The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
January 6, 2003

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 30 - December 6

  1. Claritin Goes Over-the-Counter
  2. More U.S. Teens Seek Massages, Facials
  3. Coffee Lowers Women's Risk of Gallbladder Problems
  4. Flu Shots Urged for Kids 6 Months to 2
  5. Family Violence Carries from Youth to Adulthood
  6. Breastfeeding Can Aid Weight Loss
  7. Vitamin Supplements Won't Prevent Dementia: Study
  8. Eye Injuries
  9. Cell Powerhouses May Hold Genetic Key to Aging
  10. Brain Structure Difference Linked to Disruptive Teens
  11. Canada Cannot Fund Health Increase: Minister
  12. New Treatment for Psoriasis Works Well

    SUNDAY, DECEMBER 1, 2002
     

  13. Leaving Tumors in the Cold
  14. Can't Hack the Cough?

    SATURDAY, NOVEMBER 30, 2002
     

  15. The Lowdown on High Cholesterol Counts
  16. Unattainable Goals Can Be Unhealthy
  17. A Case for More Grocers

 

FRIDAY, DECEMBER 6, 2002

 

Brace Yourself

 

HealthScoutNews
Friday, December 6, 2002

(HealthScoutNews) -- If your child's dental braces break and you're nowhere near a dentist, the Children's Hospital in Richmond, Virginia, offers this advice:

  • If it's a broken wire and it can be easily removed, take it out.
  • If a sharp portion is hurting your child, cover that section with dental wax, cotton balls, gauze or chewing gum.
  • If a wire is stuck in the gums, tongue or cheek, don't remove it yourself. Seek medical help immediately.

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Scientists Debate Possible Viagra-Aggression Link

 

By Todd Zwillich

Reuters Health
Friday, December 6, 2002

WASHINGTON (Reuters Health) - A debate has begun among scientists about whether Pfizer Inc.'s impotence drug Viagra (sildenafil) can be linked to aggressive behavior and sexual violence. One researcher has concluded that doctors should begin warning Viagra users about the possibility of psychological and emotional side effects.

But other scientists, as well as officials at Pfizer, reject the claim as unsound.

In July of this year, Dr. Harold A. Milman, a toxicologist based in Rockville, Maryland, published a report in the Annals of Pharmacotherapy examining more than 12,000 reports of adverse events in men who took Viagra.

More than 270 of the reports, collected and archived by the US Food and Drug Administration (news - web sites) (FDA), detailed psychological side effects, including dizziness, disorientation and amnesia. The drug was also listed as a suspect in 22 reports involving aggression, 13 involving rape and 6 involving murder, according to Milman's article.

FDA officials said that they have no plans to change Viagra's labeling in light of Milman's report. But one top agency official said that the study was important to scientific debate about the drug.

"(The report) had a lot of information that hadn't been pulled together in one place before," Dr. Bernard Schwetz, FDA's senior advisor for science, said in an interview.

Milman acknowledged that the adverse-event reports are anecdotal evidence. "But it's clear that these men are behaving abnormally," he told Reuters Health.

The theory that the drug may cause aggression has formed the basis of the so-called "Viagra defense," a claim made by half a dozen defendants since 1998 that the drug caused them to commit violent crimes. Milman was hired as an expert witness in one such case.

The Viagra defense has not been successful so far, but an Israeli court did mention in a 1999 ruling against a rapist that the drug had played a role in the attack.

Viagra causes erections by working directly on the blood vessels of the penis, not through actions in the brain. Clinical studies in more than 8,000 men showed that the drug caused central nervous system effects in less than 2% of users, none of whom became violent or disoriented, according to Pfizer.

"I'm not saying Viagra causes anything, but there is evidence to suggest an association," said Milman, who noted that he is not an expert in Viagra's biological mechanisms. Milman spent 18 years as a senior advisor at the US Environmental Protection Agency (news - web sites) and 10 as a cancer-drug expert at the National Institutes of Health (news - web sites).

Scientists don't consider adverse-event reports to be hard evidence of a causal link between a drug and an event. The reports don't always show which other drugs patients were taking or note their state of health when taking the medication.

"You could take any product and connect individuals who use it with certain behaviors. I think it's a coincidence," said Geoff Cook, a Pfizer spokesman. "We don't think there is any credible medical evidence linking Viagra with violent or aggressive behavior."

Still, adverse-event reports are often used as a way to flag side effects in the general population that may have been missed during clinical studies. Effects that fail to show up in several thousand test subjects have a better chance of being noticed when millions of people have taken a drug.

Milman cited research in his report showing that sildenafil can enter the brain and that the drug could affect biological pathways in parts of the brain controlling sexual responses and aggression.

In interviews, other scientists rejected Milman's claims about a link to aggressive behavior. "To me, it is an extremely remote hypothesis," said Dr. Raymond C. Rosen, a professor of psychiatry and medicine at the University of Medicine and Dentistry of New Jersey.

Rosen and Northwestern University toxicologist Dr. Kevin E. McKenna wrote to the Annals of Pharmacotherapy this month challenging Milman's article.

Rosen told Reuters Health that there is no clinical evidence in humans that the biological pathways affected by Viagra can cause aggression or violence. He said that no patient he has ever evaluated has shown such symptoms.

"Changing anything clinically or legally because of this is stretching the point totally beyond credibility," said Rosen, who is recognized as a leading expert in sexual dysfunction. He noted that he has served in the past as a paid consultant for Pfizer.

McKenna acknowledged that sildenafil could affect parts of the brain that control sexual behavior, including the hypothalamus and parts of the medulla. But studies in mice show that the drug would probably make aggression less likely, not more likely, he said.

Milman said his paper was intended to encourage more scientists to look directly at whether Viagra can cause problems. "There are a lot of question marks," he said.

On that point, McKenna agreed. "I still believe behavioral effects of sildenafil should be studied more closely," he said.

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Drink Enough Water

HealthScoutNews

Friday, December 6, 2002

(HealthScoutNews) -- If you're struggling to drink the recommended eight glasses of water a day, the Memorial Hospital of Rhode Island suggests you try adding one glass of water a day until you reach your goal.

 Following a water drinking routine can also help. For example, make it a habit to consume one cup of water before and after each meal. Another way to increase your intake is to eat lots of fruits that have high water content, such as oranges, watermelon, pears and peaches.

Cut down on coffee, caffeinated soda and alcohol, which are all beverages that cause you to lose fluids.

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Viagra May Help Some Infertile Women Get Pregnant

 

Reuters Health
Friday, December 6, 2002

NEW YORK (Reuters Health) - A small percentage of women with infertility due to problems with their uterine lining were able to become pregnant after taking the drug Viagra in a vaginal suppository form, according to a new report.

Viagra (or sildenafil, as it is known generically) appears to increase blood flow to the uterus, increasing the thickness of the uterine lining, or endometrium. A relatively small number of women who cannot conceive are infertile because their uterine lining is too thin.

"A very small percentage of woman--fewer than 5%--who seek in vitro fertilization treatment can't get pregnant because their endometrium doesn't allow attachment of the embryo," the study's lead author, Dr. Geoffrey Sher from the Sher Institute for Reproductive Medicine in Las Vegas, Nevada, told Reuters Health in an interview.

In their study, Sher and colleagues treated 73 women with this type of infertility with vaginal suppositories containing Viagra four times a day at the start of their cycle for three to 10 days. The drug therapy was stopped about 2 days before eggs were harvested for fertilization and implantation into the uterus, Sher explained. The women in the Viagra group were compared with 32 similarly diagnosed women undergoing IVF treatment who did not get Viagra.

About 70% of the women in the Viagra group experienced "enhanced endometrial development," according to the report in the November issue of the journal Fertility and Sterility. Furthermore, implantation and ongoing pregnancy were considerably more common among the Viagra group--29% and 45%--than among women who did not receive the drug--2% and zero, the report indicates.

Previously, Sher evaluated the efficacy of nitroglycerin patches in increasing blood flow to the uterus, but side effects included low blood pressure and severe headaches, he explained. The Viagra suppositories deliver the medication directly to the targeted organ, he added, thus reducing side-effect risk.

In fact, Sher reports that none of the women who took Viagra reported any side effects whatsoever.

"On the basis of our findings, we conclude that selective use of (Viagra) suppositories in the small subset of patients with a thin lining due to inadequate endometrial blood flow may represent a valuable addition to the assisted reproductive technology therapeutic armamentarium, although larger, randomized studies are needed to better validate its effectiveness," the authors conclude.

Source: Fertility and Sterility 2002;78:1073-1076.

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Caregivers Juggle Responsibilities, Squeeze Themselves

HealthScoutNews

Friday, December 6, 2002

FRIDAY, Dec. 6 (HealthScoutNews) -- Many women in the prime of their life are often caring too much for others and not enough for themselves, a new British study suggests.

