -- for Hispanics.

The CDC estimates that 13,000 women will be diagnosed with cervical cancer this year, and 4,100 will die from the disease. When screening tests catch cervical tumors early, the five-year survival rate is better than 90 percent. But only 15 percent of women in whom the cancer has already spread when detected will live that long, Kassim said.

Cervical cancer can be caused by infection with human papillomavirus, which also leads to genital warts. Earlier this month, scientists announced that a vaccine against the HPV-16 strain of the virus, microbes implicated in about half of all cervical cancer cases, blocked 100 percent of infections in women who received it.

The U.S. Preventive Services Task Force recommends Pap screening every three years for women once they become sexually active.

Jane Delgado, a psychologist and president of the National Alliance for Hispanic Health, called the latest findings "old news," and said the public health community hasn't done enough to rectify the disparity.

Although the Pap test itself is cheap, if it is combined with a visit to the doctor, the price tag can top $40, Delgado said, and that's too steep for many women with low incomes and no health insurance. Hispanics make up 35 to 40 percent of the nation's uninsured, according to Delgado.

Theresa Byrd, a health behavior specialist at the University of Texas-Houston School of Public Health's El Paso campus, said that in addition to insurance coverage, there are cultural issues that help explain why Hispanic women are less likely than whites to be screened for cervical cancer.

Byrd has been working on ways to improve screening rates in Hispanics living along the U.S. border with Mexico, a country in which cervical tumors kill more women than any other cancer.

"What we found is that there's a lot of feelings of embarrassment about the exam itself and, in older women, some sense that their partners don't want them to have the exam," she said.

Many Mexican women also feel having a Pap test is a sign that they're sexually active, an image they don't want to broadcast, she added. "I'm not sure that's completely different from other cultures, but it's more pronounced in Mexican culture," she said.

Byrd and her colleagues have devised an array of materials, from printed brochures to Spanish-language videos, to overcome the resistance to Pap testing. They recently launched their campaign in the El Paso, Texas, area and are hoping to know soon if it works.

What To Do

For more on cervical cancer, try the CDC or the National Cancer Institute.

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Walking Problems Signal Future Dementia Risk

 

By Alison McCook

Reuters Health

Wednesday, November 27, 2002

NEW YORK (Reuters Health) - Elderly patients who have certain problems with walking appear to be many times more likely than those without those problems to later develop a deterioration in mental functioning, known as dementia, according to a study released Wednesday.

The type of dementia most linked to early walking problems is vascular dementia, in which the blood vessels leading to the brain become gradually less and less able to supply it with the blood it needs.

However, lead author Dr. Joe Verghese of the Albert Einstein College of Medicine in the Bronx, New York, cautioned that many elderly people develop walking troubles as they age, and not all gait problems mean they have an increased risk of dementia.

That said, Verghese noted that particular walking difficulties--such as shorter steps, weakness on one side of the body, or unsteady walking--can be a sign that the brain is not getting enough blood. If left unchecked, the patient could eventually develop vascular dementia, the researcher noted.

Ideally, these walking abnormalities--often subtle enough to be detectable only during a clinical exam--may be used to predict who is most at risk of dementia, enabling doctors to help them reduce certain modifiable risk factors before it is too late, Verghese said.

"Now you can use this to develop a kind of strategy to predict who develops vascular dementia," he said.

Verghese and his team report their findings in the November 28th issue of The New England Journal of Medicine (news - web sites).

During the study, the researchers analyzed the gaits of 422 patients older than 75 who were dementia-free. The investigators then followed the people over time, and noted who developed different types of dementia.

At the outset of the study, Verghese and his team noted that 85 people had walking difficulties that likely stemmed from neurologic problems. Over time, they found that 125 people developed dementia, and those who showed gait problems at the outset of the study appeared to be twice as likely as others to eventually show signs of the condition.

The relationship between walking difficulties and later dementia risk appeared strongest between certain gait problems and vascular dementia, Verghese's team discovered. People who originally appeared to have an unsteady gait were twice as likely as others to develop the dementia, while those who took short steps and showed other movement problems linked to problems in the front part of the brain had a more than fourfold higher risk than others.

In addition, patients who showed weakness in one side of the body while walking, such as after stroke, appeared to have a 13-fold higher risk of developing vascular dementia, the report indicates.

In order to detect early walking problems that could herald an increased dementia risk, Verghese recommended that doctors regularly check how well their elderly patients are getting around. This will not only help estimate their future risk of dementia, he said, but will also enable doctors to determine if they are at risk of falls or need a walker.

If the doctor detects any gait abnormalities that resemble the problems linked to dementia, Verghese suggested that both doctor and patient work to reduce modifiable risk factors for dementia, to halt the process before it continues. Helpful risk-reducing steps include lowering cholesterol and blood pressure, and encouraging the patient to become more active or regulate blood sugar if diabetic, and perhaps to visit the doctor more frequently.

Source: The New England Journal of Medicine 2002;347:1761-1768.

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Device to Shrink Uterine Fibroids

HealthScoutNews
Wednesday, November 27, 2002

WEDNESDAY, Nov. 27 (HealthScoutNews) -- The U.S. Food and Drug Administration (news - web sites) has approved a medical device to shrink non-cancerous uterine fibroid tumors, sparing women from painful surgery to remove them.

The device, meant for women who no longer intend to become pregnant, could also save many from having to have hysterectomies, where the entire uterus is removed.

Made from a material called Embosphere Microspheres, the product is used in less invasive surgeries that involve uterine artery embolization (UAE), designed to block blood flow to the tumors and shrink them.

In clinical trials sponsored by the maker of the device, Biosphere Medical Inc., 132 women with uterine fibroids were treated at seven hospitals throughout the United States. After six months, 65 percent of women implanted had a 50 percent or more reduction in bleeding attributed to the fibroids.

As a condition of approval, the company is required to follow study participants for at least three more years to gauge the long-term effects of the treatment, including whether the fibroids tend to return, the FDA says.

Here is the FDA Talk Paper describing the device. For more information about uterine fibroids, visit the National Institute of Child Health and Human Development.

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More U.S. Men Reporting Sex with Men Than Before

By Alison McCook

Reuters Health

Wednesday, November 27, 2002

NEW YORK (Reuters Health) - A recent nationwide survey shows that a larger proportion of men say they are having sex with other men than in the 1980s, although whether that trend stems from an increase in same-sex activity or an increased willingness to report it remains unclear.

Dr. John E. Anderson of the Centers for Disease Control and Prevention (news - web sites) in Atlanta and his co-author found that surveys collected since 1996 showed between 3.1% and 3.7% of men reported having sex with another man during the past year. This is a sizeable jump from 1988 estimates of between 1.7% and 2%, they note.

However, along with this increase in reported activity, Anderson noted that attitudes about the acceptability of same-sex activity have also changed. In fact, he and his colleague Ron Stall found that, between 1996 and 2000, up to 34% of survey respondents said they believed homosexuality was generally not wrong, while only 24% of people who completed the survey between 1988 and 1994 had similar attitudes toward same-sex activity.

As such, society is still far from being 100% accepting of homosexuality, Anderson noted, so even the current estimates of how many men have sex with men are likely too low.

"Male-to-male sex is still a sensitive, stigmatized behavior, and...is likely to be underreported to some unknown degree. Even though these recent estimates are somewhat higher than other surveys, they probably are still low," he said.

The results from the current study, published in the November issue of Sexually Transmitted Diseases, stem from a series of surveys conducted between 1988 and 2000. Each survey included information from between 500 and 1,200 adult men about their previous sexual experiences. The surveys asked about same-sex activity over the past year and all during adulthood.

In an interview with Reuters Health, Anderson explained that it is important to search for accurate estimates of how many men have sex with men, because they tend to have a higher risk of HIV (news - web sites) and other sexually transmitted infections than other groups. "Public prevention programs have provided services to this group, and need information for evaluation and program planning," he noted.

An essential factor in gaining accurate estimates of homosexual activity is privacy, the researcher added. The current survey was confidential, Anderson noted, and each respondent reported his sexual activity privately via a paper and pencil questionnaire.

Other methods could involve asking respondents to enter information about their sexual histories into a computer, without an interviewer present, Anderson said.

Source: Sexually Transmitted Diseases 2002;29:643-646.

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Asthma Medication May Backfire

HealthScoutNews
Wednesday, November 27, 2002

WEDNESDAY, Nov. 27 (HealthScoutNews) -- People, especially children, who take high doses of the inhaled corticosteroid fluticasone for asthma may suffer acute adrenal gland problems that can result in convulsions and coma, says a study in the current issue of Archives of Disease in Childhood journal.

The findings are based on 709 questionnaires of pediatricians and endocrinologists in the United Kingdom. It found that 28 children and five adults suffered adrenal crisis associated with the use of inhaled steroids to treat their asthma.

The study found that 23 of the children, between the ages of 3 and 10, developed a sudden sharp drop in blood sugar, resulting in decreased levels of consciousness, or coma, and/or convulsions. One child with coma and convulsions died, five children and four adults became lethargic, dizzy and/or nauseous, and one adult had convulsions.

All the patients who suffered adrenal crisis had been prescribed between 500 and 2,000 mg/day of the inhaled corticosteroid fluticasone, which goes by the brand names Flixotide or Seretide.

Current guidelines for fluticasone recommend a maximum 1,000 mg/day dose to treat severe asthma in children aged five and older. But the drug is only licensed for doses of up to 400mg/day when prescribed for children.

The adrenal glands are located on top of the kidneys and produce hormones that help regulate heart rate, blood pressure, food utilization, and other important body functions.

The study authors write that it's dangerous to suddenly stop using fluticasone and say there's no evidence that the dose recommended by the manufacturers is harmful. They conclude that dose shouldn't be exceeded, unless an asthma expert is supervising treatment.

More Information

Here's where you can learn more about the adrenal gland.

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Twice-Infected HIV Patient Offers Vaccine Lesson

By Linda Carroll

Reuters Health

Wednesday, November 27, 2002

NEW YORK (Reuters Health) - An HIV (news - web sites) patient who became infected a second time may offer a cautionary tale to researchers who hope a specific type of immune response is the secret to vaccine success.

In addition, the findings also serve to remind patients that safe sex is crucial, even if their partner is also infected with HIV, according to Dr. Bruce D. Walker, director of the Division of AIDS (news - web sites) at the Massachusetts General Hospital and the Harvard Medical School (news - web sites), both in Boston.

"What we take from this is a strong recommendation to consenting partners who are both HIV infected to practice safe sex," he said in an interview with Reuters Health. "This is especially true as more drug-resistant strains of HIV present in the US."

According to Wednesday's report in the journal Nature, the HIV-infected patient was able to mount a strong immune response to the virus after receiving antiretroviral therapy in a "stop-start" protocol shortly after he was infected with the disease.

Still, the patient became infected with a closely related form of the virus after an episode of unprotected sex, the researchers reported. This "superinfection" was a surprise to the researchers who expected that a strong immune response to one strain of the virus might protect against closely related strains.

The research may point to problems for scientists trying to develop a vaccine, since an immune response to one strain of the virus may not confer protection against other strains, Walker said.

The patient in the study had been treated in a protocol designed to help the immune system develop defenses against the virus.

In this so-called stop-start therapy, patients who have recently become infected are treated with antiretroviral drugs until the virus is knocked back significantly. Then the patient is taken off the drugs and observed, with the hope that the immune system will learn to combat the disease on its own. When, and if, the virus appears to be resurging, the patient is again given drugs to combat it. When the virus is knocked back again, the patient stops taking the drugs.

The basic idea is that the drug therapy protects the patient's infection-fighting CD4 cells-which are destroyed by HIV--while the body figures out how to combat the virus with a second type of infection-fighting cell, called CD8 cells.

CD4 cells are the "generals" of the immune system's army, Walker explained, while CD8 cells might be thought of as "foot soldiers."

"In the earliest stages of HIV infection, people try to mount an immune response," Walker said. "To do that, the immune system tries to get a lot of general and infantry mobilized against HIV. The problem is, HIV selectively kills off the generals as they are being mobilized. So you're typically left with infantry (CD8 cells) that don't really know what to do."

An earlier study by Walker and his colleagues showed that by treating HIV when a patient is first infected, doctors could protect the immune system's "generals," the CD4 cells. In a study in 2000, the researchers showed that stop-start therapy allowed patients' immune systems to eventually get the virus under control on their own.

"The interruptions in treatment were done because we thought there might not be enough immunity developing," Walker said. "But if you gave patients a sort of booster dose in the form of exposure to their own virus they might have a better immune response. It's like an auto-vaccination."

In the new report, Walker and his colleagues note that the patient seemed to have gotten the virus under control during stop-start therapy, and he had a strong CD8 response to HIV. But then the patient started getting sick again. When they took a closer look at the virus particles in his blood, the researchers discovered that he was infected with two closely related strains of the type of HIV common in North America.

When the researchers checked the man's medical records they discovered that he had had unprotected sex and had shown the signs of a new infection with the virus--fever, night sweats and swollen lymph glands--a month before the new version of the virus was detected.

AIDS researchers Andrew J. McMichael and Sarah L. Rowland-Jones of the John Radcliffe Hospital, Oxford, UK, who wrote an accompanying News and Views article, agree with Walker that the study highlights the importance of safe sex.

"The results....suggest that superinfection with a second HIV strain during a period off therapy could significantly undermine viral control, so patient commitment to safe sex practices will be an important adjunct to (stop-start therapy)," they wrote. "It is not clear whether superinfection is only a risk during treatment interruption."

The British researchers suggested that more studies be done to determine whether patients were at risk whether or not they were actively taking antiretroviral therapy.

Still, McMichael and Rowland-Jones conclude, "Although causing a brief pause for thought, nothing here should slow or divert efforts to develop an HIV vaccine."

It's possible that a CD8 stimulating vaccine, if given to healthy people, might still protect against the virus, the editorialists say.

Source: Nature 2002;420:371-372, 434-439.

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Wonder What's in Your Food Other Than Food?

HealthScoutNews
Wednesday, November 27, 2002

WEDNESDAY, Nov. 27 (HealthScoutNews) -- Chemical preservatives are used to keep food fresh and slow the growth of bacteria, molds and yeasts.

But which preservatives do what, and how do they actually work? An article in the current issue of Chemical and Engineering News offers some answers.

Chemical preservatives fall under three general groups: antimicrobials that block the growth of bacteria, molds or yeasts; antioxidants that slow oxidation of fats and lipids that cause food to become rancid; and a third group that combats enzymes that cause ripening of fruits and vegetables after they're harvested.

Sulfites are a group of preservatives found in many foods, including vinegar, fruit juices and dried fruits. Sulfites block the growth of microbes by interrupting their normal cell function. Some people are allergic to sulfites.

Bakery products are kept fresh by antimicrobials called propionates, which occur naturally in apples, strawberries, grains and cheese. These propionates combat bread molds and the spores of bacterium that cause a condition called "rope," which makes bread inedible.

Benzoates, found naturally in cranberries, fight fungi.

Nitrates and nitrites preserve meat and counter deadly botulism bacteria. They give a fresh pink color to cured meat, which would turn brown without nitrates or nitrites.

Antioxidant preservatives halt the chemical breakdown of food caused by exposure to air. Unsaturated fatty acids in oils and lipids are particularly prone to oxidization, which can cause them to become rancid.

Ascorbic acid and citric acid attack enzymes that cause fruits and vegetables to over-ripen after they're picked.

More Information

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

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Full Face Transplants No Longer Science Fiction

By Ben Harding

Reuters

Wednesday, November 27, 2002

LONDON (Reuters) - Full-face transplants are no longer science fiction fantasy, a leading surgeon said on Wednesday. They are technically feasible but ethically complex.

Peter Butler from London's Royal Free Hospital called for a debate on the ethics of such an operation made possible by new drugs that stop the body's immune system from rejecting a transplanted face.

"It is not 'can we do it?' but 'should we do it?"' Butler told the BBC.

"The technical part is not complex but I don't think that's going to be the very great difficulty ... The ethical and moral debate is obviously going to have to take place before the first facial transplantation."

The British Association of Plastic Surgeons holds its winter meeting Wednesday and will discuss the microsurgical procedure, which could give new skin, bone, nose, chin, lips and ears from deceased donors to patients disfigured by accidents, burns or cancer.

But surgeons could have trouble finding enough willing donors. Butler said his survey of doctors, nurses and members of the public showed most would accept a face transplant but few were willing to donate their own after dying.

Butler said one of the possible techniques would see a "skin envelope" of fat, skin and blood vessels transplanted onto existing bone, leaving patients with many of their own features.

But in an echo of the sci-fi thriller "Face Off," another more complex procedure would transplant underlying bone as well, so the patient would end up resembling the donor.

In the Hollywood blockbuster, Nicolas Cage plays a master criminal who swaps faces with his nemesis, John Travolta, using laser technology.

Despite a number of ethical concerns, Christine Piff, who founded the charity Let's Face It after suffering a rare facial cancer 25 years ago, welcomed the possibility of face transplants.

She rejected the idea that the procedure would mean people would end up living with a dead person's face.

"There are so many people without faces, I have half a face ... but we are all so much more than just a face ... you don't take on their personality. You are still you," she told Reuters.

"If we can donate other organs of the body then why not the face. I can't see anything wrong with it."

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Fever Relief

HealthScoutNews
Wednesday, November 27, 2002

(HealthScoutNews) -- When children are achy and fussy with fevers, besides giving them an over-the-counter medicine, there are other ways you can help them feel better.