Those who juggle too many roles in midlife -- parent, worker, family caregiver and spouse -- may have reduced income and less opportunity to build sufficient pensions to support themselves in retirement, the research found. Women are hit hardest in these situations, says the study, part of the Growing Older Programme funded by the Economic and Social Research Council.

Just over half of women aged 45-59 had paid into a private pension fund, compared to 75 percent of men. Even the women who paid into a private pension fund were lagging behind men.

Their average contributions totaled 13 years, compared to 21 years for men.

The researchers say private pensions are increasingly important as the real value of government pensions declines.

The study reports that many women found it difficult to balance being a family caregiver with their work. One in five women who became a caregiver gave up work, and another one in five said they reduced their working hours, earned less money or worked only restricted hours.

Both men and women who stopped work were less likely to be part of an occupational pension plan.

The researchers argue that government needs to correct wage and pension problems experienced by people who are forced to become family caregivers. That assistance could be similar to that provided to people who take parental leave to look after their children.

More information

The AARP has information about retirement planning.

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Gene Therapy Fights Pancreatic Cancer in Mice

 

Reuters Health
Friday, December 6, 2002

NEW YORK (Reuters Health) - Because it is often caught only in its more advanced stages, pancreatic cancer--the fifth leading cause of cancer death in the US--is rarely curable.

But Japanese researchers are using gene therapy to achieve what they call "dramatic" results in shrinking pancreatic tumors in mice, even after the cancer has spread beyond the pancreas.

Treatments like these targeted to specific cancer-causing genes "offer some hope for developing a novel approach to pancreatic cancer," write Dr. Masaru Oonuma and colleagues at Tohoku University Graduate School of Medicine in Sendai, Japan.

They report their findings in a recent issue of the International Journal of Cancer.

Pancreatic cancer is most often a "silent killer," with no symptoms appearing until the malignancy has become very advanced. Surgery at this point is often out of the question, and drug therapy has limited success because pancreatic cancer cells are notoriously resistant to even the most powerful chemotherapy.

One way to short-circuit drug resistance may be to target genes within cancer cells that help the cell dodge these medications.

In their study, Oonuma's team first injected human-derived pancreatic cancer cells into mice. When the pancreatic cancer had spread beyond the pancreas itself into surrounding tissues, the researchers infected some of the mice with a harmless virus that also "piggybacked" a compound called uracil phosphoribosyl transferase (UPRT) to the area of malignancy. According to the researchers, UPRT effectively "switches on" a gene that works to overcome a cancer cell's resistance to chemotherapy.

In fact, mice treated with a combination of gene therapy plus the powerful cancer drug 5-fluorouracil (5FU) "showed a dramatic tumor reduction without adverse effects," Oonuma and his colleagues report. Tumor shrinkage occurred both within the mouse pancreas and in the areas beyond the organ, while leaving normal tissues unharmed.

Encouraged by their success, the Japanese team is conducting similar experiments in mice affected with human-derived liver tumors, as well. And they note that a human trial, using a very similar approach, is already under way in patients with head and neck cancers.

Although much work needs to be done, and routine use of these types of therapies in the hospital setting is still years away, Oonuma and his colleagues call their gene therapy approach "a promising tool for targeting (metastatic) pancreatic cancer."

Source: International Journal of Cancer 2002;102:51-59.

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Music Makes the Difference

HealthScoutNews

Friday, December 6, 2002

FRIDAY, Dec. 6 (HealthScoutNews) -- Music can help people with severe lung disease tune up their fitness levels, says a study in a recent issue of Chest.

The American study included 24 people with serious lung disease. They were divided into two groups of 12. One group listened to music while walking, and the control group walked without music.

The people who listened to music while walking covered an average of 19 total miles over the eight-week study, compared to an average of 15 total miles for the control group. That's a average distance difference of 21 percent.

At several points in the study, the participants were timed to see how far they could walk in six minutes. By the end of the study, the people who listened to music increased the average distance they covered in six minutes by 445 feet (136 meters), while the non-music group had an average decrease of 169 feet (51 meters).

The people in the music group were given a portable audiocassette player and two audio cassettes with country/western, classical, pop/Motown and big band music.

As well as improving their walking performance, the people in the music group also reported they had less trouble with shortness of breath while doing routine activities such as bathing, combing their hair and cooking meals. The non-music group didn't report any changes in their breathing.

The findings suggest music may help distract people with serious lung disease from some physical symptoms of the disease while they exercise.

More information

Here's more about how anyone can benefit from walking.

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Cutting Down on Smoking Won't Cut Death Risk

 

Reuters Health
Friday, December 6, 2002

NEW YORK (Reuters Health) - Heavy smokers hoping to stave off respiratory illness or death by cutting down on the number of cigarettes they smoke may want to rethink their choice and quit altogether, according to new study findings from Denmark.

Significantly reducing the number of cigarettes smoked did not appear to have any long-term benefit in terms of death risk compared to not cutting down at all, according to the report published in the December issue of the American Journal of Epidemiology.

In the current study, Dr. Nina S. Godtfredsen of Copenhagen University Hospital and colleagues assessed the cause of death for nearly 20,000 people over a 15-year period. The investigators compared heavy smokers (15 or more cigarettes a day) who reduced the number of cigarettes they smoked by at least half during the study but didn't quit, with smokers who did quit, as well as people who continued to be heavy smokers. The researchers also looked at consistent light smokers, who smoked 14 cigarettes or less daily.

Heavy smokers who cut their cigarette intake by half saw no reduction in deaths from any cause during the study period. Quitters, on the other hand, had a 35% lower risk of death from all causes than those who continued to smoke heavily, while light smokers' death risk was 25% lower.

And quitters cut their risk of death from tobacco-related cancer by 64%, while there was no significant difference in mortality from such cancers for those who reduced their tobacco intake.

The researchers also found no difference in respiratory disease or mortality from cardiovascular disease between people who reduced their smoking and those who continued to smoke heavily.

The authors note that the study is the first, to their knowledge, to investigate from a prospective point of view the question of whether reducing cigarette smoking can cut mortality risk.

Source: American Journal Epidemiology 2002;156:994-1001.

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New Technique Hailed for Tendon Injuries

HealthScoutNews

Friday, December 6, 2002

FRIDAY, Dec. 6 (HealthScoutNews) -- A minimally invasive technique called ultrasound needle-guided therapy can treat such problems as tennis elbow or jumper's knee and may be helpful in treating other kinds of similar injuries.

Thomas Jefferson University Hospital researchers tested the ultrasound therapy on more than 300 people for the study, which was presented this week at the Radiological Society of North America's annual meeting in Chicago.

The ultrasound can be used to treat chronic tendon problems that may not warrant surgery but that can cause bothersome symptoms. The treatment provides relief with minimal disruption to the patient's life.

The ultrasound is used to get a clear image of abnormal tendons, to identify areas of scar tissue on tendons, and to determine if the scar tissue is infiltrated with calcification.

Needle therapy, using a local anesthetic, is then used to treat the tendon problem. The needle is guided by ultrasound to areas that contain scar tissue. The needle tip is used to break up the scar tissue and any calcification. In some cases, cortisone-like medication is injected into the area.

The needle therapy encourages blood vessels to enter the affected area and that lets the body dissolve scar tissue and build new, healthier tissue.

The study found that about 65 percent of those treated (151 males, 155 females, aged 13-82) reported improvement. The study participants had various tendon, muscle and ligament injuries such as tennis elbow, golfer's elbow, jumper's knee, hamstring and rotator cuff injuries and Achilles tendon problems.

None of them had responded to other therapies such as medication, bracing, physical therapy or rest. They'd had symptoms for periods ranging from three months to 15 years.

More information

The American Academy of Orthopaedic Surgeons has more about tennis elbow.

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Memories Don't Always Match Real Life: Study

 

By Charnicia E. Huggins

Reuters Health
Friday, December 6, 2002

NEW YORK (Reuters Health) - Many older people remember experiencing the happiest and most important events of their lives during their 20s, while their saddest and most traumatic memories seem to have been created from more recent events, study findings show.

Yet, the truth of the matter is that our "memories do not simply mirror what life is," study author Dr. Dorthe Berntsen of the University of Aarhus in Denmark told Reuters Health.

For example, although someone may feel that the happiest moment in their life occurred when they were married at the age of 25, in reality, they may have experienced the same level of happiness at a later, more recent stage in life.

The reason for this apparent memory discrepancy, according to the report, may be that "autobiographical memory is organized by sociocultural 'life-scripts'--prescriptive timetables for generally expected milestones in life--that tend not to include emotionally negative events while allocating most important positive events to young adulthood," Berntsen said.

Thus, "the findings have implications for our understanding of traumas and other negative events in the life story of the individual," she added. "In the standard account of life--following the life script--such events may not be mentioned."

Berntsen and her co-author, Dr. David C. Rubin of Duke University in North Carolina, studied 1,241 people in Denmark aged 20 to 93 years.

Study participants aged 40 and older said the most important events of their life occurred during their 20s, while younger participants said those events happened more recently. When asked about the happiest moments of their lives, even those in their 30s, as well as older individuals, said those events occurred during their 20s, the researchers report in the December issue of Psychology and Aging.

Yet, for people of all ages, the saddest and most traumatic memories were from events that occurred in later, more recent years, the report indicates.

It is unlikely that a large proportion of the happiest events in the study participants' lives actually took place between the ages of 20 and 30, and the fact that the sadder and more traumatic memories were more recent would "implicate that life has been extraordinarily hard for all age groups during the last 10 to 20 years in Denmark (which) is also unlikely," the researchers write.

However, in light of the study findings, what does appear to be likely is that due to the influence of "sociocultural life scripts," what we think of as our happiest or saddest moments may be "a product of memory, not a product of life," Berntsen said.

Source: Psychology and Aging 2002;17:636-652.

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Combo Treatment Aids CO Poison Victims

 

HealthScoutNews

Friday, December 6, 2002

FRIDAY, Dec. 6 (HealthScoutNews) -- University of Toronto researchers have developed a new first-aid treatment that could prevent brain damage in people suffering from carbon monoxide poisoning.

The method delivers more oxygen to the brain than the current standard treatment.

The researchers studied 14 people who were exposed to low levels of carbon monoxide (their blood levels were about the same as those in heavy smokers) on two occasions to simulate carbon monoxide poisoning conditions.

After each of the one-hour exposures, the study subjects were given either the standard treatment of 100 percent oxygen, or the new method consisting of a mixture of mostly oxygen with some carbon dioxide. All received both treatments at random.

During the exposure to the carbon monoxide and after administering the treatments, the researchers monitored the amount of oxygen in the participants' blood and the blood flow to their brains.

The study, pubished in the December issue of the Annals of Emergency Medicine, found treatment with 100 percent oxygen diminished blood flow and oxygen delivery to the brain. Blood flow decreased by as much as 33 percent and oxygen delivery to the brain was reduced by as much as 20 percent.

That amount of decrease in blood flow to the brain is enough to cause brain damage in a person suffering from carbon monoxide poisoning.

During treatment with the oxygen-carbon dioxide combination, oxygen delivery to the brain was greater than during treatment with oxygen alone and the rate of carbon monoxide elimination increased by more than 20 percent.

This study raises the possibility that the current standard first-aid treatment for carbon monoxide poisoning constricts blood vessels going to the brain and reduces the amount of oxygen delivered to the brain.

The researchers think the small amount of carbon dioxide in their new treatment counteracts constriction of blood vessels going to the brain. In a prepared statement, they say clinical studies on this new treatment need to be done before anyone recommends changing current first-aid treatment for carbon monoxide poisoning.

More information

Here's where you can learn more about the dangers and prevention of carbon monoxide poisoning.

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FTC Sues Diet Aid Firm for Alleged False Claims

 

Reuters Health
Friday, December 6, 2002

WASHINGTON (Reuters) - Federal consumer watchdogs on Thursday filed suit against a San Antonio-based firm they charged used radio disc jockeys in 110 US cities to make false claims about their product as a weight-loss aid.

Federal Trade Commission Bureau of Consumer Protection chief Howard Beales also said he expected a federal judge to sign an order within days requiring Mark Nutritionals Inc. to strike "weight loss" from the name of its "Body Solutions Evening Weight Loss Formula."

"We will be seeking redress for consumers who purchased the product," Beales told a news conference, adding that several states including Texas and Illinois were due to file separate suits against the company on Thursday.

While the commission could go after the DJs and radio stations that ran the testimonials, he said, it was instead asking "responsible media" not to run clearly false advertisements.

Mark Nutritionals officials were not immediately available for comment. The company's Web site directs users to take the formula before bed on an empty stomach and keep a sensible weight loss goal of one to two pounds a week in mind.

It also urges potential clients to reduce snacking, drink at least 8 glasses of water a day and take one of its own brand of meal replacements in lieu of one high-fat or high calorie meal a day.

But the FTC said the firm made $190 million in sales using testimonials by the DJs on more than 650 radio stations that included claims that users could eat more, including high fat foods such as doughnuts and nachos, and still shed pounds without exercise.

"It helped me lose 36 pounds and it helps me maintain through the holidays," the FTC quoted one radio spot as saying. "I mean, I ate so much over Thanksgiving, I still have turkey burps. But thanks to Body Solutions, I keep the weight off and now I'm ready for Christmas."

Mark Nutritionals filed for Chapter 11 bankruptcy in September, the FTC said.

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Expanded Use for Chemotherapy Drug

HealthScoutNews

Friday, December 6, 2002

FRIDAY, Dec. 6 (HealthScoutNews) -- The U.S. Food and Drug Administration (news - web sites) has approved expanded use of the chemotherapy drug Taxotere, allowing manufacturer Aventis to market the drug as a first-line treatment for non-small cell lung cancer.

The drug is already widely used as a first-line treatment for breast cancer (news - web sites), meaning it is the first drug to be prescribed after diagnosis. It had also been a second-line treatment for lung cancer, to be used after patients had tried another form of chemotherapy. Taxotere had about $1 billion in U.S. sales last year.

Non-small cell lung cancer is the most common form of lung cancer, which claims about 155,000 lives each year, or 28 percent of all cancer deaths. Lung cancer is now the number one cause of cancer deaths among women, having surpassed breast cancer.

The FDA approval of the drug's expanded use was based on a clinical trial involving 1,218 patients. The drug works by preventing cancer cells from dividing to form new cells. Taxotere's primary side effects include low white blood cell count, fatigue, fluid retention and mouth sores.

Here is the company's announcement of the FDA approval. For more information about lung cancer, visit the National Cancer Institute.

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Extra B Vitamin May Keep Mind Sharp in Old Age

 

By Alison McCook

Reuters Health
Friday, December 6, 2002

NEW YORK (Reuters Health) - Elderly people who get relatively low amounts of the B vitamin niacin in their diets may be more likely to develop Alzheimer's within the next few years than others, according to preliminary research.

However, study author Dr. Martha Clare Morris of Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois cautioned in an interview with Reuters Health that this is a very early finding, which needs to be confirmed by additional studies before the B vitamin can be linked to Alzheimer's.

"This is just something of interest for further study," Morris said. "It's way too early in the research to make recommendations."

In the current study, presented during the Gerontological Society of America (news - web sites)'s 55th Annual Scientific Meeting in Boston, Massachusetts, the researchers recorded how much niacin a group of 815 dementia-free people at least 65 years old ate in their diets, and tracked who developed Alzheimer's over the next 4 years.

Food intake was recorded using a questionnaire in which participants indicated how often they ate certain foods during a previous period, often a year. Foods that contain relatively high levels of niacin include meat such as chicken, nuts, legumes and enriched grains and cereals. The current recommended daily allowance (RDA) is 16 milligrams (mg) per day for men and 14 mg per day for women.

The investigators divided people into five groups based on their niacin intake. They discovered that people who ate the most niacin--of whom half consumed more than 22 mg each day--were 79% less likely to develop Alzheimer's than were those who ate the least. Half of the lowest consumers of the B vitamin took in less than 13 milligrams per day.

Morris explained that the benefits of niacin appeared to kick in as soon as people increased their intake only slightly, for the second-lowest niacin consumers were also 70% less likely to develop Alzheimer's during the study period than those who ate the least.

"So it really looked like it was more of an increase in risk for people who had a low intake" of the B vitamin, Morris said.

But why levels only slightly below the niacin RDA were linked to an increased Alzheimer's risk remains unclear, she added.

She noted that the previous analysis did not factor in the effect of niacin, or vitamin B3, that participants took in from supplements. Later, she and her colleagues combined intake from supplements and diet, "and basically got pretty much the same results," she said.

Although how low levels of niacin in the body could lead to Alzheimer's remains unclear, Morris said that people who eat relatively little of the nutrient may develop a condition marked by confusion and psychosis, which niacin supplements can correct. Animal studies also suggest that low levels of niacin in the body could lead to brain cell damage.

Previous reports have shown that some vitamin supplements contain much higher levels of niacin than the RDA, and too much niacin may cause flushing, itching and other symptoms. As a result, Morris recommended that people who want to take in more niacin focus on getting it from foods.

"Supplemental forms of niacin should be taken under the supervision of a physician," she said.