The American Academy of Family Physicians (news - web sites) offers these tips:

  • Give your child plenty to drink to prevent dehydration and help the body cool itself.
  • Keep the room temperature at about 70 to 74 degrees.
  • Dress your child in light cotton pajamas so that body heat can escape.
  • If your child is chilled, add an extra blanket but remove it when the chill stops.

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Exercise Cuts Inflammation-Related Protein in Blood

By Alison McCook

Reuters Health

Wednesday, November 27, 2002

NEW YORK (Reuters Health) - Exercise is good for you for a number of reasons, and now researchers think they have found yet one more. Men who are physically fit tend to have lower levels of a protein linked to body-wide inflammation, new research reports.

People with high levels of this protein, known as C-reactive protein (CRP), appear to have a higher than average risk of cardiovascular disease. Indeed, a recent study suggested that testing for CRP could be an even better predictor of heart attack than high cholesterol.

The findings of the new study could help explain why exercise is so beneficial, said study author Dr. Timothy S. Church of The Cooper Institute in Dallas, Texas.

"We know exercise is good for you," Church told Reuters Health. Reducing CRP levels in the body "is one of the potential mechanisms" as to why exercise helps reduce a person's risk of heart disease and a host of other cardiovascular problems, he added.

During the study, Church and his colleagues measured fitness and CRP levels in 722 men. To determine how fit each man was, the researchers asked him to walk on a treadmill of increasing incline for as long as he could. They reasoned that the more fit a man is, the longer he could stay on the treadmill.

The investigators found that men who were the fittest also tended to have the lowest levels of CRP in their bodies, while those deemed the least fit were more likely to show the highest levels of CRP. The relationship between CRP levels and exercise remained even after the researchers eliminated other factors, such as age and obesity.

Specifically, the authors discovered that people who were in the second-to-lowest category of fitness were 57% less likely to have elevated CRP levels, relative to those who were the least fit of the group. The risk of elevated CRP decreased incrementally with increasing fitness, with those who were the most fit appearing to be 83% less likely to have high CRPs than the least fit men.

Church and his team report their findings in the November issue of Arteriosclerosis, Thrombosis, and Vascular Biology, a journal of the American Heart Association (news - web sites).

In an interview with Reuters Health, Church explained that, in women, the relationship between CRP and physical activity is likely similar, but somewhat more complicated. "I think the results will be the same," he said, but might appear less clear because of the dramatic hormonal changes women experience during menopause. For instance, he said, menopause can increase levels of CRP in a woman's body, and hormone replacement therapy can boost CRP even further.

"The main benefit is just getting out of that lowest fitness group," Church added, meaning that the biggest drop in risk of elevated CRP levels in the body occurs between the people who are the least fit, and those who are only moderately more in shape. To graduate to the next-highest level of fitness, the researcher recommended moderate physical activity for 30 minutes each day--even accumulated in bits and pieces, and not all at once--for 5 days a week. And one easy way to get that exercise: walking, he said.

"It's free, you can do it anywhere, you don't need any special equipment," he said.

"Just accumulate those steps throughout the day," Church advised.

Source: Arteriosclerosis, Thrombosis, and Vascular Biology 2002;22:1869-1876.

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Holiday Bites

HealthScoutNews
Wednesday, November 27, 2002

(HealthScoutNews) -- Packing on the pounds during the upcoming festive season is one holiday tradition most of us would happily forego. It is possible, but the secret is to be flexible and sensible.

The Medical College of Wisconsin offers these tips:

  • Be realistic -- strive to maintain, not to lose weight -- during the holidays.
  • Balance what you eat at parties with your other meals. Don't skip meals to save calories -- that leads to overeating.
  • Don't deprive yourself of your holiday favorites. Rather, skip the foods that you usually eat, or balance your favorites with low-calorie foods, such as vegetables with low-fat dip or boiled shrimp.
  • Watch your portion sizes, especially with buffets.

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Evidence Conflicts on Mercury, Heart Disease Link

Reuters Health

Wednesday, November 27, 2002

NEW YORK (Reuters Health) - Will consuming mercury-contaminated fish increase a man's risk for heart disease? Maybe yes and maybe no, according to two new studies with essentially opposite findings published in Thursday's issue of The New England Journal of Medicine (news - web sites).

While experts know that exposure to high levels of mercury can cause neurologic and kidney damage, little is known about the long-term consequences of low levels of exposure.

Previously, Finnish researchers reported a link between heart disease and increased levels of mercury in men whose mercury levels were measured from hair samples. The authors of one of the current studies note that the men were likely exposed to mercury by eating locally contaminated fresh water fish.

While consumption of fish rich in heart healthy omega-3 fatty acids is believed to cut heart disease risks, the researchers, led by Dr. Eliseo Guallar of Johns Hopkins Medical Institutions in Baltimore, Maryland, questioned whether the mercury often contained in fish might offset such benefits or increase the risk of heart disease.

To investigate, Guallar and colleagues measured levels of DHA, a type of omega-3 fatty acid, in fat tissue and mercury levels from toenail clippings in 684 men who previously suffered a heart attack. Their results were compared to a similar group of 724 men with no history of heart disease ("controls").

Mercury levels in the men who had a heart attack were "15% higher than those in controls," Guallar and colleagues write. And those with the highest levels of mercury were more than twice as likely to have had a heart attack than the men with the lowest mercury levels, the authors add.

In addition, the researchers found that after adjusting for mercury levels, high DHA levels were "inversely associated" with heart attack risk. In other words, higher levels of DHA appeared to lower a man's risk of having had a heart attack and vice versa.

Guallar's team points out that the US Food and Drug Administration (news - web sites) currently advises pregnant women and women who may become pregnant to steer clear of fish known to have higher levels of mercury, including tilefish, shark, swordfish and mackerel. In light of the new findings, they suggest that perhaps such advice should be "extended to the general adult population."

"However, our findings do not imply that people should stop eating fish," Guallar and colleagues write. "Our mercury-adjusted analysis is consistent with a protective effect of dietary fish, provided it is not heavily contaminated."

In the second study, Dr. Kazuko Yoshizawa of the Harvard School of Public Health in Boston, Massachusetts, and colleagues found no association between mercury levels and heart disease.

The researchers measured levels of mercury in toenail clippings from 33,737 male health professionals between the ages of 40 and 75. After 5 years follow-up, 470 cases of heart disease were diagnosed among the group.

While mercury levels were significantly correlated with fish consumption and dentists showed the highest mercury levels, there was no correlation between the amount of mercury in toenails and heart disease risk.

"Our findings do not support an association between total mercury exposure and the risk of coronary heart disease, but a weak relation cannot be ruled out," Yoshizawa and colleagues conclude.

The opposing findings of the two studies underscore the controversy of whether or not mercury, especially from eating fish, endangers the heart, note Drs. P. Michael Bolger and B. A. Schwetz of the US Food and Drug Administration in College Park, Maryland.

"The notion that methylmercury contributes to cardiovascular disease is certainly a testable hypothesis and one that warrants further testing," they write.

But evidence for such a link from large, well-designed studies of populations who rely on fish as a staple food would be needed to justify changes in dietary recommendations, Bolger and Schwetz conclude.

Source: The New England Journal of Medicine 2002;347:1735-1736, 1747-1754, 1755-1760.

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Chores Can Give You a Good Workout

By Lisa Girard
HealthScoutNews Reporter

HealthScoutNews
Wednesday, November 27, 2002

WEDNESDAY, Nov. 27 (HealthScoutNews) -- If you're one of the many Americans who has trouble finding the time to work out, salvation may be as close as the broom in your closet.

According to the American Academy of Physical Medicine and Rehabilitation, ordinary household chores can be turned into stretching, toning and strengthening exercises. Called "functional fitness," these exercises can increase flexibility, strengthen muscles and minimize injuries and back problems. And they're more practical than lifting weights or using gym equipment, the academy says.

"What we try to do is make the exercise program simulate what a person actually does in his life, in order to make it functional," says Dr. Joel Press, a physiatrist at the Center for Spine, Sports & Occupational Rehabilitation of Chicago. "We create exercises that look like your daily activities."

Press designed the program, and the activities can be as simple as balancing on one leg while you brush your teeth or sweeping the kitchen floor with deliberate strokes. Here are some examples of the recommended exercises:

         Laundry Toss: Stand about 10 to 15 feet away from the washing machine with the laundry basket about waist high on your left side and the washing machine on your right. Pick up pieces of the dirty laundry and, while turning at the hips, pitch the laundry into the open washer. This exercise can strengthen abdominal, lower back and hip muscles.

  • Unload and Lift: As you remove dishes from the dishwasher, turn your body from side to side so your torso twists while you reach to put the clean dishes away. Press recommends putting away one dish or piece of silverware at a time for maximum stretching.
  • Rake and Twist: Whether you're raking leaves or sweeping, take long, steady strokes, turning at your hips as you rake or sweep toward your body. Make sure you do this exercise sweeping both from left to right and from right to left.
  • Standing Side Stretch: Grab the nearest weighty object, whether it be a carton of milk or a briefcase, and hold it in one hand while standing up straight with your feet slightly more than a shoulder's width apart. Then slowly bend at the waist straight to the side, lowering the hand with the weighted object down your side as far as it will go and holding it for a count of 15 or 20. Repeat on the other side.

Physiatrists are medical doctors who specialize in diagnosing and treating acute and chronic pain conditions. They use non-surgical treatments and routinely prescribe therapeutic exercises to treat conditions such as lower back pain, arthritis and osteoporosis.

Press, who works with people who have had surgery as well as those with musculoskeletal problems, says it's particularly important for older people to increase hip and buttock strength. When developing an exercise program for his patients, he abides by three words: keep it simple.

"What I've learned in 20 years of taking care of patients with musculoskeletal problems is that you can't give them a book with 20 back exercises or a two-hour program to follow," he says. "If you can give them three to four exercises that fit into their day, there's more of a chance they're going to do them."

Dr. Richard A. Stein, a professor of clinical medicine at Weill Cornell Medical Center in New York City and a spokesman for the American Heart Association (news - web sites), agrees that patient compliance with long-term exercise programs is usually very small.

And although he doubts people will take the time to toss one piece of laundry at a time into the washing machine, he agrees that heavy housecleaning activities such as mopping and vacuuming can be good aerobic exercise.

"People need to look for the household activities that occur more than once a week and last between 10 and 30 minutes," Stein says. "There needs to be a fair amount of body movement, and it needs to cause you a fair amount of fatigue, as it would with exercise."

What To Do

For more on exercise at home, go to the American Physical Therapy Association or Physical TherapyAbout.com.

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Medicaid Does Little to Help Poor Kick the Habit

By Karen Pallarito

Reuters Health

Wednesday, November 27, 2002

NEW YORK (Reuters Health) - Few state Medicaid programs are heeding the federal government's advice for treating tobacco dependency among pregnant women, children and adolescents, a new study finds, and that could end up costing states in the long run, researchers say.

A report in the December issue of the American Journal of Public Health shows coverage of tobacco dependence treatments is inconsistent across the states and full of gaps. Pharmaceutical treatment for youths or smoking parents, one of the most widely covered benefits, is offered by just 16 states across the country.

The US Public Health Service (PHS) recommends health insurance coverage for services that help smokers kick the habit, such as advice and counseling. The 2000 practice guideline is based on strong evidence that such interventions are clinically effective and highly cost-effective.

States' failure to follow federal guidance is foolhardy, both from a public health and an economic perspective, researchers assert.

"It's not only common sense, it's actually what saves the Medicaid program money," said Helen Halpin Schauffler, director of the Center for Health and Public Policy Studies at the University of California, Berkeley, which conducted the study. She said states could avoid $3 in healthcare costs for every $1 invested in helping people kick the nicotine habit.

But while Medicaid requires states to cover preventive services, such as prenatal care and periodic health screenings for children, coverage of tobacco dependency treatments is optional.

The government does not recommend drug treatment for pregnant women because of the lack of research on how it affects their unborn children, Schauffler noted. But many believe drug treatment makes sense as part of a "harm reduction" strategy, since smoking mothers pass "many, many more chemicals" onto their fetuses by continuing to smoke, she said.

With a grant from the Robert Wood Johnson Foundation, the authors surveyed the 50 state Medicaid programs to assess their compliance with the PHS guideline.

Only 10 state Medicaid programs offer tobacco dependence treatment for expecting mothers, and all but one of those include some form of counseling, the study found. Sixteen state programs reported covering some form of counseling for pregnant smokers.

Even fewer states cover smoking cessation counseling for smoking parents or teens. Three cover parents and youths, four cover the under-21 crowd only, and one offers counseling just for parents.

Drug treatment does help smokers quit, particularly when combined with counseling, researchers told Reuters Health. Yet only one third of states (32%) offer drug coverage. Bupropion SR, the anti-smoking deterrent marketed as Zyban and Wellbutrin, is the most commonly covered treatment. Fewer than 10 states cover nicotine patches, inhalers, nasal sprays or gums as part of their childhood prevention programs, the study showed.

"It's important to remember that, without question, the biggest cause of illness and death as well as the biggest cause of expensive health outcomes particularly burdensome to state Medicaid systems is tobacco use," said Dr. Michael Fiore, a professor of medicine and director of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School.

The evidence is compelling, he said. Tobacco use causes 35% of all cancers, one third of heart attacks and strokes, and 90% of chronic obstructive pulmonary disease, which includes emphysema.

Caring for people with these serious diseases can be very expensive. A single hospitalization for heart attack can run up a tab of $15,000 to $20,000, Fiore noted. By contrast, he said, it can cost as little as $200 to $400 to help a person to quit. That's what it costs for a 3-month course of nicotine replacement therapy, such as patches and gums, or the prescription drug bupropion.

"Why aren't states doing this? I think it's because of unfounded fears that the short-term costs of treating tobacco dependency will be overwhelming to state Medicaid systems that are already in terrible financial states," Fiore added.

Schauffler's team proposes requiring states to cover effective tobacco treatments as part of the federally mandated Medicaid benefits package. The authors say that "would eliminate disparities in coverage across the states and make a significant difference in the health of low-income pregnant women and their children."

Source: American Journal of Public Health 2002;92:1940-1942.

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Don't Let the Holidays Go to Waist

HealthScoutNews
Wednesday, November 27, 2002

WEDNESDAY, Nov. 27 (HealthScoutNews) -- It's time to start planning how to avoid packing on the pounds as you're tempted to pack in all that delicious holiday food.

The holiday season extends about six weeks, starting tomorrow and lasting through New Year's, and you need to work out a game plan to ensure your waistline stays under control, says Purdue University foods and nutrition expert Olivia Bennett Wood.

You can counter weight gain by adding 10 or 15 minutes to your exercise routines or by putting some extra thought into your holiday meal preparations, Wood says.

Before you go to a holiday party or dinner, eat some small nutritious snacks. That will help moderate your food intake at the party or dinner. When you're at a party, beware of unconscious eating where you keep reaching for food without even thinking about it.

Wood offers some advice for people hosting a holiday function. Rather than a buffet, have a single menu. It doesn't have to include numerous entrees or desserts. Have one main dish and two side dishes. Skip a side dish if you include an appetizer or dessert.

Desserts should be simple or light -- fresh pineapple with pomegranate seeds, for instance.

Here are some other hosting suggestions:

         Include low-calorie items such as fresh vegetables and fruit with low-calorie or no dip.

  • Provide low-calorie beverages.
  • Don't push food on people. They know when they've had enough to eat.
  • Don't equate the amount of food eaten with the success of your recipes or your party.
  • When you prepare the food, read labels carefully. Some items that are labeled low fat may actually have almost the same number of calories as the regular product.

More Information

Additional ideas for avoiding holiday overeating and stress are included in this list of holiday tips.

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FDA Clears Osteoporosis, Attention-Deficit Drugs

By Lisa Richwine

Reuters

Wednesday, November 27, 2002

WASHINGTON (Reuters) - Eli Lilly and Co. received a double dose of good news on Tuesday as US regulators approved the company's novel osteoporosis treatment and a new drug for attention-deficit/hyperactivity disorder.

Forteo, a once-a-day injection, is the first US-approved treatment for osteoporosis to stimulate formation of new bone. The Food and Drug Administration (news - web sites) cleared Forteo for treating men and postmenopausal women who have the bone-thinning disease and a high risk of fracture.

Later on Tuesday, the FDA announced it had cleared Lilly's Strattera, which the agency said was the first new drug in three decades for treating the symptoms of attention-deficit/ hyperactivity disorder (ADHD).

Strattera is believed to be a less likely candidate for abuse by patients than other attention-deficit drugs because it is the only FDA-approved treatment for the disorder that is not a stimulant.

The approvals were positive steps for Indianapolis-based Lilly, which has experienced manufacturing problems that plagued its drug pipeline and held back earnings this year.

Forteo is an advance for treating osteoporosis because it works differently than older drugs that stop or slow bone loss.

Forteo "has the capacity to turn on bone-forming cells...and to actually make more bone. That's very appealing in patients with severe osteoporosis," Dr. Ethel Siris, director of the Toni Stabile Center for the Prevention and Treatment of Osteoporosis at Columbia-Presbyterian Medical Center, said in an interview. Siris also is a consultant for Lilly.

"I'm thrilled. We've been waiting for this," Siris said of Forteo's approval.

An estimated 8 million women and 2 million men in the United States have osteoporosis, a progressive thinning of the bones that can increase the risk of spine, wrist and hip fractures.

Forteo, known generically as teriparatide, is a fragment of a natural hormone called the human parathyroid hormone.

Lilly's research showed Forteo increased bone mineral density in postmenopausal women treated for an average of 19 months. Forteo reduced the relative risk of spinal fractures by 65% when compared with an inactive placebo.

Forteo's label will carry a "black box" warning explaining that animal studies showed an increase in the number of rats developing osteosarcoma, a rare but serious bone cancer.

"In human studies, no osteosarcomas were reported, but the possibility that humans treated with (Forteo) may face an increased risk of developing this cancer cannot be ruled out," the FDA said in a statement.

Patients also will be told about the issue in a medication guide to be distributed by pharmacists each time Forteo is dispensed.

Dr. Loren Wissner Greene, an associate professor at New York University School of Medicine, said Forteo will be targeted at mostly elderly patients who have failed to adequately benefit from older drugs called bisphosphonates, which include Merck & Co's Fosamax and Aventis SA's Actonel.

Likewise, it will be appropriate for those who currently have fractures of the hip and spine, she said.

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Diuretics a Risk for Kidney Patients: U.S. Study

Reuters

Wednesday, November 27, 2002

CHICAGO (Reuters) - Diuretics routinely prescribed to boost the urine output of patients suffering kidney failure may instead prove deadly, researchers said on Tuesday.

The primary danger is that physicians wait for diuretics to work before launching treatment such as dialysis to rid the blood of toxins normally filtered by the kidneys, they said.

Patients suffering from acute renal failure often have suppressed urine flow, and are commonly given diuretic agents to rid their bodies of excess water.

But the study of 552 kidney patients in four California hospitals conducted between 1989 and 1995 found those administered diuretics had a sharply higher risk of death or of never recovering kidney function.

Between 300,000 and 500,000 US hospital patients develop kidney failure while in the hospital, and between half and three-quarters receive diuretics, according to the report published in this week's issue of The Journal of the American Medical Association (news - web sites).

Kidney patients who do not respond to diuretics may suffer a toxic reaction to the agents, and excreting more urine could mask the severity of the kidney damage, said study author Dr. Ravindra Mehta of the University of California, San Diego.

The delay in starting dialysis while waiting for a response to diuretics can worsen respiratory, cardiovascular and nervous system problems and harm immune system functioning.

"Although we cannot securely determine that diuretics are harmful, it is highly unlikely that diuretics afford acute renal failure patients any material benefit," Mehta wrote.

Until a larger, definitive study is undertaken, "we should discourage the widespread use of high-dose diuretics in critically ill patients with acute renal failure," he added.

An accompanying editorial published in the journal agreed that the common practice of administering diuretics to kidney patients in hospital intensive care units ought to stop, and a carefully monitored trial should be undertaken.

Dr. Norbert Lameire of University Hospital, Ghent, Belgium, wrote that physicians should recognize the increased urine flow resulting from giving a patient a diuretic "only reflects the existence of a milder form of acute renal failure, has no prognostic effect, and does not justify postponing dialysis when needed."

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TUESDAY, NOVEMBER 26, 2002 

They're Not Just Cavity Fillers 

HealthScoutNews
Tuesday, November 26, 2002

TUESDAY, Nov. 26 (HealthScoutNews) -- Your dentist can do more than just ensure you have a nice smile -- she can save your life by detecting oral cancer at an early stage.

You may not associate cancer screening with your regular dental checkups, but your dentist does. Dentists check for oral cancer by inspecting your tongue, roof and floor of the mouth, and by feeling the lymph nodes on the neck.

Oral cancer can start as a tiny, white or red spot or a sore anywhere in the mouth. People who smoke and drink a lot of alcohol are at the greatest risk for oral cancer. But more than 25 percent of oral cancers occur in people with no known risk factors.

The American Cancer Society (news - web sites) estimates that this year there will be 28,900 new oral cancer cases in the United States and 7,400 deaths caused by oral cancer.

Early detection, diagnosis and treatment of oral cancer is critical to long-term survival.

Current and future oral cancer screening technologies for dentists include:

         Brush biopsy. A small brush is used to take a tissue sample. It's sent for analysis to determine the presence of pre-cancerous or cancerous cells. This method is approved for use in the United States.

  • Toluidine blue. The patient rinses with various solutions that leave a blue stain on pre-cancerous or cancerous cells. A positive test indicates the need for follow-up investigation. Toluidine blue is approved for use in various countries. Approval in the United States is pending.
  • Chemiluminescence. A liquid similar to diluted vinegar is applied to the area of the mouth to be screened. Under a special kind of light, the liquid causes pre-cancerous or cancerous cells to glow. This method is approved for use in the United States but not yet widely available..

More Information

Learn more about oral cancer at the Oral Cancer Foundation.

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After Heart Attack, Risk May Linger for Lifetime

 

By Alison McCook

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - A study of heart attack patients from the 1950s, 1960s and 1970s suggests that 5% of heart attack survivors who do not receive modern medications --such as aspirin--will die each year after leaving the hospital.

The risk seems to persist indefinitely, "probably for the rest of a person's life," Dr. Malcolm R. Law of the University of London in the UK and colleagues report in the November 25th issue of Archives of Internal Medicine (news - web sites).

The researchers found that if such patients did suffer a second heart attack, 33% died before reaching the hospital, 20% died in the hospital, another 20% died in the first year after leaving the hospital and mortality was 10% per year after that.

Law told Reuters Health he hopes these figures will alert doctors to the importance of treatment to help patients who have ever experienced a heart attack--also known as a myocardial infarction (MI)--stay alive. "Ensure that everyone who has had an MI, even years previously, takes preventive treatment," he said.

Patients can also take steps to stay healthy after a heart attack, Law added, by taking the preventive treatments offered by their doctors, stopping smoking and asking housemates to stop smoking as well.

Law and his colleagues base their findings on an analysis of 23 previously published studies in which researchers followed people after they experienced a heart attack. Together, the studies included information on 14,211 patients and 6,817 deaths. None of the studies followed patients past 1980, when better treatments became available.

In an interview with Reuters Health, Law explained that treatments that can help keep patients alive after they experience heart attack include aspirin or other drugs that prevent blood clots, and medications designed to reduce high blood pressure, which include beta-blockers, ACE inhibitors or calcium channel blockers. In addition, he said that doctors now often give patients cholesterol-lowering statins, or even folic acid, which recent research suggests may help ward off cardiovascular disease. Although aspirin has been around for more than 100 years, the first randomized trial showing that it could help heart attack survival was published in 1979, according to the report.

Indeed, before 1980, Law's team found that 10% of patients who survived a first heart attack died within a year following the episode, and 5% of these patients died during each subsequent year. After 15 years, 70% of all patients who had experienced a heart attack had died from cardiovascular disease, the authors report.

After a second heart attack, patients' deaths jumped to 20% during the first year, and plateaued at 10% for every subsequent year of their lives.

Law explained that a heart attack indicates that some of the heart muscle no longer functions. As such, he noted, some people lose so much heart muscle, they are unable to survive even one year after their attack. A second heart attack can damage their heart muscle even further, Law added.

"Death rates are higher after a second MI because not many people have sufficient functioning heart muscle left after two MIs," he said.

Source: Archives of Internal Medicine 2002;162:2405-2410.

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Early Signs Crucial in Lung Cancer

HealthScoutNews
Tuesday, November 26, 2002

TUESDAY, Nov. 26 (HealthScoutNews) -- Knowing the symptoms of lung cancer can help you get an early diagnosis and improve your chance of survival.

Lung cancer symptoms can include chest pain, chronic fatigue, bloody sputum, a persistent cough, and repeated bronchitis and pneumonia, says the Global Lung Cancer Coalition (GLCC).

Raising awareness of lung cancer symptoms and the importance of early diagnosis is the main message of the GLCC's Action on Lung Cancer campaign in November.

Lung cancer is the leading cause of death in men and women around the world, killing more than 1 million people each year. Lung cancer survival rates following treatment lag far behind survival rates for other common cancers such as breast and prostate.

Only 1 in 10 lung cancer victims can expect to live five or more years, and one of the reasons is that lung cancer is rarely caught in its early stages. The early symptoms of lung cancer are often mistaken for less serious diseases. That means it's more likely the cancer has already spread through the lungs and to other parts of the body before it's diagnosed.

If caught early enough, lung cancer may be treated successfully by surgery.

More Information

To see the full lung cancer symptom checklist, go to the GLCC Web site.

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Antioxidants Missing in Mouths with Gum Disease

 

By Alison McCook

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - People with serious gum disease--which can be a major cause of tooth loss--have lower levels of antioxidants in their mouth than those without the condition.

The findings suggest that one way to protect people with serious gum disease would be to recommend they boost their intake of antioxidants, study author Dr. Iain Chapple of the University of Birmingham in the UK told Reuters Health. Antioxidants protect against a host of health problems.

"It may be that antioxidant supplementation could help," he said.

In the study, Chapple and his team tested gingival crevicular fluid (GCF), a fluid that seeps from the crevice under the gums into the mouth, in 10 patients with serious gum disease and 10 patients with healthy gums. In the healthy participants, the researchers found high levels of antioxidants. However, those with serious gum disease had substantially lower levels of the antioxidants in both GCF and in their bloodstream when compared to their peers with healthy gums.

The findings are published in the recent issue of Journal of Clinical Pathology: Molecular Pathology.

Chapple explained that one antioxidant that appears to be important in GCF may also play an important role in the fluid in the lungs and in samples from the cervix. This suggests that these surfaces need extra protection from environmental damage caused by particles known as free radicals, and rely on antioxidant-rich fluid for help, he said.

But why do people with serious gum disease appear to have less protection from free radicals? Chapple suggested that these patients may naturally produce less antioxidants than others, or, alternatively, that they have more free radicals than others, so more of their antioxidants get used to fight them off. "Or it could be a combination of the two," he said in an interview.

Gum disease is found in between 10% and 15% of people across the globe. It results from a buildup of bacteria-containing plaque, which can lead to inflammation and, eventually, tooth loss.

Chapple speculated that gum disease patients may eat a less antioxidant-rich diet than others, or produce less antioxidants than healthy people. "It could also be that the oxygen radicals produced during periodontal inflammation 'spill out' into the blood stream and use up peripheral antioxidants from the blood stream," he added.

The study was funded in part by grant from Unilever Dental Research.

Source: Journal of Clinical Pathology: Molecular Pathology 2002;55:367-373.

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Office Aerobics

HealthScoutNews
Tuesday, November 26, 2002

(HealthScoutNews) -- Is your work schedule too hectic to accommodate regular exercise? If so, some minor adjustments to your routine can keep you reasonably active.

Memorial Hospital of Rhode Island suggests you:

  • Take a walk around your office building during breaks or lunch.
  • Stand when you talk on the phone.
  • Skip the elevator and take the stairs.
  • Walk around the airport while waiting for your flight.
  • Use hotel fitness centers or swimming pools when on business trips.

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Handful of Nuts Every Week May Ward Off Diabetes

 

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - Women who enjoy an occasional handful of almonds or walnuts or a serving of peanut butter may have a lower risk for developing type 2 diabetes than women who rarely eat such food, Harvard researchers report in a study released Tuesday.

Women who ate about 5 ounces of nuts a week had a diabetes risk 27% lower than women who never or rarely ate nuts, according to the report in the November 27th issue of the Journal of the American Medical Association (news - web sites). Women who ate between 1 ounce and 4 ounces of nuts a week had a 16% lower risk, even when they had other diabetes risk factors.

While more research is needed to confirm the findings, the study suggests that unsaturated fats found in nuts may improve the body's ability to use insulin and regulate blood glucose (sugar). Previous research has shown that eating nuts may be associated with a lower risk of heart disease, which is also affected by insulin and blood sugar control.

However, the authors recommend that nuts, which are high in fat, be used as a substitute for other foods such as certain types of meat or refined grain products. Adding calories to the diet makes weight gain more likely, which can raise the risk of both type 2 diabetes and heart disease, they note.

"To avoid increasing caloric intake, regular nut consumption can be recommended as a replacement for consumption of refined grain products or red or processed meats," conclude Dr. Rui Jiang from Harvard School of Public Health in Boston, Massachusetts, and colleagues.

Their study included nearly 84,000 female nurses living in the US, who filled out several questionnaires about their diet over 16 years. The women ranged from 34 to 59 years old when the study began, and had no history of diabetes, heart disease or cancer.

According to the results, women who ate the most 1-ounce servings of nuts and peanut butter were the least likely to develop type 2 diabetes. For instance, women who reported never or rarely eating these foods had no change in risk, while those who ate at least 5 1-ounce servings of nuts or peanut butter weekly cut their risk by at least 20%.

Women who included between 1-4 ounces of nuts in their weekly diet reduced their diabetes risk by 16%, and those who reported eating less than 1 ounce of nuts a week had an 8% lower risk for the disease.

Although women who consumed more nuts tended to weigh less, exercise more and smoke less than their peers who ate fewer servings of nuts, the association between nuts and diabetes risk remained regardless of body mass index (BMI), smoking and alcohol intake.

"Our data...support potential benefits of increasing nut consumption in reducing type 2 diabetes risk," the study concludes.

Type 2 diabetes, the most common form of the disease, is often linked to obesity. Once seen almost exclusively in older adults, the disease is on the rise among adults and children in the US. Diabetes increases the risk of blindness, amputation, kidney failure, nerve damage and heart disease.

The study was funded by the National Institutes of Health (news - web sites).

Source: Journal of the American Medical Association 2002;288:2554-2560.

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Hair Dryer Hazards

HealthScoutNews
Tuesday, November 26, 2002

(HealthScoutNews) -- Hand-held hair dryers may be essential beauty tools, but they can also be dangerous. As with any electrical appliance, using them calls for common sense precautions.

The U.S. Consumer Product Safety Commission (news - web sites) recommends you follow these specific safety rules:

  • Unplug your dryer when it's not in use.
  • Never use one while bathing.
  • Don't leave it where it can be pulled into a basin or tub.
  • Don't reach for a hair dryer if it falls into water or other liquid. Unplug it immediately, then remove it.
  • Don't block the appliance's openings by resting it on a soft surface, such as a bed, while you're using it. The air vents might be blocked; it can overheat and cause a fire.

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Teens Do Listen to Parents About Smoking, Drinking

 

By Keith Mulvihill

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - Contrary to popular belief, many teens and young adolescents look to parents for guidance about smoking, drinking and doing drugs, according to a new study that gauged teens' acceptance of parental authority.

"The typical parent-child relationship involves an imbalance of power--parents have more skills, more knowledge, more experience, more resources than children--and they appropriately have most of the power," said Dr. Christine Jackson of the University of North Carolina at Chapel Hill.

"This power differential allows parents to control many aspects of their children's lives," the researcher added. "But as children approach adolescence, the playing field begins to even out. Eventually, adolescents must decide whether and when they will accept parental authority."

Teens are said to "legitimize" parental authority if they agree that parents should have a say about issues like education, career choices, dating relationships, driving, or drug and alcohol use, explained Jackson.

In her investigation, Jackson interviewed 1,220 middle school students about a variety of aspects relating to parenting style and how they view parental authority. The findings are published in the November issue of the Journal of Adolescent Health.

The researcher found that 80% of young adolescents in this study think their parents should have a say about whether they smoke cigarettes or drink alcohol.

"This finding discredits the notion that adolescents uniformly reject parental influence," Jackson told Reuters Health.

"Adolescents don't want parents to tell them how to dress or what kind of music to listen to--but they do want and need parental involvement in many other aspects of their lives, including (alcohol and tobacco use)."

In addition, this study also compared teens who rejected parental authority about smoking and drinking versus teens who were receptive to parental authority about use of these substances.

"Teens who rejected parental authority about smoking were 400% more likely to smoke and teens who rejected parental authority about alcohol use were 380% more likely to report current drinking than peers who were receptive to parental influence on these issues," said Jackson.

"In brief, being receptive to parental influence means being less likely to use tobacco and alcohol," she added.

The big question now is why do some teens accept parental authority while other teens reject it?

This study found that one answer is parenting style. The teens of parents who used ineffective parenting practices were seven times more likely to reject parental authority regarding substance use than teens whose parents followed recommended parenting practices, explained Jackson.

Parents should keep in mind that "effective parenting skills are the best tool parents have for keeping their children from smoking cigarettes or drinking alcohol," said Jackman. "The style of parenting that 'works' is one that combines strong, firm discipline with a high level of warmth and attention."

Jackson pointed out that many previous studies have shown parents who stick with this balanced style of parenting throughout the childhood years get a big "pay-off" in the long-term. "Their teens won't agree with every request or follow every rule, but they will trust and respect their parents," she said.

"This trust and respect is the key to sustained parental influence, including parental influence about smoking and drinking," Jackson concluded.

Source: Journal of Adolescent Health 2002;31:425-432.

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Kids' Obesity Program Focuses on More Than the Food

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 26, 2002

TUESDAY, Nov. 26 (HealthScoutNews) -- When an overweight youngster sheds pounds at an obesity program in Brooklyn, N.Y., the custom is to honor the parents.

"Kids get a kick out of giving rewards to their parents for making lifestyle changes, too," says Maureen Haugh, a pediatric psychologist and assistant director of The Kids Weight Down Program at Maimonides Medical Center.

This shared approach is an example of the appeal and success of the five-year-old, non-profit program that involves the whole family in a child's obesity problem.

The clinic approaches weight loss through a variety of disciplines: medical treatment, psychological supervision and family involvement. The intense 12-week program has doctors and health professionals at Maimonides aiming for lifestyle changes that are pervasive and long-lasting.

"Our program is unique in that there are lot of resources being used in a setting where there is constant positive reinforcement, a no-blame setting and realistic goals for weight management," says the program's director, Dr. Henry Anhalt.