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Extramarital Sex is Bad for Your Health

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Friday, December 6, 2002

FRIDAY, Dec. 6 (HealthScoutNews) -- Sex is like a walk in the park -- except when the walk takes place in the wrong bedroom.

A British report has found the energy expended during sex for the average middle-aged man is the equivalent of walking a mile in 20 minutes, and is thus generally safe, even for those men with heart disease.

However, in the very rare cases of sudden death during sex, 75 percent of those deaths occurred during extramarital relations, reports Dr. Graham Jackson, a cardiologist at Guys' and St. Thomas' Hospital in London.

"The overall incidence of sudden death during sex is very low, less than 1 percent," says Jackson. However, he adds, the large majority of men studied who died in this way were in their 50s or 60s and had been with younger women who weren't their wives.

"They were with an unfamiliar partner, in an unfamiliar setting, had too much to eat and drink and too much to prove," Jackson says.

Jackson reviewed three studies that analyzed the results of autopsies of nearly 35,000 men and women who died of heart disease. Only 0.6 percent of the deaths occurred during sex. He announced the results of his review in an address this week to sexual health professionals in Hamburg, Germany.

Dr. Nieca Goldberg, a cardiac rehabilitation expert at Lenox Hill Hospital in New York City, agrees the heart risks posed by sex are small. "Basically, sex is comparable to a brisk walk, and an orgasm is like climbing a flight of stairs," she says. "It is considered moderate activity."

However, if someone is a little less comfortable during sex because he is not with his regular partner, it could make the heart work harder and increase cardiac risk, she says.

Jackson says the percentage of deaths during extramarital relations was remarkably consistent in the three studies he reviewed, from Japan; Frankfurt, Germany; and Berlin.

In each study, 75 percent to 77 percent of those men who died during sex were with younger partners to whom they were not married.

People in their 20s have sex more often and in a more vigorous fashion than do people in their 50s and 60s, so when an older man is with a younger woman "you can see the mismatch, sort of wishful thinking," Jackson says.

For most people, sex is hardly a dangerous activity.

"The risk of dying during sex is very low, and the risk of a heart attack during sex is very low. If you can keep physically fit and have a healthy lifestyle, the risk is even lower," Jackson says.

The health risks of sex for people with heart disease aren't that significant, Goldberg says. However, some continue to worry.

"It is a quality of life issue," adds Goldberg. "Worry about having a recurrent heart attack or dying suddenly is on their minds and is often not verbalized at a doctor's visit."

"If the doctor doesn't bring it up, you should," she says.

What To Do

Check for the warning signs of a heart attack by visiting The American Heart Association. The AHA also offers some advice about resuming sex after a heart attack.

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Cold Weather Blues Linked to Sunlight, Serotonin

 

By Alison McCook

Reuters Health
Friday, December 6, 2002

NEW YORK (Reuters Health) - Levels of serotonin, a chemical that is low in the brains of people with depression, also dip during the cold and dark months in the brains of healthy people, according to researchers.

These findings suggest that seasonal affective disorder (SAD), a regular recurrence of depression during the fall and winter, is caused by a drop in serotonin levels in the brains of susceptible people, lead author Dr. Gavin Lambert of the Baker Heart Research Institute in Melbourne, Australia, told Reuters Health.

Patients with SAD often improve after basking under bright light, a technique known as phototherapy. Little is known about why phototherapy works, but Lambert and his team discovered that serotonin levels rise in the brain on days with longer periods of sunlight, regardless of the season. Consequently, he suggested that bright light may boost mood by activating neurons, or nerve cells, that contain serotonin, thereby increasing levels of the chemical in the brain.

"It would seem that, from our results, (the) condition may well be due to a reduction in brain serotonin neuronal activity and that bright light therapy may act to increase the activity of brain serotonin neurons," he said.

"There remains a stigma attached with SAD and mental illness in general," Lambert added. "Our results hopefully will go some ways to reassuring people that there is an underlying biological reason for their condition."

During the study, published in the December 7th issue of The Lancet, Lambert and his team tested blood samples taken at different points in the year from blood vessels leading directly from the brain in 101 men with no history of depression.

The investigators discovered that the activity of neurons that contain serotonin was lowest when measured during the fall and winter months, and highest in spring and summer, the seasons with the longest daily periods of daylight.

Based on these findings, "it would seem that sunlight in some way activates those neurons in the brain that contain serotonin," Lambert said in an interview, causing them to release more serotonin in the brain.

In addition, the researchers found that samples taken during especially bright days--in whatever season--invariably showed higher activity of serotonin neurons than those taken on darker days. "The level of brain serotonin is directly related to the amount of bright sunlight on the day of testing," Lambert noted.

Although the study was conducted with men only, the researcher said he expected that women also experience a drop in serotonin levels during the darker months. However, he noted that the extent of the drop likely differs between the sexes, since sex hormones can influence the activity of serotonin-containing neurons.

Source: The Lancet 2002;360:1840-1842.

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Swaddled Infants Sleep Better, Safer

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Friday, December 6, 2002

FRIDAY, Dec. 6 (HealthScoutNews) -- Babies who sleep in swaddling cloths wake up less frequently and get twice as much REM sleep during a nap as those sleeping with normal blankets, says new research.

Moreover, swaddling babies appears to help them stay on their backs when they sleep, reducing the risk of sudden infant death syndrome, according to the study in the December issue of Pediatrics.

"Everybody's impression is that swaddles make babies feel safe and secure," says lead author Dr. Claudia Gerard, a clinical instructor in pediatrics at Washington University School of Medicine in St. Louis. "They slept really well. Quiet little babies sleeping."

In the study, Gerard and other researchers evaluated 26 infants during naps lasting an hour to an hour-and-a half. Each baby was laid to sleep with a conventional blanket, and then on a separate occasion in a tight swaddle made of cotton and spandex about the thickness of a T-shirt.

As the infants slept, the team measured their rapid eye movement (REM), breathing patterns, brain waves and the number of times they were startled or woke up. When swaddled, the babies not only woke up and startled less frequently, they also fell asleep again much sooner after arousal. And the length of REM sleep during the nap doubled for the swaddled infants, from about 450 seconds to 900.

"Now we have scientific evidence to support the age-old belief that swaddled infants sleep better than unswaddled infants," says Gerard, who is also a doctor at the St. Louis Children's Hospital.

The swaddle Gerard's team developed for the trial sculpted to the infant body shape. It allowed some movement, but restrained the infants enough to keep them on their backs. That technique, as well as the light weight of the swaddle fabric, corresponds with recommendations from other studies.

For example, in 1992, the American Academy of Pediatrics recommended that parents put toddlers to sleep on their backs, and as a result, the number of cases of sudden infant death syndrome (SIDS) has since dropped by 50 percent.

Moreover, a study just released in the Journal of the American Medical Association (news - web sites) also supports the notion that babies should be wrapped in light fabrics. In that study, by the U.S. Department of Health and Human Services (news - web sites), researchers found that babies wearing at least two layers of clothing -- excluding a diaper -- had more than a sixfold increase risk of dying of SIDS.

"Over-bundling or over-clothing leads to overheating when the baby is sleeping," says Dr. Solomon Iyasu, an epidemiologist with the reproductive health program at the U.S. Centers for Disease Control and Prevention (news - web sites) and lead researcher on the HHS study. "This relation has been shown in other studies as well."

Parents should ensure that clothing and blankets don't cover the face of their infant, which is also associated with SIDS. And when deciding how many blankets to put over an infant, parents should use themselves as a barometer, he says.

"It really depends on room temperature," Iyasu says. "We advise people to put as much clothing on the baby as would be comfortable for themselves."

In her research, Gerard has interviewed women from Eastern and Mideastern countries about how they swaddled their infants. Unlike Americans, who generally only wrap their babies tightly in the hospital, those women used a swaddle much longer.

"I think most people in America give it up once they get out of the newborn period. But other cultures in the world do it for six months, and in some cases 12 months," Gerard says.

The problem with the common American technique is that unswaddled babies can more easily flip onto their bellies when they sleep, which risks SIDS, especially during the infant's first six months, Gerard says.

Although she and her team now have a patent on the cotton/spandex swaddle they developed for the study, they don't intend to market it any time soon, she says.

What To Do

For recommendations about children's sleepwear, visit the American Academy of Pediatrics. For facts about sudden infant death syndrome (SIDS), visit the National SIDS Resource Center.

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West Nile Survivors Fare Well After Illness

 

Reuters Health
Friday, December 6, 2002

NEW YORK (Reuters Health) - Older adults who survive a bout of West Nile virus (news - web sites) are unlikely to suffer future disability, new study findings suggest.