And it seems to be working. Anhalt says what will be most telling are five- and 10-year follow-ups of the program participants, data that is not yet available. So far, however, reports on the approximately 2,000 children who've completed the program indicate a three- and four-year success rate of approximately 35 percent, measured by follow-up Body Mass Index's (BMI) of the children.

Not a moment too soon. Obesity in kids is now epidemic in the United States, according to the National Institutes of Health (news - web sites). The number of children who are overweight has doubled in the last two to three decades; currently one child in five is overweight. The increase is in both children and adolescents, and prevalent throughout all age, race and gender groups.

The Brooklyn program includes, first, a medical workup. Type II (so-called adult onset) diabetes is increasingly common among overweight children, as is high cholesterol, and doctors look to see if the child needs medical treatment.

Second, the child has an age-appropriate evaluation with a psychologist to assess his or her eating patterns and behavior around food and to see if there are any eating disorders or depression.

"The whole idea is to implement lifestyle changes for the whole family, to get the parent out of the role of a policeman limiting the intake of the child and put him or her in the role of a coach, encouraging their children to make changes and to make changes themselves, as well," says Haugh.

Strategies include having the child keep food and activity logs, which are reviewed with parents at the end of the day. The children are all encouraged to follow a diet based on research from Buffalo psychologist's Leonard H. Epstein's "Stop Light Diet for Children." This program divides foods into red (high-calorie, low-density sweets), yellow (staples like lean meats and fish) and green (fruits and vegetables that don't exceed 20 calories).

Equally important is to increase the family's physical activity. "We don't call it exercise, which is viewed as drudgery and sounds punitive, but activity level," says Haugh.

Recommendations include taking family bike rides, making a game of finding stairs to climb instead of taking elevators, or parking as far away as they can from a store and walking there.

And then there are the rewards. Children and parents each get points for participating in the program. Children get points for things like completing their food and activity logs every day, limiting their intake of "red" foods and losing or not gaining weight. Parents' points come from reviewing the food and activity logs with their children, establishing regular meal and snack times and keeping healthy foods in the house.

The parents reward the children with things like a bowling trip, a bike ride, or a walk along the Coney Island boardwalk, while children can reward their parents by cleaning up their room, letting the parents sleep in one morning, or reading to their them.

"Childhood obesity is truly a family affair, and as the incidence of obesity increases, these programs are going to become more and more important," says Maureen Storey, director of Center for Food and Nutrition Policy at Virginia Tech, in Alexandria, Va.

What To Do

The American Heart Association explains why physical activity is so important for children. For advice on helping your overweight child, visit The Mayo Clinic.

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Patient's Death Highlights Need for Oral Care

 

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - Poor oral hygiene and tooth decay in a 76-year old man with Alzheimer's disease (news - web sites) appears to have hastened his death, according to a new report. A dental bridge became lodged in the man's esophagus, leading to an infection.

The case underscores the need for preventive oral care for patients with dementia, according to Dr. John S. Oghalai of the University of California in San Francisco, the author of the report.

"In the nursing home population, poor oral hygiene is common, with a 50% prevalence of dental cavities," Oghalai writes in the November 27th issue of the Journal of the American Medical Association (news - web sites).

The man was brought to the emergency room after having had a cough and fever for three days. He had severe Alzheimer's and was unable to communicate. Caretakers noted that he had "copious oral secretions, severe halitosis, and poor dentition."

A chest x-ray revealed that the man had partially swallowed a four-tooth dental bridge, which had torn his esophagus, resulting in swelling and infection.

"In all likelihood, this bridge had been aspirated several weeks prior to presentation, but because the patient was fed through a gastrostomy tube, no symptoms were identified prior to esophageal perforation," Oghalai writes.

The bridge is believed to have come loose due to cavities, which rotted away the roots of the man's teeth.

Rather than more surgery, the family elected for comfort care and the man died shortly thereafter, the report indicates.

"Because many nursing home patients are unable to communicate to staff, it is critical that such patients receive prophylactic dental hygiene," Oghalai concludes.

Source: Journal of the American Medical Association 2002;288:2543-2544.

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Drowsy Driving Can Steer You Into Disaster

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 26, 2002

TUESDAY, Nov. 26 (HealthScoutNews) -- On Dec. 21, 1999, Melissa Cullen and her father were driving down Rte. 20 in rural Delaware to put Christmas greenery on her mother's gravesite. Melissa's mother had died just eight months before. To Melissa, the day was a wonderful opportunity to spend time getting to better know her father.

The two had been on the road for only a few minutes when Cullen noticed an oncoming car drifting into their lane and pointed it out to her dad. "He told me to hang on," she says.

The next thing Cullen remembers is waking up in a hospital bed and seeing two police officers by her side. Her father had been killed in a car accident, they told her. Melissa herself had suffered a broken shoulder, nose, foot and many other injuries in addition to amnesia (she had to be told about her mother's death all over again).

The woman who had hit them had fallen asleep at the wheel at 11:40 in the morning.

This kind of tragedy can and does happen all year, a consequence of everyone's relentless push to work and study harder. But the likelihood increases during the holiday season.

"During the holidays, people drink alcohol, and alcohol is a depressant. It causes people to be sleepy," says Dr. Elaine Josephson, an emergency room physician at St. Luke's-Roosevelt Hospital Center in New York City and a spokeswoman for the American College of Emergency Physicians (news - web sites) (ACEP). "The other issue is that people are up all night. They go to parties. They enjoy themselves, they're preparing for the holidays and they have less sleep."

Add bad weather into the mix, and you could have a recipe for potential disaster.

According to the National Highway Transportation Safety Administration, drowsy driving is the cause of 100,000 police-reported crashes each year, costing more than 1,550 deaths, causing 71,000 injuries, and resulting in $12.5 billion in economic costs.

The problem may actually be much bigger, says Mark Rosekind, a member of the board of directors of the National Sleep Foundation and a psychologist who used to run a fatigue program.

"Most people think that fatigue probably accounts for up to 20 percent of all crashes," he says. In a country with about 6 million crashes a year, that translates into 1.2 million crashes caused by fatigue.

Perhaps even more frightening, the National Sleep Foundation's "2002 Sleep in America" poll found that more than half of all American adults admit to driving while drowsy, while 17 percent said they had actually fallen asleep at the wheel in the past year.

Of the 51 percent of adults who said they had driven while drowsy, 56 percent were males. The overwhelming majority (71 percent) were between the ages of 18 and 29.

The less people sleep, obviously, the greater the likelihood of crashing. The woman who crashed into Melissa Cullen's car was a shift worker who had slept only three hours in the past 24-hour period.

According to a study by the AAA Foundation for Traffic Safety, people who sleep six to seven hours a night are twice as likely to be involved in such a crash as those sleeping at least eight hours or more. People sleeping less than five hours increased their risk four to five times.

The woman who was responsible for Cullen's father's death received only two points on her license and a $115 fine. Although such penalties are likely to get stiffer, the real punishment goes to those who survive.

Cullen has had chronic headaches, loss of vision, and sinus and back problems, among other things, since the accident.

And Tom Callaghy, a college professor whose wife of 33 years was killed when he fell asleep at the wheel, refers to "the total horror of waking up and realizing that my wife had died because I fell asleep at the wheel. I mean, it's total devastation for her family, for my family, and it's a guilt that I'm going to live with for the rest of my life."

Callaghy was a speaker at a recent two-day summit held in Washington, D.C., by the National Sleep Foundation to increase public awareness of the dangers of drowsy driving.

Before you hit the road this holiday season, plan ahead, make sure you get enough sleep and follow these tips:

         Have another driver with you so you can relieve each other whenever one starts to feel tired.

  • If you can, stop for the night and get a good rest. Otherwise, pull into a safe, well-lighted area and take a 15-to-20 minute nap.
  • Don't rely on caffeine, radio playing, or opening a window for longer than 15 or 20 minutes, Rosekind advises. These tricks will get you to a resting spot, but they won't get you safely to your destination.
  • Be vigilant to the people around you. If someone is driving too slowly or drifting towards the center lane, stay away from that car.
  • If you're going to a holiday party, make sure you have a designated driver, or arrange for a taxi to take you home if it's late and you're tired.
  • Continue to take your medications as prescribed, Josephson advises. Forgetting medications or altering your dosing schedule in any way can cause drowsiness.
  • Be careful what you eat, especially if you have heart disease or diabetes. This can also alter how alert you feel.
  • Learn to read your own body and recognize when you're tired. Some classic symptoms are yawning, fidgeting in your seat, and finding your eyes are focused and not looking around so much. You may have additional signs such as a headache, rapid eye blinking, or a stomachache. "Figure out what those signs are so when you see them, that's a cue to take action," Rosekind says.
  • Finally, pull over immediately if you have any of these symptoms: difficulty focusing, frequent blinking, or heavy eyelids; trouble keeping your head up; repeated yawning; trouble remembering the last few miles driven; missing exits or traffic signs; drifting from your lane, tailgating, or hitting a shoulder rumble strip.

What To Do

For more on drowsy driving, visit the National Sleep Foundation or the AAA Foundation for Traffic Safety.

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Millions in Vietnam at Risk of Worms from Raw Fish 

Reuters

Tuesday, November 26, 2002

HANOI (Reuters) - Millions of Vietnamese are exposed to parasitic infections because many people in the southeast Asian country eat raw fish, health officials said on Tuesday.

"Around five million people are exposed to the risk of infection...and around 400,000-500,000 are estimated to be infected," Vietnam's health minister Tran Thi Trung Chien said during a 3-day workshop on parasites that began on Tuesday.

Seafood is a staple for Vietnam's 80 million people and eating raw fish is common. About one third of the population lives below the poverty line.

Residents living in high-incidence areas for worm infections would be advised to stop eating raw fish, health officials said. In October, the government also set up a fund to provide health screening for the poor.

Around 40 million people worldwide--mostly in eastern and southern Asia--are infected with trematode worms, conference organizers the UN Food and Agriculture Organization (news - web sites) and the World Health Organization (news - web sites) said in a joint statement.

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Interferon Causes Major Depression for Hepatitis C Patients

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 26, 2002

TUESDAY, Nov. 26 (HealthScoutNews) -- Interferon therapy, considered the most effective treatment for people who have hepatitis C, causes severe depression in many patients, new research has found.

But doctors at the Portland Veterans Administration (VA) Medical Center, where the study was done, say anti-depressants can alleviate the problem.

In the study of 39 patients with the life-threatening liver disease, one third became severely depressed after several months of interferon therapy and stopped taking their medication. When given an anti-depressant, 85 percent of those who were depressed improved enough to continue their treatment.

"Many people who have hepatitis C have depression, and their depression becomes so uncomfortable they often stop treatment on their own without seeing a physician, or their doctor will stop the interferon," says Dr. Peter Hauser, associate director of the Northwest Hepatitis C Resource Center at the Portland VA Medical Center. "But if they don't stay on the medicine, they don't have the chance to be treated."

Hauser is the lead author of the study, which appears in the November issue of Molecular Psychiatry.

Interferon therapy, combined with an anti-viral agent called ribavirin, is currently the most effective treatment for the disease, which is caused by the hepatitis C virus and which Hauser estimates afflicts approximately four million Americans. It inflames the liver, interfering with its function, which can lead to chronic liver disease like cirrhosis and liver cancer, according to the Mayo Clinic.

There is no vaccine to prevent hepatitis C, and the interferon/ribavirin therapy can help up to 80 percent of those diagnosed with the disease, Hauser says. That's why it's so important that depression not stop people from continuing the treatment, he adds.

"We are looking at a very common side effect, and we need to devote more time and research money to study these side effects, like depression, because if we don't treat the side effects, we won't succeed with treating the disease," he says.

Dr. George Nikias, medical director of the Hepatitis Treatment Center at Hackensack University Medical Center, says that screening for depression among hepatitis C patients is very necessary.

"Studies have been done on this before, and the work is very important. We need to raise the awareness that depression is very common but also very treatable. We're very sensitive to it here," he says.

In Hauser's study, the 39 patients on interferon therapy were monitored for depression on a weekly basis using the Beck Depression Inventory, a standard assessment for depression. Thirteen of the patients developed a major depression after approximately three months of treatment.

Hauser and his colleagues treated them with a selective seretonin reuptake inhibitor (SSRI) called citalopram that goes by the trade name of Celexa. Within an average of five to six weeks, 11 of the patients were no longer depressed, and by an average of nine weeks, the study reported that they were in remission from depression. An SSRI was chosen, Hauser says, because interferon seems to cause seretonin depletion.

Hauser found it significant that the depression occurred at approximately the same time for all the patients.

"There seems to be a threshold effect. The patient will be fine for two or three months, but once the depression starts there is a rapid escalation in its onset, often in a two-week period," he says.

"This suggests that we should be monitoring patients for the treatment of depression every two weeks or no less often than every four weeks."

There was no differences in gender, age, past history of major depression or substance abuse between those who became depressed and those who did not. However, there was significantly less depression among the African-Americans in the study, who represented half the study participants.

Hauser says that African-Americans, who have a much higher prevalence of hepatitis C than do whites, have a very poor response to interferon therapy and there could be a connection between their lack of response to interferon and the low incidence of depression.

The study was initiated by Hauser and his colleagues, and they received grant support for their work from Integrated Therapeutics, a subsidiary of Forest Laboratories, Inc. which manufactures Celexa.

What To Do

A fact sheet on the hepatitis C virus can be found at National Center for Infectious Diseases, and The National Digestive Diseases Information Clearinghouse (NDDIC) has a complete explanation of interferon therapy.

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Feds Will Help States Insure High-Risk Individuals

 

By Edward Winnick

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - In an effort to decrease the ranks of the uninsured, the US Department of Health and Human Services (news - web sites) (HHS) on Tuesday announced that it would provide states with financial assistance to support the creation of high-risk insurance pools.

High-risk pools, which are generally non-profit associations created by states, offer health coverage to individuals who otherwise would have difficulty obtaining coverage because of pre-existing medical conditions. More than 153,000 individuals are currently covered by such pools, according to HHS.

Initial funding of $20 million for the programs was provided for in the Trade Act of 2002. Under the plan, grants are being made available to states that did not have a qualified high-risk insurance pool as of August 6, 2002, the day President Bush (news - web sites) signed the Trade Act into law.

The criteria for defining a "qualified" high-risk pool is derived from the Public Health Service Act, which requires that such pools provide coverage to all individuals who are guaranteed coverage through the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

HHS Secretary Tommy Thompson said, "This is the first time that federal funding assistance has been available for high-risk people. These pools have proven to be an effective mechanism to provide comprehensive health coverage to individuals who are unable to get health insurance in the private market because of poor health."

According to the agency, 27 states and the District of Columbia would be eligible to receive up to $1 million each to support the creation and initial operations of high-risk pools. In addition to the initial $20 million in available funding, the Trade Act set aside another $80 million over two years to offset potential losses incurred by states from operating the high-risk pools.

But even the full $100 million in funding is not likely to cover the costs incurred by all of the pools. For example, Minnesota, which covers more than 26,000 people in its high-risk pool, expects to lose nearly $59 million on its program, according to Deborah Chollet, a senior fellow at Mathematica Policy Research in Washington DC.

In an interview with Reuters Health, Chollet pointed to Minnesota as a model for such programs. She noted that its program covers 6% of the state's individually insured population and accounts for nearly a quarter of high-risk pool enrollment nationwide.

Chollet authored an article recently published in the journal Health Affairs that highlighted the many problems facing individuals enrolled in high-risk pools, including high costs, long waiting periods for coverage of pre-existing medical conditions and limited benefits.

But despite the significant funding requirements and the problems associated with some of the pools, Chollet told Reuters Health, "I think high-risk pools are a great idea in principle. They just don't receive the funding they need to make them work the way they are supposed to work."

She added, "I would be a strong advocate of serious federal funding for high-risk pools and some rules in place that standardize the practice of high-risk pools across states."

But an HHS spokesman said that, at this point, agency officials have not discussed standardizing the rules under which the pools would operate. He noted, however, that states would have to show that they are charging premiums no more than 150% of standard risk.

The high-risk pools would also have to "show how they are going to meet their losses...and they must allow HIPAA-eligible people to sign up for the program," he added.

There are roughly 41 million uninsured Americans, and according to a recent US Census Bureau (news - web sites) report, an estimated 14.6% of Americans had no health insurance coverage during all of 2001, up from 14.2% in 2000. HHS officials are unsure how many currently uninsured people will benefit from the establishment of the high-risk pools.

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Common Kidney Therapy Harms More Than Helps

 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 26, 2002

TUESDAY, Nov. 26 (HealthScoutNews) -- Using diuretic drugs to increase urine output in patients with acute kidney disease, a common practice in the situation, can mask the signs of potentially fatal kidney failure, a California study finds.

The slight increase in urine output that results from the diuretic treatment can fool the physician into thinking that truly drastic measures, like an artificial kidney, are needed, a group led by Dr. Ravindra L. Mehta, professor of medicine at the University of California at San Diego, reports in tomorrow's Journal of the American Medical Association (news - web sites).

The study, which included 552 patients with acute renal -- kidney -- failure treated at four university intensive care units, found that the death rate for patients given diuretics was 77 percent higher than for those not given the drugs.

"Acute kidney failure often goes unrecognized," Mehta says. "The longer it goes unrecognized, the more likely the patient is to have a bad outcome. Depending on diuretics to augment urinary output can cloud the issue."

Acute kidney failure is not always easy to detect, and even small changes in function can lead to a bad outcome, Mehta says. The higher death rate was most notable in patients who had only a small response to the diuretics, he says.

"Our study suggests that if you don't get a good response, you shouldn't push it," he adds.

An accompanying editorial by Dr. Norbert Lameire and others at University Hospital in Ghent, Belgium, calls the study "timely and important" because the use of diuretics to increase urinary output for patients in intensive care units "is still relatively common practice."

"Until data from a sufficiently powered clinical trial can properly answer the question of whether critically ill patients are harmed by loop diuretics, the practice of routine administration of these agents to such patients should be discouraged," the editorial says.

The study results are "very disappointing" because "it says that one of the things we thought would help doesn't," says Dr. Darracott Vaughan, a professor of urology at Weill Cornell Medical Center in New York and a past president of the American Urological Association.

"A modality that we have thought for years might convert these people, push them into a recovery stage, did not," Vaughan says.

Despite all efforts, "we continue to have a very high morbidity and mortality with acute renal failure," he adds. "What is truly needed is basic research in understanding acute renal failure. We need to start all over again and see what will work."

What To Do

You can learn about your kidneys, how they work and how they fail, from the National Institute of Diabetes and Digestive and Kidney Disease or the National Kidney Foundation.

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Testosterone Boost May Help Some with Parkinson's

 

By Alison McCook

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - Giving extra testosterone to Parkinson's disease (news - web sites) patients with low levels of the hormone seems to curb some symptoms of the disease, according to preliminary study findings.

However, lead author Dr. Michael S. Okun of the University of Florida in Gainesville stressed to Reuters Health that the study did not compare these patients to a similar group given an inactive drug. Consequently, he explained, the results could stem from the so-called "placebo effect," when people on an inactive drug or therapy show an improvement in their symptoms. In order to understand the benefits of a new drug, researchers need to compare it to placebo to gauge the therapy's true benefit, he said.

Nevertheless, the new findings suggest that testosterone may hold promise for these patients, he added. In the current study, published in the November issue of the Archives of Neurology, Okun and his team found that patients given testosterone lost an average of two non-movement related symptoms often seen in men with reduced testosterone levels and Parkinson's disease.

These symptoms include fatigue, energy problems, sexual dysfunction and depression, Okun told Reuters Health.

The findings from the current study are bolstered by previous research, which has shown that older men with similar symptoms as a result of a marked drop in testosterone also benefit from supplementation with the hormone. Whether or not these results also apply to men with low testosterone and Parkinson's had been unclear, the authors note.

Parkinson's disease is a progressive neurological disorder marked by the loss of brain cells that produce dopamine, a chemical key in controlling muscle activity. Some of the classic, movement-related symptoms of Parkinson's disease include tremor, muscle rigidity and sluggish movements.

During the study, Okun and his team gave 10 men with Parkinson's and low testosterone levels a testosterone gel to rub on the skin of the shoulders, chest, and abdomen once daily, and followed patients for 1 month. The researchers followed 6 of the patients for 2 additional months.

Okun and his team found that patients' testosterone levels increased after using the gel. They also showed an average of six symptoms related to testosterone deficiency at one and three months after starting therapy, a drop from the previous average of eight.

In an interview with Reuters Health, Okun cautioned that extra testosterone can worsen congestive heart failure, cause a rash and exacerbate sleeping problems such as sleep apnea, in which people temporarily stop breathing during sleep. "But under a doctor's supervision, it's safe for a vast majority of people," he noted.

The next step, Okun added, is to determine whether patients with Parkinson's are more likely to have low levels of testosterone than similarly aged men without the disease. Additional research is also needed to compare people given testosterone gel to those given an inactive gel, to determine the role of the placebo effect in these findings, the researcher said.

"We really think this has implications, so we're following it up," Okun said.

Source: Archives of Neurology 2002;59:1750-1753.

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Eat Fish and Veggies and Prosper

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 26, 2002

TUESDAY, Nov. 26 (HealthScoutNews) -- New research confirms what we should already know: Diets low in saturated fats, high in omega-3 fatty acids and high in fruits, vegetables, nuts, and whole grains are the best for your heart.

"The information was scattered in various papers," says Dr. Frank Hu, lead investigator of the study and an associate professor of nutrition and epidemiology at Harvard School of Public Health. "We tried to put all the pieces together to solve the puzzle."

The study, which appears in tomorrow's issue of the Journal of the American Medical Association (news - web sites), identifies three "dietary strategies" that seem to be effective in preventing coronary heart disease (CHD).

"Such diets," the researchers write, "together with regular physical activity, avoidance of smoking, and maintaining a healthy weight, may prevent the majority of cardiovascular disease in Western populations."

"That's a huge statement by well-known researchers. That's the bottom line," says Samantha Heller, a senior clinical nutritionist at New York University Medical Center in New York City.

"What they're saying is stay away from saturated fat and cholesterol, stay away from meat, whole milk, mayonnaise, ice cream. Moving towards a plant-based diet is your best defense against not only heart disease, but obesity and diabetes as well," she adds.

The authors of the study, both professors at the Harvard School of Public Health in Boston, searched the MEDLINE database of medical literature for epidemiologic and clinical studies of dietary factors through May 2002. The authors ultimately examined 147 different studies and reviews for conclusions on diet and coronary heart disease prevention.

Three individual strategies emerged as the best for fighting heart disease. And they worked even better in combination.

The first is to substitute unsaturated fats for saturated and trans-fats. (Trans-fats are fats that have been altered, like those found in cookies, crackers, candy and margarine).

What does that mean to the average person?

"That means not eating red meat, whole milk, mayonnaise, ice cream and other whole dairy products," Heller says. "That has definitely been shown to decrease the risk of heart disease."

Eating meat or cheese interferes with the liver's ability to process fats and therefore raises cholesterol in the arteries.

The second strategy is to up your consumption of omega-3 fatty acids from fish oil or plant sources. You can get these fatty acids from eating fish regularly, and from consuming canola oil, soy bean oil, and flaxseed oil.

The third strategy is to consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains.

The glycemic index (GI), which attempts to rank foods on how they affect blood sugar levels, is still controversial, Hu says. It may be useful to some degree in classifying starchy foods such as bread and potatoes but it is not useful for classifying other foods such as protein, fruits, and vegetables.

Similarly, the study authors found that the relationship between dietary fat and obesity is extremely controversial.

"The conventional wisdom is that high-fat diets lead to obesity and diabetes. This hasn't been supported by the scientific evidence," Hu says.

Calories in general may lead to obesity, but not just calories from fat. In fact, Hu adds, "there's more evidence that calories from carbohydrates, especially refined carbohydrates and sugars, could be more detrimental for obesity and diabetes."

Your best bet is to combine the three dietary strategies outlined in the report. "I can be a vegetarian and still eat a lot of white flour, processed food, and white chocolate and still be overweight," Heller says. "You want the effect of all three strategies. Nuts, seeds, legumes, vegetables, fruits, whole grains, and soy products contain chemical compounds like phytochemicals, antioxidants, vitamins and minerals that help fight disease of all kind. You're reinforcing your body's ability to stay healthy every time you eat a food like that. So why not?"

What To Do

For information on how to follow a healthy diet, visit the American Heart Association. The U.S. Department of Agriculture (news - web sites) offers an online dietary assessment tool for you to assess your own eating habits.

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Green Trees, Sunshine in Home, Linked to Longevity

 

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - Seniors who live on tree-lined streets and within walking distance of grassy parks appear to survive longer than those with less exposure to greenery, according to a team of Japanese researchers.

Why? Seniors who live near "walkable green streets" may be more likely to answer the call of the great outdoors, they said.

"The availability of space near your own residence for taking a stroll is believed to increase the chances of walking outside of the residence, which helps to maintain a high physical functional status," write Dr. Takehito Takano of Tokyo Medical and Dental University in Yushima, Japan and colleagues.

They therefore recommend that urban planners and health workers take seniors' needs into account when designing towns or residences.

The researchers studied 3,144 people born between 1903 and 1918 who lived in densely populated urban areas of Tokyo. The seniors were first surveyed in 1992 and again in 1997.

Overall, 29% of the people died during the five-year study period, leaving 2,211 survivors, the investigators report in the December issue of the Journal of Epidemiology and Community Health.

Women were more likely to survive than men, but the men and women most likely to survive were those who lived near grassy or tree-filled walking areas and those who lived near parks and on tree-lined streets, study findings indicate.

Furthermore, this positive impact of the community's greenery on the seniors' five-year survival remained true even when the researchers took into consideration other factors known to influence longevity, such as the seniors' age, gender, marital status and socioeconomic status, the report indicates.

In other findings, men were less likely to survive if they lived in noisy areas clogged with automobiles and factories. And women were more likely to survive if they actively communicated with their neighbors and had initially reported a preference to continue living in their same community.

What's more, the number of hours that sunlight streamed into home windows seemed to influence longevity as well. The more hours of sunshine in the home, the greater the likelihood for surviving the five-year study period. This was true for men but not women.

The results suggest that "the value of parks and tree lined streets near residences is particularly high in densely populated urban areas for the senior citizens living there," the researchers write.

Consequently, "close collaboration should be undertaken among the health, construction, civil engineering, planning, and other concerned sectors in the context of the healthy urban policy, so as to promote the health of senior citizens," the researchers conclude.

Source: Journal of Epidemiology and Community Health 2002;56:913-918.

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Most Are Wary of Medical Research

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews
Tuesday, November 26, 2002

TUESDAY, Nov. 26 (HealthScoutNews) -- Medical research can help save and extend lives, but a new study finds that many people distrust medical research, the researchers who conduct it, and even their own doctors, who often explain the research and refer them to studies.

And that's especially true for blacks. The study found, overall, they were far more likely to be distrustful than whites.

Not surprising for anyone who knows the story of the Tuskegee (Alabama) Syphilis Study, conducted by the government from 1932 to 1972. Black males in that research study were not given treatment for the sexually transmitted disease syphilis. The fact was covered up, and a formal apology was only just issued in 1997.

In the new study, appearing in the latest issue of Archives of Internal Medicine (news - web sites), Dr. Giselle Corbie-Smith and her colleagues analyzed a telephone survey conducted in 1997 with more than 500 blacks and almost 400 whites, ages 18 and older. The volunteers were asked about their attitude, beliefs and knowledge about clinical research.

Nearly 80 percent of the blacks and 52 percent of the whites polled said they believe they or "people like them" could be used in medical research as "guinea pigs" without their consent. (In fact, research subjects must be briefed on the research and, if they are willing to participate, sign "informed consent" forms.)

Even after the researchers factored in education, income and employment status, the findings of distrust held, says Corbie-Smith, an assistant professor of social medicine and internal medicine at the University of North Carolina.

Nearly 42 percent of the blacks and more than 23 percent of the whites didn't trust their doctors to fully explain research and their participation, and about 15 percent of blacks and 8 percent of whites said they did not feel like they could question their doctors freely.

More than 45 percent of the blacks and nearly 35 percent of whites said they felt their physicians exposed them to unnecessary risks in deciding their treatments.

Corbie-Smith says her team expected distrust among the blacks, in light of history, but the whites' distrust came as a bit of a surprise.

"What is remarkable is the high level of distrust among white Americans," Corbie-Smith says.

The new research yields "startling findings," says Dr. William Cunningham, an associate professor of medicine and public health at the University of California, Los Angeles, who is an expert on minority health care.

But the findings, he adds, jibe with his own recent research. Last year, he published a paper in which his team explored access to health care among Hispanics, blacks and whites. The survey found that a lack of trust in providers actually helped to explain the disparity in access to care among minorities.

The new study, he says, expands on his research in an important way. "It looks directly at trust, and not only in providers but in research and researchers."

Corbie-Smith says that health-care providers and researchers "need to do a better job of demonstrating our trustworthiness."

One way to accomplish that, she says, is to set up a community advisory board when attempting to do community research. For a recent study on barriers to flu vaccines for elderly black people, she did just that and listened to the board's suggestions and input before progressing.

Another key to improvement, Cunningham says, is to improve the relationship between patients and doctors.

"Doctors need to determine what patients fear," he says, and then address their concerns openly and honestly.

What To Do

For more information on clinical trials, visit the National Institutes of Health. For information on the Tuskegee Syphilis Study, click on the University of Virginia.

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Toy Safety Improving, but Still Lacking-Report

 

By Todd Zwillich

Reuters Health

Tuesday, November 26, 2002

WASHINGTON (Reuters Health) - Toy manufacturers and retailers are doing a better job of promoting toy safety, though several gaps remain in how and where potentially dangerous toys are labeled, according to a report issued Tuesday by a consumer watchdog group.

The report found that traditional toy and party stores have gotten better at keeping toys that pose choking hazards away from young children. Many manufacturers have also improved the consistency of labeling for choking hazards or toys containing small parts, it concludes.

"They are definitely doing a better job," said Jennifer Thompson, a consumer advocate at the US Public Interest Research Group and author of the report. The survey is part of an annual effort by the organization to publicize toys and manufacturers that violate federal safety standards.

"We're finding fewer toys on the shelves either in violation of federal regulations or mislabeled. I would have to give the manufacturers and retailers credit for working harder" than in the past, Thompson said.

But despite the improvements, parts of the industry still lag in safety, according to the report. A fall survey of 45 online toy retailers found none that consistently use hazard warnings for toys with small parts as the law requires in traditional stores.

About half of the online retailers post age labeling information along with toy descriptions on their Web sites, the survey found.

Choking caused 123 toy-related deaths between 1990 and 2000, according to data from the federal Consumer Product Safety Commission (news - web sites) (CPSC).

The group also criticized the CPSC for continuing to allow phthalates in soft plastic toys intended for children under 5. The chemicals are used to soften polyvinyl chloride, and some research has linked them to cancer.

On Tuesday, the CPSC released a list of toys that had been recalled by manufacturers for safety reasons during 2002, urging consumer to check if they had bought the toys. The recall list, available at www.cpsc.gov, includes air-powered rockets manufactured by Estes Industries and animal toy sponges sold at Dollar Tree Stores.

US PIRG's report contains a list of 37 available toys that it says are mislabeled or unsafe due to choking hazards, phthalate ingredients or unsafe noise levels. It includes several brands of balloons that can choke small children and several other toys with small parts. The full list and the report are available at www.toysafety.net.

The Toy Industry Association, which represents leading toy manufacturers and importers, issued a statement noting that phthalates have been given "clean bill of health" by researchers and that toy safety remains a "top priority" of the industry.

"We question the motives of the organizations that use this annual pre-holiday ritual as a means of garnering media attention for their other interests. Withholding this information for the timely release at their once-a-year press conference does not serve in the best interest of the public or the children who they claim are at risk," the group's statement reads.

Thompson credited the 1994 Child Safety Protection Act with helping to improve toy safety by requiring labeling for products with small parts and other choking hazards. Thompson also said that companies also deserve credit for what she called "incremental progress" in toy safety.

"I would have to give the manufacturers and retailers credit for working harder. And then there's groups like us," she said.

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Moderate Beer Drinking May Be Heart Healthy

 

Reuters Health

Tuesday, November 26, 2002

NEW YORK (Reuters Health) - Drinking a few glasses of beer with dinner may provide some protection against heart disease, Dutch researchers report.

In their small study, levels of C-reactive protein (CRP), a compound associated with inflammation, and fibrinogen, which contributes to blood clots, declined among a group of middle-aged adults who consumed three or four glasses of beer with dinner.

Studies have suggested that even moderately elevated levels of CRP may increase the risk of atherosclerosis, or hardening of the arteries, through an inflammatory process. Fibrinogen is a clot-promoting protein that is associated with an increased risk for heart attack and stroke.

The findings, published in the November issue of the European Journal of Clinical Nutrition, add to the body of research linking moderate drinking to a lower risk of heart disease through a variety of potential mechanisms.

"An anti-inflammatory action of alcohol may help explain the link between moderate alcohol consumption and lower cardiovascular disease risk," Dr. HFJ Hendriks, from TNO Nutrition and Food Research in Zeist, The Netherlands, and colleagues write.

To investigate, they had 19 healthy, middle-aged adults consume either three (women) or four (men) glasses of beer with their dinner over 3 weeks. After a week during which no alcohol was consumed, participants drank three or four glasses of a non-alcohol beer with dinner. The diets of the volunteers remained steady throughout the study.

According to the results, blood CRP levels declined by 35% after 3 weeks of regular beer consumption compared with levels after 3 weeks of drinking non-alcoholic beer. The effect was particularly pronounced among those with higher levels of CRP at the outset, including women. Levels of CRP have been shown to be higher among postmenopausal women compared with men their age.

Blood levels of fibrinogen fell by about 12%, while levels of HDL ("good") cholesterol rose by 11% during the same period.

There was no association between beer and triglyceride, another type of blood fat linked with heart disease, the authors note.

Exactly how alcohol reduces CRP levels is not clear, they add.

Source: European Journal of Clinical Nutrition 2002;56:1130-1136.

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Healthy Aging Clues from Centenarians, Their Kids

 

By Natalie Engler

Reuters Health

Tuesday, November 26, 2002

BOSTON (Reuters Health) - Children of 100-year-olds have healthier hearts than their peers whose parents did not reach such a ripe old age, according to research suggesting that cardiovascular wellness runs in the family.

Based on a study of 176 children of centenarians, Dr. Lara Terry of Boston University Medical School found that the participants had a far lower risk of coronary artery disease, high blood pressure and diabetes than their counterparts of the same age whose parents had died in their 70s.

Interestingly, she said, she found no differences between the two groups in depression, lung disease or other health measures not associated with heart disease and its risk factors.

"This suggests that maybe there is something specific to heart disease" that offers a clue to why some people are predisposed to longer life spans, Terry said here Monday at a meeting of the Gerontological Society of America (news - web sites).