The findings are based on an investigation conducted in Israel on 32 people 65 and older who contracted West Nile virus during the summer and fall of 2000.

In older adults, West Nile virus infection carries a high death rate--about one in five people--"but the outcome is favorable for the survivors," write lead author Dr. Yitshal N. Berner of Sackler Medical School in Kfar-Saba and colleagues.

In the study group, seven people died, and all fatalities were among those over age 78. Similarly, functional decline and residual damage appeared only in the older age group, with 88% of the survivors able to return to the level of functioning they had before they became ill, the authors report in the Journal of the American Geriatrics Society.

"The younger old, namely those between 65 and 74, survived the disease with neither residual damage nor fatalities," Berner and colleagues write.

West Nile virus, which is spread by mosquitoes, causes encephalitis, or inflammation of the brain. The virus was first reported in the United States during the summer of 1999, striking dozens in the New York City area and leading to widespread use of pesticides to control mosquitoes. Seven people died in that outbreak.

Source: Journal of the American Geriatrics Society 2002;50:1844-1846.

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Blood Test Reportedly Effective for Monitoring MS

 

By Rossella Lorenzi

Reuters Health
Friday, December 6, 2002

FLORENCE (Reuters Health) - A simple blood test could replace magnetic resonance imaging (MRI) in monitoring the course of multiple sclerosis (MS), according to researchers from Florence University who developed the test and hope to market it within a year.

The innovative tool, called MS Pepkit, was presented on Friday in Florence at a meeting on the role of peptides in immunology research.

In MS, the slow destruction of myelin--the thin, protective coating that insulates nerve fibers in the brain and spine--can lead to numbness, muscle weakness and stiffness, impaired vision and coordination problems. MS is believed to be an autoimmune disease, meaning that the immune system turns against the body's own cells.

Dr. Anna Maria Papini and colleagues from Florence University have identified and synthesized a molecule--glycopeptide CSF114--able to detect disease-causing, self-attacking antibodies in MS patients' blood.

CSF114 has been used as a marker in the development of the prototype diagnostic kit.

The test centers on serial studies of MS patients that showed the level of these autoantibodies correlated with disease activity. An increase in antibody level is detectable before new myelin lesions can be identified by MRI, the researchers said.

"This kit can be a cheap methodology to follow-up the disease activity, target the therapies and help the patients to achieve a better quality of life," Papini told Reuters Health.

Funded by Csf, a Florentine company active in the biomedical sector, the MS kit will represent the first "spin off" from Florence University. In the venture, Csf will hold 55% of shares, the university 20%, and researchers involved in the project will share the remaining 25%.

"The kit validation is in progress. More than 300 sera of MS patients, corresponding to monthly control for at least 12 months, are being tested, in parallel with MRI. Important research centers and hospitals are involved in the project. We believe that the kit will be put on the market within a year," Papini said.

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High Iron Level Increases Tuberculosis Risk

 

Reuters Health
Friday, December 6, 2002

BERLIN (Reuters Health) - German scientists have raised hopes that new ways of fighting tuberculosis (TB) could be devised after showing that high levels of iron in the body boost the development of the deadly disease.

A connection between the reproduction of the Mycobacterium tuberculosis bacterium and levels of iron has long been suspected; in Africa, studies have shown that people who consume large amounts of iron are at greater risk from the disease. Now scientists at the Berlin Max Planck Institute for Infection Biology say they have proved it.

A team led by Dr. Ulrich Schaible reports in the December issue of the Journal of Experimental Medicine that the rate at which TB bacteria reproduce increases in an iron-rich culture, be that in the laboratory or in model organisms.

They worked with mice specially bred to lack the beta-2 microglobin gene, which is a crucial part of the immune system. Such mice lack the immune system's "killer T-cells" and MHC molecules. They are also far more sensitive to TB than normal mice.

Scientists have taken this to mean that the T-cells and MHC are needed to fight off TB.

But the team points out in their report that a different breed of mice that simply lack T-cells, rather than beta-2 microglobin, are not nearly as TB-sensitive. Beta-2 microglobin is also involved in the function of another protein, HFE, that controls the uptake of iron into the body's cells.

A lack of HFE leads to haematochromatosis, an inherited condition in which the body's cells become overloaded with iron.

Working on the theory that iron overload could be an important factor in TB susceptibility, the Max Planck researchers took beta-2 microglobulin-lacking mice and infected them with TB. They then treated them with lactoferrin--an iron-binding protein found in milk and other body fluids, which in effect "mopped up" excess iron in the animals' bodies.

The amount of mycobacterium tuberculosis carried by the mice was reduced dramatically, they report. In contrast, normal mice given high levels of iron were more susceptible to the disease.

The identification of iron as crucial for mycobacterium tuberculosis to thrive should give researchers a good place to start in developing new ways to fight the disease, Schaible said in a statement.

"Iron as an important growth factor for tuberculosis pathogens can, in high concentrations, make the disease worse. And conversely, this opens up new approaches to more effective ways in which to treat the disease particularly in areas where iron overload and tuberculosis are present at the same time."

TB is considered one of the most dangerous diseases, killing around 2 million people a year. Treatment is complicated, lengthy and expensive and thus often unavailable in poor countries.

Source: Journal of Experimental Medicine 2002;196:1507-1513.

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Racial Disparity Gap Narrows for Prenatal Care

 

Reuters Health
Friday, December 6, 2002

NEW YORK (Reuters Health) - The gap in use of prenatal care between black and white US women has substantially narrowed over the last 20 years, new study findings show.

But it is unlikely that women of any race will meet the public health goal set out by the federal government that 90% of pregnant women start prenatal care by their first trimester of pregnancy, Greg R. Alexander of the University of Alabama at Birmingham and colleagues note.

Over the last two decades, lawmakers have enacted legislation making more pregnant women eligible for Medicaid. In its "Healthy People 2000" and "Healthy People 2010" policy papers, the federal government set the goal that 90% of pregnant women would initiate prenatal care in their first trimester.

The "Healthy People" papers are considered by most in the healthcare field to be the main framework for establishing funding priorities for health research and services at the federal level.

To investigate how close women in the US were to reaching this goal, Alexander and his team reviewed national data on births in the US between 1981 and 1998. Their findings are published in the December issue of the American Journal of Public Health.

While 61% of pregnant African-American women began getting prenatal care in the first trimester of pregnancy in 1981-1982, 73% were getting first-trimester care by 1997-1998. Eighty percent of white women received first-trimester prenatal care in the early 1980s, compared to 85% by the late 1990s.

But the researchers found that racial disparities in prenatal care actually grew among teen mothers.

While the level of prenatal care use improved during the 1980s and 1990s, and the racial gap in use of prenatal care narrowed, "at this point, it is not realistic to suggest that the Healthy People 2000 objective of 90% of pregnant women starting prenatal care in the first trimester will soon be attained for African Americans or even whites," Alexander and his team write.

And, the authors note, future studies will be needed to assess the extent to which disparities exist for other racial, ethnic and high-risk groups.

Source: American Journal of Public Health 2002;92:1970-1975.

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Key-Hole Stomach Surgery Done on German Baby

By Hannah Cleaver

Reuters Health
Friday, December 6, 2002

BERLIN (Reuters Health) - A German hospital has made surgical history by using minimally invasive surgery to repair an infant's esophageal defect, which had left her unable to swallow.

Professor Benno Ure conducted the operation on the 3-month-old girl, making just five punctures, one in her navel, one in her throat and three in her abdominal wall.

"This is the future," he told Reuters Health. "Minimally invasive surgery has revolutionized child surgery. And now we have performed one of the most difficult operations with this technique and we can go further and further to enlarge the spectrum of procedures conducted with the technique."

The 4-1/2 hour operation went perfectly, he said, and the girl was able to take in food through her mouth for the first time in her life 8 days after the operation.

Ure, head of the Child Surgery Department of the Hanover Medical School, explained that the girl was one of what he said was around 10 or 15 children born each year in Germany without a continuous esophagus. The condition is known as esophageal atresia.

This left her unable to swallow anything, neither food nor her own saliva. After her birth she was fitted with a feeding tube directly into the stomach and another to clear saliva from her throat.

These were left in place for 3 months while she was at home with her parents and could be cared for almost normally as she grew and became strong enough to withstand an operation.

"Although it is a rare condition, the procedure is a standard one. The difference with the way we did it was that we did not have to open up her thorax or abdomen. This led to far less tissue damage than a conventional operation would cause," Ure said.

The operation, known as a gastric pull-up, involves stretching the stomach up to sit in the upper part of the chest and lower part of the throat while leaving the connection between stomach and the lower part of the digestive system intact.

The complicated part of the procedure is linking the stomach and the upper esophagus pouch, but Ure said that the procedure went according to plan.