Terry followed 176 children of centenarians for 10 to 15 years and compared their overall health to that of a control group whose parents were born at the same time as the centenarians, but only lived to age 73--the average life expectancy.

Besides having a 64% reduced risk of heart disease, a 66% reduced risk of high blood pressure and a 59% lower risk of diabetes, the children of centenarians tended to weigh less and have a lower body mass index (BMI), a measure of weight in relation to height used to gauge obesity, said Terry. They also took far fewer medications and functioned better in daily life.

Her finding confirms what has long been observed--people tend follow in their parents' footsteps.

"What we are showing is the ability to age well is familial--which means it is probably a combination of genetics and environment," said Terry. However, it will be up to further research to decipher precisely how each comes into play.

A separate study, this one of centenarians themselves, may begin to explain why so many more women than men live to celebrate their 100th birthdays.

Jessica Evert, a medical student at Ohio State University College of Medicine and Public Health, measured the functional ability of 409 centenarians using a standardized test. On average, she found, the women tended to score lower than the men (63.2 vs. 74.4).

"But although women start with a lower functional score," she said, "once you add a disease or two or three, they maintain same level of functional performance."

Men, on the other hand, "are typically in great shape. But when they have problems it seems to be precipitous."

In other words, if a man gets a heart attack or stroke, he will more readily die of it than will a woman in the same situation. But the woman is more likely to endure her illness, and continue to function at a reduced capacity.

"There's something about women, socially or environmentally or genetically, that allows them to not cower in the face of illness or translate morbidity to functional decline," Evert explained in an interview at the meeting.

Precisely what that "something" is, however, remains unclear.

The research does back up another phenomenon however. Doctors have long observed that women are more resilient, said Evert. "This is the first time science has been able to quantify the trend."

Another researcher investigating gender differences among centenarians is Dr. Margery Silver, assistant professor of neurology at Boston University Medical School and associate director of the New England Centenarian Study (NECS), a national study of centenarians, their children and their siblings, at Boston Medical Center.

Conducting personality testing among 23 female centenarians revealed nothing unusual in most categories. But in the fifth area, "neuroticism"--they scored lower than the norm.

Such a score translates into an ability to "not dwell on things or internalize them but let them go," fellow researcher Dr. Thomas Perls, associate professor of medicine at Boston University Medical School and director of the NECS, explained in an interview.

The finding supports previous studies linking stress to age-related diseases such as heart attack or stroke. But this new research "speaks not to having less stress in their lives but managing stress well," said Perls.

This personality type also lends itself to being humorous and gregarious, Perls noted. "Such traits make it more likely that people will like them," which makes it easier to build social networks that also may act as a "safety net."

In a previous study of the siblings of centenarians, Perls found that brothers and sisters of 100-year-olds had half the mortality risk of their peers.

Further investigation into the theoretical link between genetics and longevity revealed a region on chromosome 4 that may explain 5%-10% of centenarians' ability to get to 100, said Perls. He is conducting this genetic research through a biotechnology company he helped found called Centagenetix, in Cambridge, Mass.

"We are coming close to finding the gene responsible for the positive linkage on chromosome 4," he said, but we're not quite there yet."

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Societal Change Hasn't Left Seniors Lonelier-Study

 

By Natalie Engler

Reuters Health

Tuesday, November 26, 2002

BOSTON (Reuters Health) - Just because older people are more likely to live alone these days doesn't mean more of them are lonely. According to a recent study of British seniors, older people of today are no lonelier than seniors of half a century ago. And most of today's seniors are no lonelier now than they were when they were young.

The findings contradict stereotypes of old age as being a time of loneliness and isolation, said researcher Dr. Christina Victor of St. George's Hospital Medical School in London, who presented her findings here Saturday at the annual meeting of the Gerontological Society of America (news - web sites).

In a survey of nearly 1,000 people 65 and older, 9% reported they were "often lonely," compared with 5% to 8% who gave the same response in studies conducted during the 1940s and 1950s.

And a mere 23% said they were more lonely than they were a decade ago. By contrast, 67% reported no change, and 10% said they were less lonely now than they were 10 years ago.

In addition to asking people to rate their degree of loneliness on a four-point scale, Victor and her colleagues interviewed 45 seniors in-depth about their patterns of social engagement and participation and how those changed as they retired. They asked participants for their views of loneliness and suggestions for remedying it.

These interviews revealed certain "risk factors" for loneliness, Victor said. These included being unmarried, widowed or divorced, having poor physical and mental health and spending a great deal of time alone. Living alone, however, does not appear to make people vulnerable to feeling lonely.

That may be good news, given that the percentage of people over 65 in Britain who live alone has increased from 10% to nearly 39% since 1945, Victor told Reuters Health in an interview.

"Researchers use loneliness and living alone interchangeably," she observed. But her research suggests older folks see things differently.

How do seniors define being lonely? A lack of contact with family and friends; practical limitations, such as poor health, financial troubles or lack of transportation; having difficulty coping; and being socially isolated, Victor said.

Finding a better way to define loneliness is important, she added, because loneliness has long been associated with a poor quality of life. "Designing interventions and measuring their success makes no sense if we're using the wrong question to ask about loneliness," she explained.

The interviews with seniors also revealed two factors that seem to protect people against loneliness. The first is old age itself. "It's a survival mechanism," she noted. "If you can't hack it, you die."

She said another way people guard against loneliness is through education. Her research showed that people who were less lonely had stayed in school after age 14. However, she has no explanation for why these extra years of schooling made people less vulnerable to feeling lonely later in life.

Having children does not seem to guard against loneliness, she noted.

There are people who were lonely when they were young and remain lonely in old age. "There's not much you can do for those people," she said. There are those who became lonely after losing friends or a spouse. And then there are people who said they felt less lonely than in the past--largely because they learned to cope with, or enjoy, more isolation.

These findings, said Victor, may help devise better interventions for helping people suffering from loneliness.

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MONDAY, NOVEMBER 25, 2002 

Linking a Sore Point to Heredity 

HealthScoutNews
Monday, November 25, 2002

MONDAY, Nov. 25 (HealthScoutNews) -- Do you suffer from recurrent cold sores? Well, it may run in your family.

University of Utah researchers say it's likely that people who are predisposed to cold sores have inherited that trait through one of six genes.

Cold sores are actually caused by the herpes simplex virus. Most people are infected with this virus, but only certain people suffer from frequent cold sores. The researchers traced cold sore susceptibility to a region of six genes on human chromosome 21.

They did a mathematical analysis and found that the odds of linkage from one of the six genes on chromosome 21 to cold sores stands at 2,500:1. That's strong enough to indicate a connection, according to the researchers who presented their finding at the recent Infectious Disease Society of America's annual meeting.

They say more research is needed to determine which of those six suspect genes is actually the culprit that makes some people suffer more cold sores.

Cold sores are more than an uncomfortable annoyance. They can lead to more serious problems such as ocular herpes - which can cause blindness - and genital herpes.

More Information

Here's where to go to learn more about cold sores.

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Married Men More Likely to Get Health Screenings 

By Natalie Engler

Reuters Health

Monday, November 25, 2002

BOSTON (Reuters Health) - Unmarried older men are less likely to get necessary health screenings than their married peers, according to a new study of men over age 65 in the UK.

With the number of single men living alone expected to more than double by 2021, according to the 2002 British census, the problem has potential health implications for the country, said Dr. Kate Davidson, who presented her findings here Saturday at Gerontological Society of America (news - web sites)'s annual meeting.

To examine the link between marriage and self-reported health, Davidson and her colleague Tom Daly, both of the University of Surrey in Guilford, England, analyzed three national databases and interviewed 85 men over age 65.

They found that divorced men and those who have never been married were less likely to have their cholesterol and high blood pressure checked routinely.

The divorced and never married men also reported worse physical and mental health, were more likely to smoke and were more likely to drink to excess--defined as consuming more than 22 alcoholic beverages a week.

It is not that the husbands were better informed, Davis explained in an interview with Reuters Health. Nearly all of the study participants "know what constitutes good health," she said. For example, they knew the recommended alcohol limit per week, were aware of the dangers of smoking, understood what was meant by a "good diet" and realized they should exercise.

The difference was that the married men put that knowledge into practice.

In other words, Davidson said, their overall health, or at least their perception of it, was better because their wives "bossed them into" going in for routine check-ups and screenings.

Davidson explained that while women routinely visit the doctor--for family planning, pregnancy, or to take their children to their pediatrician--the men in her study seemed to consider going to the doctor a "sign of weakness."

They did not want to "give in" to sickness, she observed, adding that even men on regular medication for high blood pressure or breathing difficulties didn't want to admit to seeing a doctor.

In addition to these men, whom she calls "stoics," she interviewed a large number of "skeptics" who see physicians as quacks.

One man said he would "rather go to a vet than see a doctor," she reported. Another likened the reliability of a physician's diagnosis to that of a weatherman's predictions.

But doctor avoidance becomes a vicious circle, Davidson warned. These elderly men postpone making an appointment until they are sick. They then have negative associations with the doctor because they only go when they are in pain or discovering bad news, for example, about their prostate.

They may be too embarrassed to endure a rectal exam, Davidson noted. "But prostate cancer (news - web sites) is one of the most treatable forms of cancer if caught early."

Speaking with Reuters Health, she said she does not believe this ostrich mentality is unique to older men. On the contrary, all generations of men tend to stick their heads in the sand, she said. "But the neglect is potentially disastrous for older men because they are more likely to suffer the consequences," she added.

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A Working Model for Diabetes Management

HealthScoutNews
Monday, November 25, 2002

MONDAY, Nov. 25 (HealthScoutNews) -- The U.S. federal government has joined with private business to launch a new Web site to address diabetes-related workplace issues.

The diabetes-at-work site offers a resource kit that can be used by employees, managers, occupational health providers and benefits and human resources managers to learn about the latest trends in diabetes management and work site wellness strategies. The site also incorporates other interactive tools to help with on-the-job diabetes management.

Key features of the site's resource kit include a worksheet that enables companies to assess their need for workplace diabetes education and management as well as a guide on how to choose a company health care plan that covers diabetes care needs.

The kit also has more than 30 lesson plans and fact sheets to help promote employee diabetes education and management.

About 17 million Americans have diabetes and the numbers are increasing. Workers with diabetes miss, on average, about 8.3 days of work per year. That adds up to about 14 million disability days a year, says the Centers for Disease Control and Prevention (news - web sites).

People without diabetes miss, on average, about 1.7 days of work a year.

Diabetes costs the United States $44 billion a year in direct medical costs and $54 billion a year in disability, work losses, and premature death.

More Information

Here's where to go to learn more about diabetes.

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Laser Used to Move Brain Cells in Lab Experiment 

By Merritt McKinney

Reuters Health

Monday, November 25, 2002

NEW YORK (Reuters Health) - In an advance that sounds like science fiction, scientists have used a laser beam to guide and control the growth of brain cells in the laboratory.

This is not the first time that scientists have used lasers to manipulate human cells, but the new method has an important advantage, according to the lead investigator, Dr. Allen Ehrlicher, of the University of Leipzig in Germany. Unlike another laser technique called "optical tweezers," the approach used in the study, Ehrlicher told Reuters Health, moves cells without actually touching them.

Moving cells often damages them, but the researchers found that cells manipulated using the new technique appeared to grow at a faster-than-normal pace while being stimulated to make up to 90-degree directional turns.

One eventual goal is to use lasers to develop a network of neurons in the lab, according to Ehrlicher. This "brain in a bottle" could be used as a testing ground for experimental pharmaceuticals, he said. Another aim, according to Ehrlicher, is to see whether lasers can be used to repair nerves in living animals.

Although the researchers worked with neurons, Ehrlicher noted that the method may also allow scientists to manipulate the growth of other types of cells.

"We are the first to control the natural biological process of cell (movement) with light," he said. "This affects many different fields, and as we have shown, may have significant impact in neuroscience," but also be useful in studies of aggressively mobile cancer cells, he said.

The research is in its early stages, but eventually it could lead to a way to repair damaged neurons, according to the study's authors. A report on the research is published online in the early edition of the journal Proceedings of the National Academy of Sciences (news - web sites).

"We have shown experimentally that we can use weak optical forces to guide the direction taken by the leading edge, or growth cone, of a nerve cell," Ehrlicher said. "In actively extending growth cones, we place a laser spot in front of the nerve's leading edge, promoting growth into the beam focus."

This method "allows us to guide neuronal turns as well as enhance growth," he said.

"We are therefore using light to control a natural biological process," Ehrlicher explained.

The German scientist said that one of the next steps would be to conduct more trials of the system, which was tested in rat and mouse cells in the lab.

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.252631899.

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Avoiding a Medication Mix-up

HealthScoutNews
Monday, November 25, 2002

(HealthScoutNews) -- Medications can react adversely with each another and with different foods.

When you are prescribed a new drug, the U.S. Department of Health and Human Services (news - web sites) suggests you ask your doctor or pharmacist the following questions:

  • What is the name of the medicine and what's it for?
  • Is it ok to substitute a less-expensive generic medicine for the name brand?
  • Are there foods, drinks, or other medicines I should avoid while taking this drug?
  • What are the possible side effects and what should I do if they occur?
  • What should I do if I miss a dose?
  • What should I do if I accidentally take more than I'm supposed to?
  • Have you got any written information for me?

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Memory Faulty? About 140 Genes May Share the Blame 

By Merritt McKinney

Reuters Health

Monday, November 25, 2002

NEW YORK (Reuters Health) - Using technology that provides a glimpse at thousands of genes at once, scientists have identified more than 100 genes believed to be involved with memory. What's more, brain injections of a growth factor--identified as important in the gene analysis--increased the learning ability of rats.

The identification of memory-related genes could one day lead to therapies to boost learning and memory in humans, according to the study's authors.

"One of the most ambitious goals of modern neuroscience is to identify the mechanisms whereby our brain codes, stores and retrieves memories," the study's lead author, Dr. Sebastiano Cavallaro, of the Blanchette Rockefeller Neurosciences Institute in Rockville, Maryland, told Reuters Health. Even though scientists have known that memory storage involves genes, identifying the responsible genes has been difficult, he said.

In the past, scientists have studied rats learning to navigate a maze to identify genes that are activated in the hippocampus, a part of the brain that is important for making memories. These experiments screened only a small proportion of the total number of genes, however.

Now, Cavallaro and his colleagues report that they have used technology called microarrays, which make it possible to view thousands of genes at once on a single chip, to see which genes are turned on, or expressed, in the hippocampus during the learning process.

Cavallaro and his colleagues put rats through a learning task, and then they analyzed gene activity in the hippocampus 1, 6 and 24 hours later. The researchers identified 140 genes that seem to be related to memory. A report on the findings is published in the advance online edition of the journal Proceedings of the National Academy of Sciences (news - web sites).

There were six major groups of memory-related genes, with the largest being genes involved in cell signaling. One of these signaling genes contains the blueprints for a substance called fibroblast growth factor (FGF)-18. Cavallaro's team found that injecting extra FGF-18 into the rats' brains improved their ability to learn.

The learning boost provided by FGF-18 shows that some of the pathways involved with the genes identified in the study "can indeed be effective in facilitating learning and memory," the authors conclude.

According to Cavallaro, the research eventually may lead to methods of improving memory, both under normal circumstances and in people with Alzheimer's disease (news - web sites) and other illnesses that impair memory.

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.242597199.

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Many Malpractice Cases on Drug Reactions Preventable

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews
Monday, November 25, 2002

MONDAY, Nov. 25 (HealthScoutNews) -- Nearly three-quarters of physician malpractice claims involving bad reactions to drugs could be avoided with safety measures like computerized prescribing systems and greater pharmacist involvement in patient care, a new study has found.

The study of more than 2,000 New England malpractice claims in the 1990s found 6 percent were a result of adverse drug reactions. Of those, 73 percent were a result of overdoses, botched orders and other preventable mix-ups. Most of the incidents, some of which were deadly, involved antibiotics, blood thinners and other cardiovascular drugs, mood medication, and anti-psychotics.

"One of the main problems was communication" between doctors, said Dr. Jeffrey Rothschild, a Harvard University physician and lead author of the study. Errors also occurred when hospitals had nurses doing tasks better left to residents, Rothschild said. And many resulted from inadequate training.

A controversial 1999 report from the Institute of Medicine (news - web sites) found that 44,000 and 98,000 people die each year from medical errors. The 7,000-plus medication errors annually eclipses the number of workplace deaths in this country.

Harvard University doctors conducted the new study, which appears in today's Archives of Internal Medicine (news - web sites).

Rothschild and his colleagues evaluated 2,040 medical malpractice claims filed in New England between 1990 and 1999. Of those, 129 (or 6.3 percent) were the result of adverse reactions to drugs. Nearly half of these cases were serious or fatal. Two doctors who reviewed the cases deemed that 94 of them (73 percent) to be preventable blunders.

Costs to insurers of defending the adverse drug reaction claims ran about $65,000 for non-preventable outcomes -- for instance, a bad reaction that couldn't be foreseen -- that occurred in a hospital. However, the price tag for the blunders that were deemed to be preventable rose to $376,000.

Using computers to process prescriptions and catch potential mistakes could prevent about 40 percent of drug errors, Rothschild said. Having clinical pharmacists go on rounds with physicians could avoid 50 percent of such mistakes. Also effective are "smart" infusion pumps that help nurses at the bedside administer appropriate doses of medications.

In 1999, the Institute of Medicine panel called for a 50 percent reduction in errors by 2004.

Panelist Mary Wakefield, a nurse who directs the Center for Rural Health at the University of North Dakota in Grand Forks, said the last three years have seen "substantive" progress. "That report's not a sleeper," she said.