He added that the girl would now have to learn how to swallow, having not developed that skill as a newborn, and that the stomach would have to develop the ability to perform peristalsis as it had not done so before. The nerves to the stomach had also been removed for its transfer from its original position.

But these are all normal parts of recovery from the gastric pull-up and generally take place without problems, he said.

The advantages of using minimally invasive techniques for this operation were less the reduced recovery time, said Ure, and more the reduced degree of tissue damage, which subjected the child's body to far less stress.

He said, "There is the cosmetic aspect of it, she will barely have a scar, and her body was far less stressed than if the operation had been conducted conventionally."

He plans to report his success at upcoming international congresses and to publish in spring 2003.

But he noted that key-hole surgery is not completely without problems or concerns.

"During an operation like this, the body cavity has to be filled with gas to inflate it and give the surgeon room for maneuver. We use carbon dioxide and do not yet know much about the effects that may have on the body. Anesthetists have to cater for that and we know this. We also know that, for example, kidney function is reduced during such a procedure and is then restored. We are conducting studies to look at this kind of thing."

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THURSDAY, DECEMBER 5, 2002 

Brain Hormone Tied to Seasonal Affective Disorder 

HealthScoutNews
Thursday, December 5, 2002

THURSDAY, Dec. 5 (HealthScoutNews) -- New research on the hormone serotonin provides more proof that the effect of sunlight on brain neurotransmitters is a significant factor in seasonal mood disorders.

That's the finding of a report by Australian scientists in this week's issue of Lancet.

Previous evidence suggested serotonin plays a role in causing seasonal depression. However, scientists had found that concentrations of serotonin and other neurotransmitters, such as dopamine and norepinephrine, are normal in the cerebrospinal fluid of people with seasonal affective disorder.

The Australian researchers used a more accurate method of assessing serotonin concentrations in the brain. They measured the serotonin concentrations in blood vessels draining the brain.

They took blood samples from the jugular veins of 101 healthy men and compared serotonin levels based on weather conditions and seasons. They found the turnover of serotonin was lowest in the winter and the amount of serotonin produced by the brain was directly linked to prevailing sunlight duration.

More information

The National Mental Health Association has more about seasonal affective disorder.

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Gov't Sues Weight-Loss Product Maker 

By David Ho

Associated Press Writer

The Associated Press
Thursday, December 5, 2002

WASHINGTON (AP) - A company that claims its weight-loss product burns away fat while you sleep was sued Thursday by the federal government and two states, claiming deceptive advertising.

Mark Nutritionals Inc., based in San Antonio, used radio disc jockeys on more than 650 stations in 110 cities to sell its Body Solutions Evening Weight Loss Formula, the Federal Trade Commission said.

The FTC said the false claims included statements that the product would "cause substantial weight loss even if users eat substantial amounts of high-calorie foods such as pizza, beer, tacos, nachos, cheese grits, and doughnuts."

One radio ad for Evening Formula included this claim read by a DJ: "It helped me lose 36 pounds and it helps me maintain through the holidays. I mean, I ate so much over Thanksgiving, I still have turkey burps. But thanks to Body Solutions, I keep the weight off and now I'm ready for Christmas."

The agency is not suing the DJs who read the ads, which were broadcast in English and Spanish.

"This was bilingual deception," said Howard Beales, director of the agency's consumer protection bureau.

The FTC lawsuit was filed in U.S. District Court in San Antonio. Texas and Illinois officials filed similar lawsuits Thursday.

The company, which filed for bankruptcy protection in September, has taken in $190 million since 1999 selling its Body Solutions products, the FTC said. The company still sells the weight-loss product on its Web site.

Larry Cochran, acting chief executive of Mark Nutritionals since the bankruptcy, said the company has agreed to change its advertising to address the FTC's concerns.

"We are moving forward with a new way to promote and advertise our product," he said.

The weight loss formula is a liquid that consumers are instructed to drink before going to bed and at least three hours after eating or drinking. The ingredients have changed over time, the FTC said, but most recently included aloe vera gel and various of herbs and supplements.

The FTC said there is no scientific proof that any of the ingredients promote weight-loss.

Consumers ordered it over the Internet or by calling a toll-free number. The product also has been sold since the summer in Wal-Mart, Eckerd, KMart and Walgreens, the FTC said.

The FTC is seeking preliminary and permanent injunctions against the company to stop any deceptive claims. The agency also is seeking refunds for consumers.

Beales criticized the media for accepting advertisements like those for the weight-loss formula.

"We need help from responsible media outlets to keep these kinds of advertising from reaching the public," he said.

Beales said the FTC is developing a list of dubious weight-loss claims and wants to work with the media to screen those promotions.

On the Net:

FTC: http://www.ftc.gov

Body Solutions: http://www.bodysolutions.com

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Potential Melanoma Biomarker Discovered

HealthScoutNews
Thursday, December 5, 2002

THURSDAY, Dec. 5 (HealthScoutNews) -- A potential biomarker for melanoma, the deadliest form of skin cancer, has been identified by American researchers.

Their findings are reported in the current issue of the Journal of the National Cancer Institute (news - web sites).

This marker may help distinguish people with melanoma who have a better prognosis after the melanoma is removed.

The researchers focused on a molecule called HDM2. They measured the amount of HDM2 in melanoma tissue samples from people treated and followed at New York University Medical Center from November 1972 to November 1982.

The study found that tissue samples from people with higher levels of HDM2 were associated with people who lived much longer after treatment than people with low levels of HDM2.

The study found that 53 percent of the people with low HDM2 levels suffered a cancer recurrence, compared with 28 percent of the people with high HDM2 levels. After 10 years, 55 percent of the people with low levels had died, compared to 38 percent of the people with high levels of the molecule.

Cases of melanoma are increasing, and it's expected that more than 53,000 American will be diagnosed with melanoma this year and about 7,400 Americans will die from the disease.

Melanoma is the ninth most common cancer in the United States. A family history of melanoma, a fair complexion, and too much sunlight exposure increase the risk of melanoma. With early detection and treatment, melanoma is highly curable.

More information

The National Cancer Institute has more information about melanoma.

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Young Baby Brain Already Primed to Learn Language 

By Alison McCook

Reuters Health

Thursday, December 5, 2002

NEW YORK (Reuters Health) - New research shows that babies' brains are primed to learn language long before they utter or understand their first words.

Dr. Ghislaine Dehaene-Lambertz of the Center National de la Recherche Scientifique in Paris and her colleagues found that while 3-month-old babies are read to in their native language, they show brain activity in some of the regions of the adult brain that specialize in language. Much of that activity disappears when sentences are read to the babies backwards, the authors report in the December 6th issue of the journal Science.

These findings indicate that babies' brains are gearing up to learn and understand language at a very young age, Dehaene-Lambertz told Reuters Health.

"Babies are doing things very early," she said.

Dehaene-Lambertz and her colleagues obtained their findings from imaging scans of 3-month-old babies' brains as they listened to sentences read in their own language, and as the speech was pronounced backwards. Dehaene-Lambertz explained to Reuters Health that backward speech has many similarities to forward speech, but lacks certain overall cues babies likely use to determine whether the words are in their own language or not, such as dips at the end of sentences and other qualities.

The authors found that babies showed more activity in brain regions associated with speech in adults when hearing words in their own language than when the words were read backwards.

In an interview with Reuters Health, Dehaene-Lambertz explained that one of the baby brain regions active during speech is the left angular gyrus, which, in adults, is more active when people listen to words than to non-words. The other region active in baby brains is the right prefrontal region, an area that shows more activity in adults when they hear words that had been said to them moments before, but not when listening to other words.

A long-standing debate exists in the field of childhood language development, Dehaene-Lambertz noted. Some experts argue that babies are born already primed to process language, while others believe that babies are born as a blank slate, and all of the techniques used by the brain to understand language are learned by experience, she explained.

While the current study does not answer that question, Dehaene-Lambertz said that she believed no research study ever would--for who can state, for certain, when babies begin to have experience with language, when they can hear inside the womb. However, she noted that at 3 months, baby brains are already quite specialized, indicating that if experience is at work, it had to work fast.

"If they have learned, they have learned very fast," she said.

She added that while many brain regions focus on language, the brain is highly adaptable; so even if babies experience brain damage in one of the areas normally used to process language, it can be overcome. "Everything is plastic," Dehaene-Lambertz said.

Source: Science 2002;298:2013-2015.

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Stopping the Spread of Tuberculosis

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews

Thursday, December 5, 2002

THURSDAY, Dec. 5 (HealthScoutNews) -- Screening and treating new immigrants from developing nations for the latent stage of tuberculosis would produce substantial public health benefits, a new study from Toronto suggests.

Targeting the treatment to take into account global differences in patterns of antibiotic resistance is also crucial, says study author Dr. Kamran Khan, a clinician-scientist at St. Michael's Hospital at the University of Toronto. The report appears in today's issue of The New England Journal of Medicine (news - web sites).

Tuberculosis (TB), an infectious and potentially life-threatening bacterial infection, kills about 2 million people a year, according to the World Health Organization (news - web sites) (WHO). Antibiotics are used to treat the active disease. Globally, the TB epidemic is becoming more dangerous, and differences in antibiotic resistance patterns from region to region are complicating efforts to contain the disease, experts say.

Khan's team constructed a decision-analysis mathematical model, using statistics from the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC) and other sources and also plugging in region-specific drug resistance profiles.

Khan explains the focus on immigrants. "The reason we conducted the study was that in the United States and other industrialized countries, including Canada and much of Western Europe, we see a growing proportion of all TB cases among immigrants. In Toronto, for instance, 90 percent of all TB cases are [in] foreign-born. In Australia, it's 80 percent."

"Our study found screening and treating immigrants for what we call latent-stage TB would result in substantial public health and economic benefits," he says.

"TB can exist in two stages, latent infection and active, sometimes called active disease," Khan says. "If a normal immune system is exposed [to TB], the body would contain the infection and keep it in the latent stage. There would be no symptoms, and it would not be transmissible." However, if the immune system is weakened -- by contracting HIV (news - web sites), for instance -- that can trigger active disease.

Finding and treating those with latent disease, the study found, can reduce their risk of developing active disease by about 70 percent. Screening all immigrants for latent disease for a year would prevent up to 10,000 future cases of active disease, the model predicts, and would save between $60 million and $90 million in costs to society.

Khan's team also took into account the antibiotic resistance that has developed in different geographic regions and makes recommendations about regimens. For instance, rifampin and pyrazinamide is the preferred drug combination for those originally from Vietnam, Haiti and the Philippines.

Khan acknowledges the rifampin-pyrazinamide regimen should be closely monitored, because of reports of severe and fatal liver injuries, which prompted a CDC public health dispatch last month.

Another expert, Dr. Peter Katona, an assistant professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, applauds the study. "Their idea to screen [for latent infection] is a very good idea," he says.

Containing TB infections in immigrants can only boost public health, he adds. A single TB infection, if active, can infect numerous other persons, he says. According to the WHO, each person with active TB who is not treated will infect at least 10 more persons a year.

"So it is definitely cost-effective [to screen and treat] for public health," Katona says.

What To Do

For more information on tuberculosis, see the World Health Organization. For more information on guidelines for rifampin and pyrazinamide, see the U.S. Centers for Disease Control and Prevention.

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CDC Says Brain Injury Death Rate Lower

The Associated Press
Thursday, December 5, 2002

ATLANTA (AP) - The death rate from brain injuries in the United States dropped 11 percent from 1989 to 1998, probably because of stricter seat belt laws and other safety measures, officials said Thursday.

The death rate over the 10-year period declined from 21.9 deaths for every 100,000 people to 19.4 for every 100,000 people, the Centers for Disease Control and Prevention (news - web sites) said.

The total number of deaths per year fell from 54,501 to 52,506 over the period, the CDC said.

Seat belt and child safety seat laws and health education campaigns probably played a role, the CDC said.

Injuries from guns, motor vehicles and falls account for 84 percent of all traumatic brain injuries, the CDC said.

On the Net:

http://www.cdc.gov

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It's Not Too Late to Inoculate

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Thursday, December 5, 2002

THURSDAY, Dec. 5 (HealthScoutNews) -- So you think it's too late to get your flu shot? Maybe not.

"There is a notion out there that once you get past Thanksgiving, it's too late. Wrong," said Dr. William Schaffner, director of the National Foundation for Infectious Diseases and a preventive medicine expert at Vanderbilt University School of Medicine.

Flu causes about 110,000 hospitalizations and 20,000 deaths every year in the United States. It also takes a major toll on the nation's economy, leading to as many as 100 million lost days of work and billions in lost productivity, said Dr. Kristin L. Nichol, chief of the medicine service at the VA Medical Center in Minneapolis.

Each flu shot given saves the country more than $13 in health care costs and lost productivity from the virus.

Schaffner and Nichol spoke during a teleconference with reporters today to promote the flu vaccine. Nichol said she has heard anecdotal reports of low turnout at immunization clinics so far this year, and especially at store-front facilities like supermarkets and drug stores. But, she added, there's no concrete evidence yet of a trend.

Nichol said that if the anecdotes prove true, they might reflect confusion about when to receive the vaccine. Last year, for instance, there was a shortage of the vaccine, so healthy people were urged to delay getting their shots until high-risk groups had their turn. This year, however, health officials estimate that vaccine makers produced 93 million doses of flu shots, up from 87 million in 2001.

Low immunization rates, if they exist, might also be the result of a string of relatively mild recent flu seasons, Nichol said, leading some people to become complacent about getting vaccinated.

Between 5 percent and 15 percent of working adults get the infection, she said. "It's not like being on vacation."

Flu activity this seasons so far has been low, according to the U.S. Centers for Disease Control and Prevention (news - web sites). But spread of the virus is expected to gather momentum in the coming weeks. "This is the time now for everyone to be immunized," Nichol said.

Nick Peterson, nurse manger at the Fenway Community Health Center in Boston, called demand for the vaccine "about normal" this year and said he and his colleagues had dispensed almost all of their allotment of 1,400 to 1,500 doses. The Fenway clinic serves a high-risk population for flu, including the elderly and many patients with HIV (news - web sites) and AIDS (news - web sites).

Several medical groups, including the American Medical Association, the American Academy of Pediatrics and the CDC have declared, with an Elizabethan touch, the first two weeks of this month to be "National Influenza Vaccination Catch-Up Fortnight."

For the first time, doctors are suggesting that parents of children ages 6 months to two years consider having them immunized against the virus, Schaffner said.

Last month, Wyeth Vaccines announced that it would no longer produce flu shots, though it is working on a nasal spray. The company's departure leaves two manufacturers still making the injected inoculation.

Health officials said Wyeth's move doesn't jeopardize this year's supply of vaccine. The two remaining firms, Aventis Pasteur and Evans Vaccines, have said they will increase their output next season to make up for the difference, officials said.

Aventis has funded the National Foundation for Infectious Diseases' flu awareness efforts.

What To Do

For more on the flu, try the CDC or the National Coalition for Adult Immunization.

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US Plans Fund for Vaccine Trials, Manufacturing

By Alicia Ault

Reuters Health

Thursday, December 5, 2002

WASHINGTON (Reuters Health) - The US government is planning a fund for biotech companies to use to pay for late-stage clinical trials and manufacturing of vaccines, the head of the National Institute of Allergy and Infectious Diseases (news - web sites) said Thursday.

At first, the fund would be for vaccines against bioterrorism agents, but it would eventually be expanded to cover other infectious diseases, Dr. Anthony Fauci said at the Partnership for Global Health Forum, sponsored by the Biotechnology Industry Organization (BIO) and the Bill & Melinda Gates Foundation.

"If we're going to get vaccines off the ground, we need to meet industry halfway," Fauci said, noting that he is working with Health and Human Services (news - web sites) (HHS) Secretary Tommy Thompson to get the fund in place.

Small biotech companies developing new therapies and vaccines for diseases that primarily affect developing nations have complained they can't get financing for late-stage development because of uncertain demand.

"Lots of good medications and vaccines are in the pipeline, but they are stuck," said Una Ryan, president and CEO of Avant Immunotherapeutics. The problem comes to a head with phase III (late-stage) clinical trials and manufacturing--a low-risk, but expensive juncture, she said.

Fauci said the government understands the problem, but that it is "cost-prohibitive" for the National Institutes of Health (news - web sites) (NIH) to finance late-stage trials out of its own budget.

So Fauci has been discussing with Thompson a separate fund that could provide for phase III studies and manufacturing. The proposal "is in very active negotiations right now," he said.

The fund amount would be based partly on what price the government could be expected to pay for the vaccine. But the government would not set the price, Fauci said.

It is one of many new government approaches, he noted, adding that it will also pursue more partnerships with manufacturers, as mentioned by NIH director Elias Zerhouni at the same meeting on Wednesday.

HHS and the White House have become much more interested in infectious diseases that are undermining stability in developing nations, according to Fauci. The economic impact of AIDS (news - web sites), malaria and tuberculosis is "galvanizing everyone," he said.