Wakefield said the document has catalyzed debate and changes at all levels of health care, from hospitals and medical school campuses to providers and patient groups.

Dr. Joseph Scherger, dean of the college of medicine at Florida State University in Tallahassee, who was also on the errors committee, said he's optimistic that the 2004 goal is achievable, if not even beatable.

However, Scherger said lack of adequate funding for safety initiatives and "inertia" on the part of doctors has blocked more rapid progress.

What To Do

The Institute of Medicine and the U.S. Food and Drug Administration have information on medical errors. For more on patient safety, visit the National Patient Safety Foundation.

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Slight Yellow Tint May Be Protective for Newborns 

By Alison McCook

Reuters Health

Monday, November 25, 2002

NEW YORK (Reuters Health) - Babies may develop jaundice--a yellowish color in the skin and eyes--after birth as a mechanism to protect their bodies against damaging substances called free radicals, new research suggests.

All babies' and adults' bodies contain mechanisms that protect them against this type of damage, study author Dr. Solomon H. Snyder of Johns Hopkins University in Baltimore, Maryland, told Reuters Health. However, the current findings suggest that many babies get an extra boost of protection from the yellowish pigment bilirubin that accumulates in their bodies. The pigment serves as an antioxidant, but also renders them slightly jaundiced.

He cautioned that babies who aren't jaundiced at birth are not in trouble. But Snyder added that doctors may want to reconsider immediately treating babies with slightly higher levels of bilirubin in their bodies after birth.

"This would suggest, you shouldn't worry too much" about light jaundice in newborns, Snyder said.

Bilirubin is a substance formed when old red blood cells and other body components that contain heme are broken down. Jaundice occurs when bilirubin builds up in the blood rather than being excreted by the liver into the intestine.

Doctors have known for a long time that too much bilirubin can be bad for babies, but the purpose of small increases of bilirubin after birth have remained unclear. In healthy infants, bilirubin levels can rise to 15-20 milligrams per deciliter (mg/dL) of blood in the first week after birth, but severe jaundice--over 25-30mg/dL of bilirubin--can cause brain damage if left untreated.

Treatment for serious cases of jaundice usually involves phototherapy--exposing the infant to bright light, which causes the bilirubin to change into a compound that is easily excreted with urine.

To determine what the purpose of slight increases in bilirubin after birth might be, Snyder and his colleagues gathered a group of human cells in the lab and turned off the enzyme that makes bilirubin, then exposed the cells to free radicals.

According to their report in the early edition of the Proceedings of the National Academy of Sciences (news - web sites), cells without bilirubin became damaged and died. However, cells that were able to produce bilirubin were also able to survive a thousand-fold increase of the free radical-producing substance used in the previous experiment.

In an interview with Reuters Health, Snyder explained that bilirubin is particularly good at fighting free radicals in the body because it can recycle itself over and over again. When bilirubin mops up one free radical, he explained, it converts into a substance that, with the help of another enzyme, can be changed back into bilirubin.

In terms of why babies might need higher levels of bilirubin at birth than they do as adults, Snyder explained that, in many ways, it's harder on the body to be a newborn than an adult. "You don't have to be a scientist to just think for a second of the radical change in the environment of the womb to that of outside," he said.

Bilirubin is not currently sold in stores, Snyder said, but previous research has suggested that extra--but less than dangerous--levels of bilirubin might lessen the effect of stroke and even reduce the risk of cancer or heart attack. As such, he noted, it's reasonable to think that, one day, a pill that gives people an extra boost of bilirubin might also improve their health.

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.252626999.

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Eternal Vigilance Needed for Heart Attack Survivors

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews

Monday, November 25, 2002

MONDAY, Nov. 25 (HealthScoutNews) -- Looking back at the medical records of people who had heart attacks before current advanced treatments were developed, British physicians find a lesson for today's patients and the doctors who treat them: Never relax your vigilance, because the increased risk of death persists for many years.

It's a lesson that often can be ignored because of lack of awareness of the persisting risk, says Dr. Malcolm R. Law, a professor of epidemiology and preventive medicine at the University of London, and the leader of the group reporting the study results in today's issue of the Archives of Internal Medicine (news - web sites).

"People sometimes forget that they had a heart attack," Law says. "They might imagine that they are OK after a few years, but it goes on indefinitely."

The magnitude of the risk, and the length of its persistence, came as a surprise, Law says. He and his colleagues analyzed 23 published studies in which 14,211 patients who had heart attacks in the decades before the 1980s. On average, 23 percent of them died before reaching the hospital, and another 13 percent died in the hospital.

One of every 10 survivors died in the first year after they left the hospital. In the years that followed, the annual death rate was 5 percent -- indefinitely. After 15 years, the overall death rate was 70 percent.

The record was worse for people who had a second heart attack. A third died before reaching the hospital, 20 percent died in the hospital, and the annual death rate after release was 10 percent -- again, indefinitely. "The risk never went away," Law says.

"The high mortality rate emphasizes the need to ensure that everyone who has had a myocardial infarction [heart attack], even years previously, receives effective preventive treatment," the researchers write.

It doesn't always happen, Law says. "If two men go into the hospital, one who had a heart attack years ago and the other with high blood pressure, doctors might pay more attention to the one with high blood pressure," he says. "But the first guy is the one at higher risk."

As for everyday care, data from hospital records and private medical practices indicate that many heart attack survivors are not getting the care they need, the researchers say. Two-thirds of them are not prescribed cholesterol-lowering statin drugs, half are not prescribed beta-blockers and other basic heart medications and up to half are not taking aspirin to prevent blood clots.

A large number of people need special care, the report says. In Western countries such as the United States and England, 6 percent of people ages 55 to 64 and 9 percent of those ages 65 to 74 have had heart attacks. Yet "it is unusual for physicians to seek out patients who have had myocardial infarctions years before to advise them of their ongoing high risk and to commence or reinstate preventive treatment," they write.

"It is difficult to identify any other group in the population at such high risk of death that can so readily be prevented by medical means," they say.

The long-term death rate for heart attack survivors has not changed all that much over the decades, says Robert J. Goldberg, director of the Worcester Heart Attack Study, which has followed more than 10,000 patients in that Massachusetts community for two decades.

"The mortality rate is about 8 to 15 percent in the first years, then 3 to 5 percent in the years that follow," Goldberg says.

It does not diminish with time for a variety of reasons, such as patients not complying with doctor's instructions and the presence of other illnesses, Goldberg adds.

What To Do

To learn more care after a heart attack, consult the American Heart Association or the Heart Information Network.

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Urine Test May Predict Long-Term Memory Loss 

By Natalie Engler

Reuters Health

Monday, November 25, 2002

BOSTON (Reuters Health) - Measuring levels of a stress hormone in urine may identify older men with a high risk of age-related memory loss, preliminary research suggests.

Investigators found that an increase in epinephrine, a hormone released during times of physical or emotional strain, was associated with greater mental decline in men in their 70s.

A test for the hormone could ultimately identify people at risk of Alzheimer's disease (news - web sites), the study's lead author, Dr. Arun Karlamangla, told Reuters Health in an interview.

However, Karlamangla, a physician and researcher at the University of California, Los Angeles, emphasized that he does not recommend instituting such a test until researchers see if reducing epinephrine levels can actually help.

"We know stress hormones predict poor health outcomes," he said in an interview. What is not known, is whether lowering a person's stress hormones will improve their health.

He presented his findings here Saturday at the annual meeting of the Gerontological Society of America (news - web sites).

Previous studies have shown that blood levels of stress hormones, including epinephrine, norepinephrine and cortisol, are associated with a greater risk of mortality, heart disease, mental impairment and frailty in older people.

In his study, Karlamangla and his colleagues studied 154 men and women in their 70s who were not in nursing homes and had good mental and physical function.

In 1988, the researchers collected participants' urine overnight and recorded the levels of epinephrine. They also measured participants' mental functions using tests of language, memory and abstraction. The subjects were tested again 2.5 and 7 years later.

After adjusting for other variables, including gender, blood pressure and cortisol--a stress hormone that has been linked to mental decline in women--they found that, at least in men, larger increases in urine epinephrine were associated with larger declines in mental function. Men who had an increase in epinephrine over the first 2.5 years were more likely to have a decline in memory and mental scores over the next 4.5 years compared with their peers.

"Just like high blood pressure and high cholesterol levels are markers of bad things to come, similarly, high levels of cortisol or epinephrine can also serve as additional markers," Karlamangla told Reuters Health. "But we know that lowering blood pressure and cholesterol improves health outcomes. We don't know that about stress hormones yet."

Karlamangla noted that previous research has associated health with wealth and social status. His results, he said, add to the theory that "elevations in stress hormone levels may be the mechanism by which low socioeconomic status causes poor health."

Thus, he recommends future studies to "identify lifestyle, medication, and social factors that affect stress hormone levels and design interventions to lower their levels."

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Asthma Doesn't Travel Well 

HealthScoutNews
Monday, November 25, 2002

MONDAY, Nov. 25 (HealthScoutNews) -- People with asthma are more likely to suffer an attack on vacation if they use their inhalers frequently before a trip or if they do strenuous hiking while on holiday, says an Israeli study in today's issue of the Archives of Internal Medicine (news - web sites) journal.

Tel Aviv University researchers studied 203 people with asthma, average age 24, who visited a travel clinic at the university in 1995.

Before their trips, the study participants were assessed for asthma exacerbation risk factors and did treadmill exercise and lung capacity tests. When the participants returned from their trips, they answered questions about their journeys and their asthma severity while traveling.

Of the 203 people in the study, 147 did high-altitude trekking and 88 had asthma attacks while traveling. Of those 88, 40 reported their asthma worsened during travel, 32 said they experienced their worst-ever asthma attack, and 11 reported a life-threatening asthma attack.

The researchers pinpointed two independent risk factors for asthma attack during the participants' travels. People who used their asthma inhaler at least three times a week before travel were more than three times as likely to suffer an asthma attack.

And people with asthma who went trekking were twice as likely to suffer an asthma attack. When both risk factors were combined, people in the study were more than five times as likely to have an asthma attack.

The authors write that both doctors and people with asthma need to be aware that asthma might become much worse during travel.

"Optimal asthma control before travel should be achieved by adequate use of medications in any patients with active disease. Travelers who have used inhaled beta-agonist bronchiodilators three times weekly or more during the year preceding travel should be advised to postpone travel to developing countries until better asthma control is achieved. Travel planning to avoid triggers for exacerbation, especially intensive exercise during trekking, is important," the authors write.

More Information

The American Lung Association has more about asthma.

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Half of Heart Attack Patients Don't Call Ambulance 

Reuters Health

Monday, November 25, 2002

NEW YORK (Reuters Health) - Half of individuals who are having a heart attack fail to call for an ambulance to bring them to the hospital, potentially risking their lives by delaying their access to treatment, according to new research.

Life-saving treatments for people experiencing a heart attack--also known as myocardial infarction (MI)--include surgery to open up a blocked blood vessel and drugs that discourage the body from forming blood clots, which can completely close off blood vessels, the authors report.

And driving themselves to the hospital, or asking someone to drive them there, may not get heart patients the treatments they need fast enough, according to Dr. John G. Canto of the University of Alabama Medical Center in Birmingham and his colleagues.

Indeed, the investigators found that people who called for an ambulance, on average, received anti-clotting drugs or an operation to open blocked blood vessels 12 and 31 minutes faster, respectively, than did those who didn't use an ambulance. Canto and his team report their findings in the November 26th rapid access issue of Circulation: Journal of the American Heart Association (news - web sites).

"Of the MI patients who die, over half die within the first hour, so public policy mandates that individuals with the signs and symptoms of an MI should (call for an ambulance)," Canto told Reuters Health.

"We have the opportunity to improve the outcomes of our patients by encouraging them not to delay getting medical help by calling (for an ambulance) when they have the signs and symptoms of an MI," he added.

Canto and his team base their findings on information collected on 772,586 patients who checked into a hospital after a heart attack between 1994 and 1998. During that 4-year period, the authors note, only one in two patients called 911 to request emergency medical services, which, in some cases, included trained professionals and equipment to keep them alive until they reached the hospital.

The researchers found that younger patients and males, as well as those who appeared to have relatively fewer risk factors for heart attack, were less likely than others to call emergency medical services.

Speculating as to why many patients choose not to call for an ambulance, Canto's team writes that some may believe they have relatively mild symptoms that don't require an ambulance. Others may be in denial, they add, or fear a loss of control or the embarrassment that comes with calling for and riding in an ambulance.

Source: Circulation 2002;10.1161/01.CIR.0000041246.20352.03.

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Good Enough to Eat

HealthScoutNews
Monday, November 25, 2002

(HealthScoutNews) -- Are you worried about those grayish-brown, leathery looking marks on the food in your freezer? No need to fret. According to the U.S Food and Drug Administration (news - web sites), freezer burn is a food-quality issue, not a food-safety problem.

The dry spots are caused by air seeping through packaging that's not airtight, and the color changes are a result of chemical changes in the food's pigment. The food is fine to eat -- just cut away the dry areas either before or after cooking the food.

Next time you freeze food in plastic bags, push all the air out first.

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New Evidence Backs Flu Shots for Healthy Children 

By Gonzalo Argandona

Reuters Health

Monday, November 25, 2002

SANTIAGO (Reuters Health) - The flu vaccine may be helpful for healthy children as well as people older than 50, children with respiratory problems and people with weak immune systems, according to new findings presented here last week at the 3rd World Congress of Pediatric Infectious Diseases.

"Flu vaccination is the best strategy for preventing influenza infection. However, few data are available for healthy children, so we decided to measure the effectiveness of such immunization," Dr. Sussana Esposito of the University of Milan in Italy told Reuters Health.

Before last year's influenza season in Italy, Esposito and her colleagues administered a flu vaccine to 202 healthy children aged 6 months to 5 years. The doctors used an intramuscular vaccine called Inflexal V, made by Berna.

The vaccinated children showed a 31% reduction in respiratory illnesses in the following months compared with infants who did not receive the flu shot. In addition, they required fewer medical prescriptions during the influenza season and missed fewer days of school. The vaccination also led to a 56% decrease in lost days of work for mothers to care for the ill child.

These results support the recommendation that an annual influenza immunization not be restricted to children at risk, but should also be given to healthy infants because of its clinical and economic benefit, Esposito said in her presentation at the Congress.

In an interview with Reuters Health during the meeting, Esposito explained that there are two main limitations to implementing a new policy for flu immunization in healthy infants. One is the higher cost required for the vaccination of every child. The second concern is the intramuscular application of the vaccine.

"Many parents are not very comfortable with the idea of their kids receiving that kind of vaccine every year. But this concern will be easily overcome with the new flu vaccine spray that is expected to be available soon," Esposito said.

In a parallel presentation at the Congress, Dr. Terho Heikkinen of Turku University Hospital in Finland commented that children younger than one year are hospitalized for influenza-related illnesses at rates similar to those of high-risk adults. Recent studies also indicate that influenza is the leading cause of febrile convulsion in infants.

"All this evidence and the central role of children in the spread of influenza in the community are encouraging a more widespread vaccination of children against influenza," Heikkinen said.

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Tooth Decay Linked to Heart Arrhythmia in Very Old 

By Natalie Engler

Reuters Health

Monday, November 25, 2002

BOSTON (Reuters Health) - Elderly people with a certain type of tooth decay known as root caries may be more likely to have irregular heartbeats, according to a new study of octogenarians in Sweden.

Root caries are decayed or filled root surfaces that emerge as a person's gums recede. They are common among older adults.

The reason for the link is not clear, but a sudden increase in root surface lesions may be a "marker that something is going on in the body," the study's lead author, Poul Holm-Pedersen of the University of Copenhagen in Denmark, told Reuters Health in an interview. The finding supports other research that has linked poor oral health to poor general health.

At a meeting of the Gerontological Society of America (news - web sites) here Saturday, Holm-Pedersen presented the results of a study of 129 healthy dental patients over age 80 living independently in Stockholm, Sweden.

The investigators looked at participants' medical histories and performed a cardiovascular exam. They also looked at the number of root caries and the severity of gum disease.

They found that 71% of those who had root caries also had irregular heart rhythm, compared with 56% whose roots were cavity-free.

After adjusting for variables such as age, gender, ability to function and smoking habits, they found that the people with root caries had more than twice (2.4 times) the risk of arrhythmia compared to their peers.

Surprisingly, Holm-Pedersen and his colleagues found no connection between gum disease and irregular heartbeats. Such a result seems to contradict recent research suggesting that gum disease may increase the risk of heart attack.

Offering a possible explanation, Holm-Pedersen pointed to the age of his study participants.

Gum disease and heart disease occur mostly in younger and middle-aged people, he noted. People who suffer from both may not reach their 80th birthdays.

The authors caution that although "root caries may be a marker of beginning physical decline in the oldest old...the biologic pathway is not obvious. The results point to the need for further studies on these relationships."

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Some Heart Disease Risk Factors on the Rise in US 

Reuters Health

Monday, November 25, 2002

NEW YORK (Reuters Health) - If findings from one US city are any indication, efforts to get Americans to reduce cholesterol, stay slim and exercise more haven't fared very well over the last two decades.

"Heart disease and stroke are the first and third leading causes of death, respectively, in the United States," the researchers explain. As such, public health experts believe that Americans should avoid behaviors that put them at high risk for these diseases, such as smoking or eating a high-fat diet.

"Continued assessment of...trends in risk factors is needed to inform population strategies to reduce risk and predict the future burden of cardiovascular disease," Dr. Donna K. Arnett and colleagues from the University of Minnesota in Minneapolis write in the new study.

The researchers conducted four surveys of adults living in Minneapolis-St. Paul, in 1980-1982, 1985-1987, 1990-1992 and 1995-1997. Each survey included 4,000 to 6,000 people. The findings are published in the November issue of the American Journal of Epidemiology.

Over the course of the study, dietary fat consumption fell, as did the proportion of people with high blood pressure and the percentage of smokers. The number of people using drugs to lower blood pressure and cut cholesterol also grew.

But blood cholesterol and obesity climbed, and people's level of physical activity fell.

"These findings suggest that the population burden of cardiovascular disease may increase in the near future. Programs or strategies targeted to increased physical activity, reductions in body weight, and improved diet and eating patterns are urgently needed," the authors conclude.

Source: American Journal of Epidemiology 2002;156:929-935.

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High Blood Lead Levels May Shorten Life

Reuters Health

Monday, November 25, 2002

NEW YORK (Reuters Health) - High blood lead levels appear to be associated with an increased risk of death from all causes, especially circulatory disease and cancer, new study findings suggest.

As a result, the researchers are calling for a reduction in allowable blood lead levels for US workers exposed to lead at their jobs, according to the report published in the November 25th issue of the journal Archives of Internal Medicine (news - web sites).

The toxic metal lead can be absorbed into the body through the skin, lungs or digestive tract and can damage the brain, nerves, kidneys and other organs. Most of the metal ends up in the bones, but it can also bind to red blood cells.

Drs. Mark Lustberg of the University of Maryland and Ellen Silbergeld of Johns Hopkins University, both in Baltimore, evaluated the relationship between death and blood lead levels for a group of 4,292 US adults between the ages of 30 and 74.

After adjusting for a variety of factors that affect life span such as smoking, body mass index, age, sex, income and education, the authors report that individuals with blood lead levels between 20 micrograms per deciliter (mcg/dL) and 29 mcg/dL experience a 46% increased risk of death from all causes, a 39% higher risk of death from diseases of the circulatory system, and a 68% increased risk of death from cancer compared to people with blood lead levels at or below 10 mcg/dL.

"Given the strength and consistency of...these data, we are particularly concerned for workers who are occupationally exposed to lead, many of whom continue to have blood lead levels of at least 25 mcg/dL," the authors write.

The current "action level" permitted by the US government is 50 mcg/dL, the study indicates, meaning workers whose blood lead reaches this level should be removed from jobs involving lead exposure.

"We strongly encourage efforts to reduce lead exposure for occupationally exposed workers and the 1.7 million Americans with blood lead levels of at least 20 mcg/dL," the authors conclude.

Currently, Lustberg and Silbergeld estimate that 1.7 million people living in the US have blood lead levels at or greater than 20 mcg/dL. And upwards of 29 million Americans had similarly high blood lead levels during the late 1970s, according to their report.

Source: Archives of Internal Medicine 2002;162:2443-2449.

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SUNDAY, NOVEMBER 24, 2002 

GERD: A Growing Concern

 

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews
Sunday, November 24, 2002

SUNDAY, Nov. 24 (HealthScoutNews) -- Gastroesophageal reflux disease, or GERD, is a chronic condition that is more common than you might think but missed more often than you might guess.

Yet, GERD's symptoms are all too familiar to the 25 million American adults who experience them on a daily basis: heartburn; an acid taste in your mouth; trouble swallowing; and regurgitation of food.

Most mild cases are easily treated with changes in eating habits and medications, and more severe ones can be treated with the latest in surgical procedures. But some doctors are starting to make the troubling link between the increasing number of GERD cases and a similar jump in the number of cases of esophageal cancer.

GERD occurs when stomach acid makes its way into the esophagus, usually because the valve that separates the two relaxes as people age. Alcohol, chocolate, caffeine and heavy meals can aggravate the condition.

"For most people, GERD is a lifestyle issue," says Dr. Garth Ballantine, a New Jersey surgeon who treats those with serious GERD. "If you're like me and have steak and red wine for dinner and maybe a cigar and glass of port afterwards, well, anyone who has that meal is going to have reflux. And I can choose not to have reflux by avoiding those foods."

However, those whose symptoms are more constant and more severe need to get treatment before more serious conditions develop.

That's part of the reason why the fourth annual GERD Awareness Week starts today, supported by the International Foundation for Functional Gastrointestinal Disorders (IFFGD).

"GERD, of which heartburn is the most common symptom, is pretty common among adults," says Dr. Timothy Wang, head of gastroenterology at the University of Massachusetts School of Medicine. "And the major concern is that esophageal cancer is the fastest-rising cancer in the United States -- up 8 percent a year -- and a presumption is that the rise is related to GERD."

"But while there is a lot of research on GERD, there aren't a lot of answers," Wang adds. "So we are treating GERD more aggressively, but don't want to over-alarm people, as those at risk for cancer are a pretty small group, only about 1 percent."

That group includes those with a condition called Barrett's esophagus, which occurs when chronic GERD has changed the cellular makeup of the lining of the esophagus, Wang says. When that happens, those people face a higher risk of esophageal cancer.

Esophageal cancer strikes men three times more often than women, according to the American Cancer Society (news - web sites). It's not a common cancer -- roughly 13,100 new esophageal cancer cases will be diagnosed in 2002, according to estimates. That compares to 131,600 new cases of colon cancer.

Although people with Barrett's esophagus need to be monitored regularly, Wang says, the majority of people with GERD can turn to simpler treatments to control their discomfort.

"The usual numbers are that 40 percent of the adult population get heartburn once a month, 7 percent once a week and 3 percent once a day. And 98 percent of these symptoms are controlled by lifestyle changes or over-the-counter medicines," Ballantine says.

To relieve symptoms, people can take antacids, which eases heartburn by neutralizing the acid in the esophagus. For chronic reflux, he says, doctors prescribe stronger medicines, including Pepcid and Tagamet, and proton pump inhibitors such as Prilosec.

For approximately 2 percent of people, however, medication doesn't help. Doctors then have to check for a hiatal hernia -- when part of the stomach moves up into the chest. They can also assess the acid levels in the esophagus and look at the lining of the esophagus through a small camera, a procedure called an endoscopy, Wang says.

The procedure can find inflammation, ulcers or the cellular changes in the esophageal lining that signal Barrett's esophagus, Wang says, "but most peoples' esophageal linings look normal."

If doctors do find that chronic GERD is too uncomfortable or dangerous to a person's health, there are some surgical procedures that can tighten the valve that controls the amount of acid that leaks into the esophagus.

The U.S. Food and Drug Administration (news - web sites) (FDA) recently approved two minimally invasive surgeries for GERD that can be done on an outpatient basis. One procedure uses a tube with a tiny device on the end that can stitch and tighten the valve, and the other uses a catheter with needle electrodes that use radio waves to tighten the valve. However, Ballantine and Wang say early results on both of these procedures are mixed.

As a last resort, Ballantine says, patients can have laparoscopic surgery that can correct a hiatal hernia or tighten the stomach around the bottom of the esophagus.

Better yet, he says, you can stop GERD before it leads to problems.

"Most people can choose among certain lifestyle changes that will or will not prompt reflux," he says.

What To Do

A thorough description of GERD can be found at the National Digestive Diseases Information Clearinghouse or the International Foundation for Functional Gastrointestinal Disorders.

The IFFGD also maintains a Heartburn Helpline (888-964-2001) for additional information on GERD.

Information about esophageal cancer can be found at The National Cancer Institute.

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Educating Schools About Asthma 

HealthScoutNews
Sunday, November 24, 2002

SUNDAY, Nov. 24 (HealthScoutNews) -- Six strategies to help schools better manage the problems faced by students with asthma are offered in a new report by the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC).

The guide, called "Strategies for Addressing Asthma Within a Coordinated School Health Program," is meant to help schools cope with the increasing numbers of children with asthma. From 1980 to 1994, there was a 74 per cent increase in asthma among children 5 to 14 years old.

About 5 million American children and adolescents have asthma, which accounts for 14 million lost school days each year.

Schools can help those students by adopting 'asthma-friendly' policies and procedures and providing asthma education for students and staff, said Lloyd Kolbe, director of the CDC's adolescent and school health program, in a prepared statement.

The CDC report says schools:

         Should establish appropriate management and support systems.

  • Provide appropriate health and mental health services for students with asthma.
  • Offer a safe and healthy school environment to reduce asthma triggers.
  • Provide asthma education and awareness programs for students and staff.
  • Establish safe and enjoyable physical education and activity opportunities for students with asthma.
  • Coordinate school, family and community efforts to manage asthma symptoms and reduce student absences.

More Information

You can view the full report by going to the CDC.

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Teens Lack Knowledge on Seizures 

HealthScoutNews
Sunday, November 24, 2002

SUNDAY, Nov. 24 (HealthScoutNews) -- Many American teenagers don't know what to do if a friend has an epileptic seizure, says a survey by the Epilepsy Foundation.

One in 100 American teens has epilepsy, but 68 percent of teenagers in the survey said they wouldn't know how to help someone having a seizure.

In order to address that lack of awareness, the Epilepsy Foundation is focusing on seizure education during the second year of its "Entitled to Respect" public information campaign.

The campaign's goal is to increase awareness of epilepsy among all teenagers and 10-12 years olds, to provide them with the knowledge to help when someone's having a seizure, and to increase respect for children and teenagers who have epilepsy.

Most epileptic seizures last a minute or two and are not an emergency. But it's important to know basic first aid.

Here are nine recommended steps for dealing with a person having an epileptic seizure:

         Cushion the person's head and remove her glasses if necessary.

  • Loosen tight clothing.
  • Turn the person on her side.
  • Time the seizure with a watch.
  • If the seizure lasts more than five minutes, call for medical help.
  • Don't put anything in her mouth.
  • Look for medical I.D.
  • Do not hold the person down.
  • As the seizure ends, offer the person help and support.

More Information

To learn more, visit the Entitled to Respect Web site.

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SATURDAY, NOVEMBER 23, 2002 

Many Older Children Struggle With Bedwetting

 

By Jennifer Thomas
HealthScoutNews Reporter
HealthScoutNews

Saturday, November 23, 2002

SATURDAY, Nov. 23 (HealthScoutNews) -- If you've been washing your child's urine-stained bed sheets every morning for far too many years, don't punish him -- he may have a condition called nocturnal enuresis.

That's the medical term for bedwetting, a common problem that affects an estimated 5 million to 7 million older children in the United States.

Children generally stop wetting the bed by age 3, says Dr. Marc Cendron, a professor of surgery (urology) and pediatrics at Children's Hospital at Dartmouth in Lebanon, N.H.

Though kids may have the occasional "accident" up to about age 5, children who are still wetting the bed on a regular basis after that probably have nocturnal enuresis. The problem, which is more common in boys than in girls and can run in families, can sometimes persist throughout the teen years.

What many parents don't realize is that bedwetting is treatable, Cendron says. Unaware that something can be done about it, many parents don't think of raising the issue with their child's doctor. And pediatricians aren't doing a good job of routinely asking whether bedwetting is an issue with the child, Cendron adds.

They should. Nocturnal enuresis is very common in older children. About 20 percent of 5 year olds wet the bed, according to the American Academy of Pediatrics, as do about 10 percent of 6-year-olds and 3 percent of 12-year-olds.

"What I find almost outrageous is there are treatments out there and kids can get help and support and they're not offered by doctors," Cendron says. "There are a lot of kids out there who have this problem, and it's not addressed as well as it should be."

Two factors can contribute to bedwetting in children. The first is underdeveloped internal signals to wake the child when he or she needs to urinate.

"Bedwetters are in a situation where the bladder is not communicating with the brain," Cendron explains. "The bladder empties spontaneously without the brain knowing it."

One method of developing these internal signals is by having the child wear pajamas or underwear that have a moisture sensor, which sets off an alarm when the child starts to urinate.

Because most children with nocturnal enuresis are deep sleepers, there's a good chance the child will sleep right through the alarm -- but the rest of the family will wake up.

Even if the parents have to then wake the child and take him to the bathroom, repeating the process night after night can help the child learn to wake himself, Cendron says.

A second option is medication.

One type decreases the amount of urine produced at night. Children who wet the bed tend to have low levels of a hormone called antidiuretic hormone, which regulates urine production by the kidneys, Cendron says.

The hormone helps the kidneys retain water, thereby reducing the amount of urine filling the bladder. Low levels of the hormone means a child tends to produce a lot of urine at night.

A medication called DDAVP can reduce the amount of urine the kidneys produce at night. It may also help a child wake more easily at night, Cendron says.

Another option is imipramine, an anti-depressant that can have a similar effect. But imipramine can cause nausea, insomnia and dry mouth. In high dosages, imipramine can also cause irregular heartbeats and even death, Cendron says. For those reasons, he rarely prescribes it.

What's certain is that punishing or berating the child is never the solution, says Dr. Edward Goldson, a professor in the department of pediatrics at the University of Colorado Health Sciences Center.

"It simply doesn't help, and it can be counterproductive," Goldson says. "By blowing it up and embarrassing the child, you will not accomplish what you want, which is nighttime dryness."

Parents can understandably get extremely frustrated by a child who wets the bed, mistakenly believing the child is "acting out" and wetting on purpose, Goldson says.

Making matters worse, siblings can tease. And the child can be too embarrassed to go to sleepovers or to camp. Wetting the bed can also damage the child's self-esteem, especially if parents blame him.

"As the child gets older, it can be a huge psycho-social stressor," Cendron says. "It can cause some real psychological difficulties."

Wetting the bed runs in families. If both parents wet the bed when they were kid, their child has a 70 percent chance of being a bed wetter, according to the National Kidney Foundation.

The good news is about 15 percent of children who wet the bed stop wetting spontaneously with each successive birthday, Cendron says.

Only about .01 percent of adults still wet the bed, he says.

The best thing for parents to do is reassure the child that he will stop wetting the bed in time and, if it persists, to get treatment.

One final note: It's important to differentiate between what's known as "primary" nocturnal enuresis from "secondary" nocturnal enuresis. "Primary" means the child never had control of his bladder at night.

With primary nocturnal enuresis, less than one percent of the cases are caused by some underlying medical problem, such as diabetes or kidney or bladder infections, according to the American Academy of Pediatrics.

But if a child has control of his bladder and then starts wetting the bed later in life -- "secondary" nocturnal enuresis -- you should take the child to a pediatrician for a check-up, Goldson says.

While it's usually nothing serious, it could in some cases mean a bladder infection or some emotional trauma that's causing the problem, he adds.

What To Do

For more information on the causes and treatments of bedwetting, check with the National Kidney Foundation or the American Academy of Pediatrics.

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Making Hospitals Safer 

HealthScoutNews
Saturday, November 23, 2002

SATURDAY, Nov. 23 (HealthScoutNews) -- When you go to the hospital you want to get better, not worse.

But thousands of patients are put at risk every day by preventable medical errors that happen in American hospitals. A U.S. Institute of Medicine (news - web sites) report released a few years ago said that medical errors are responsible for thousands of deaths and near-deaths every year in American hospitals.

The University of Michigan Health System hopes to remedy that with a Patient Safety Enhancement Program that was introduced in 2000. It's meant to improve the quality of patient care by doing research on methods to avoid or prevent harm to patients when they're receiving medical care.

For example, program researchers found that using antiseptic coated catheters reduced hospital infections by 36 percent.

The program also educates and encourages patients to protect themselves from medical errors.

Here are patient safety guidelines from the Agency for Health Care Research and Quality:

         Speak up if you have questions or concerns. Select a doctor you feel comfortable talking to about your health and medical treatment.

  • Keep a list of all the medicines you take so that you can inform your doctor and pharmacist. Your list should include over-the-counter products such as aspirin and ibuprofen and dietary supplements such as vitamins and herbal remedies.
  • Be sure to get the results of any test or procedure. Ask your doctor or nurse how and when you can get those results.
  • If you need hospital care, talk with your doctor about options. If you can choose from different hospitals, ask which one has the best care and results for your medical condition.
  • Get a full understanding from your doctor or surgeon of what will happen if you need surgery. Ask who will be in charge of your care while you're in hospital and get details about the surgery and recovery. If you have allergies or have had a previous bad reaction to anesthesia, tell your surgeon, anesthesiologist, and nurses.

More Information

You can learn more about patient safety at the U-M Patient Safety Enhancement Program.

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Seeing the Light on Skin Conditions 

HealthScoutNews
Saturday, November 23, 2002

SATURDAY, Nov. 23 (HealthScoutNews) -- New laser/light therapies may help millions of Americans with hard-to-treat skin conditions.

These laser and light treatments show promise as viable alternatives to medications for several common skin conditions, including psoriasis, eczema, seborrheic dermatitis, vitiligo and hypopigmentation, says Dr. Arielle N.B. Kauvar, a clinical associate professor of dermatology at New York University School of Medicine.

Kauvar provided an overview of the laser/light treatments at a recent American Academy of Dermatology meeting.

These skin conditions are often treated with such medications as corticosteroids and antibiotics. But the results vary from person to person and the medications can cause side effects. The laser/light therapies provide non-invasive, medication-free alternatives.

For example, yellow pulsed dye laser and excimer laser have been shown to clear skin lesions caused by psoriasis. The excimer laser and intense pulsed UVB light have been shown to be effective in treating vitiligo and hypopigmentation. Pulsed UVB light may also help people with eczema and seborrheic dermatitis.

In a prepared statement, Kauvar said the new laser therapies have provided remarkable improvements in people with these common skin disorders.

More Information

To learn more about skin conditions and treatments, go to the American Academy of Dermatology.

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