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Fewer Teen Fatal Alcohol-Related Crashes 

The Associated Press
Thursday, December 5, 2002

ATLANTA (AP) - Fatal alcohol-related crashes involving drivers too young to legally drink dropped by more than half over the past two decades, the Centers for Disease Control and Prevention (news - web sites) said Thursday. Overall, between 1982 and 2001, fatal crashes involving alcohol — that is, where the driver had a blood alcohol level of 0.01 percent or greater — fell 46 percent among all age groups, from a rate of 12.6 per 100,000 people in 1982 to 6.7 per 100,000 in 2001.

The sharpest drop involved 16- and 17-year-old drivers, who had a 60 percent decrease in the rate of such crashes, from 12.1 per 100,000 to 4.8 per 100,000. Drivers ages 18 to 20 had a 55 percent drop.

The CDC credited strict laws against drunken driving, community education campaigns, and a shift in public attitudes toward drinking and driving.

Alcohol-related crashes caused 17,448 deaths last year, according to the CDC.

"These are the kinds of deaths that are preventable and people make a choice to drink and drive," said Gail Hayes of the CDC.

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Oven Fries Beat Deep Fried Chips for Health, Safety

Reuters Health

Thursday, December 5, 2002

LONDON (Reuters Health) - Convincing more people to choose oven-ready fish and chips over the traditional deep-fried version could have a major impact on public health, British researchers said on Thursday.

Considering that deep frying at home causes 25% of non-fatal fire injuries in Britain, besides being a high-fat way to cook, Professor Ian Roberts and Diane Rowland from the London School of Hygiene and Tropical Medicine wanted to see if promoting oven-ready chips was a feasible way to prevent household fires.

As part of a larger study, they polled 1,072 low-income households in the inner London borough of Camden. Of these, 521 deep-fried food--7% of them on a daily basis, the authors write in the December issue of the journal Injury Prevention.

Questioned about their reasons for frying, half of households cited taste as the main reason, while 32% said it was the ease and speed of the process that prompted them to cook that way.

The researchers point out that low-income households are much more likely to suffer a household fire than their wealthier counterparts.

"Despite high-profile government campaigns, chip pan fires continue to be the single largest cause of casualties in house fires," they write. "Changing cooking behavior in low income households may be feasible if the alternatives provide the same quality and convenience as home fried food at an acceptable price."

They conclude that a decrease in the numbers who choose to deep-fry, alongside other fire-prevention methods, "may have important repercussions for public health in the UK."

Source: Injury Prevention 2002;8:328-329.

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What to Do for Thermal Burns

HealthScoutNews
Thursday, December 5, 2002

(HealthScoutNews) -- Thermal burns are caused by contact with open flames, hot liquids, hot surfaces or other high heat sources. Like any burns, they require a specific and immediate first aid routine.

Follow these steps suggested by Shriners Hospitals for Children:

  • Stop the burning and remove the person from the heat source.
  • Cool the burn with cold water.
  • Cover the burn with a sterile pad or clean sheet.
  • Maintain the person's body temperature and get to the nearest doctor or hospital.
  • Do not apply any oils, sprays or ointments to a serious burn.

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Arthritis Pain, Disability Has Daily Cycle: Study

Reuters Health

Thursday, December 5, 2002

NEW YORK (Reuters Health) - Many people with arthritis in their hands experience a daily fluctuation in pain, stiffness and dexterity, and tend to feel best in the afternoon, according to researchers.

These findings may provide doctors with a better idea of when to time arthritis treatment, report Dr. N. Bellamy of Mayne Medical School in Brisbane, Australia and colleagues. In addition, patients who can anticipate how much pain they will feel at different times may be better able to schedule daily activities around their condition, they note.

According to Bellamy's team, most patients with osteoarthritis in their hands say that the pain and stiffness they feel varies over the course of the day, and they feel the least pain and stiffness at a few minutes after 4 PM. As pain and stiffness improve, the investigators found that patients also notice an improvement in their dexterity, peaking each day at a few minutes before 4 PM.

These findings indicate that pain from arthritis, like many other body systems, runs on a "clock." The body's internal 24-hour clock, or circadian rhythm, controls when we sleep and wake, and plays a role in other biological processes as well, such as hormone production and blood pressure. The main circadian clock is in the brain, but there are so-called peripheral clocks throughout the body, including the skin.

All patients in the current study suffered from osteoarthritis, which occurs when the cartilage that cushions joints breaks down, leading to pain and swelling. In the US, osteoarthritis is a leading cause of disability among the elderly. There is currently no cure for osteoarthritis, and treatment focuses on reducing symptoms.

Reporting in the December issue of Annals of the Rheumatic Diseases, Bellamy and colleagues write that they have shown in previous research that pain, stiffness and dexterity shows a 24-hour cycle in many patients with osteoarthritis in their knees, and in patients with rheumatoid arthritis. This form of arthritis occurs when the immune system, for unknown reasons, mistakenly attacks the joints, leading to inflammation, swelling and pain.

In the current study, Bellamy and colleagues asked 21 patients with hand osteoarthritis to record how much pain and stiffness they felt at six different times during the day, for 10 days in a row. At the same time, the patients completed a test of hand dexterity, in which they had to place beads in a narrow tube.

The investigators found that the vast majority of patients reported they felt a 24-hour fluctuation in their levels of pain, stiffness and dexterity. They appeared to feel the least pain at 4:10 PM, the least stiffness at 4:18 PM, and the most dexterity at 3:48 PM.

"Assuming that these findings are generalisable to the OA hand population as a whole, there are important implications for scheduling activities of daily living, for measurement in clinical trials, and possibly for the time at which antirheumatic drugs are given," Bellamy and colleagues write.

Source: Annals of the Rheumatic Diseases 2002;61:1075-1080.

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Shovel Safely

HealthScoutNews
Thursday, December 5, 2002

THURSDAY, Dec. 5 (HealthScoutNews) -- Make sure you don't end up with a load of trouble from shoveling all that snow.

Shoveling is rigorous aerobic exercise that places great physical demands on the body, and you need to be properly prepared to do it, advises the American Academy of Orthopaedic Surgeons.

Here are some snow-shoveling injury prevention guidelines:

·         Warm-up your muscles by doing light exercises for 10 minutes before you pick up your shovel.

  • When you shovel, keep the shovel close to your body. Don't extend your arms when handling a shovel full of snow. That puts too much weight on your spine.
  • Try to keep the snow in front of you when pushing it.
  • If you have to lift a shovel full of snow, bend your knees, squat and lift with your legs. Don't bend your back.
  • Scoop up small amounts of snow and walk it to where you're dumping it. Don't toss snow over your shoulder or to the side. The ligaments and discs in your back are more prone to injury when you're in a twisted position.
  • Wear boots or shoes that have slip-resistant soles.
  • If there's a heavy snowfall, don't try to clear it all away at once.
  • Make sure you're well-rested and drink plenty of water or other non-alcoholic liquids or non-caffeinated liquids before and after you shovel.

More information

North Dakota State University has more snow shoveling safety tips.

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US Flu Season Starts Slow, Should Pick Up Soon

Reuters Health

Thursday, December 5, 2002

NEW YORK (Reuters Health) - This year's flu season has gotten off to a slow start, but US health officials expect it to pick up in the coming weeks and months.

So far, "things have not been very active," Dr. Jennifer Wright of the Centers for Disease Control and Prevention (news - web sites) (CDC) in Atlanta, Georgia, told Reuters Health.

But, she added, "Influenza activity usually begins to peak in the next coming weeks."

As of November 23, just 0.5% of the 10,036 respiratory specimens tested for influenza by the CDC and collaborating laboratories were positive, the CDC reports in the December 6th issue of the agency's Morbidity and Mortality Weekly Report.

Starting the first week of October, the weekly percentage of samples testing positive ranged from 0% to 2.3%, according to the CDC. During the week ending November 23, 28 states and New York City reported no influenza activity.

Because flu virus strains vary each year, health officials reformulate the flu vaccine each season in order to fight the strains they believe will predominate that year. So far this year, the CDC notes, the strains that have been tested are "well matched" to those included in this year's vaccine.

Because millions of Americans at high risk for complications from influenza do not get vaccinated each year, the American Medical Association and the CDC have declared December 2nd through December 13th as "National Influenza Vaccination Catch-up Fortnight."

People at particular risk of flu complications, such as pneumonia, include adults age 65 and older and anyone with serious chronic illnesses such as diabetes and diseases of the heart, lungs or kidneys.

"It's still not too late to go ahead and vaccinate patients--the sooner the better," Wright said. "Vaccination efforts should continue through December and the rest of the influenza season."

Unlike in past years, there is currently an adequate supply of influenza vaccine, according to the CDC.

Source: Morbidity and Mortality Weekly Report 2002;51:1095-1097.

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Detecting Cancer's Spread

HealthScoutNews
Thursday, December 5, 2002

THURSDAY, Dec. 5 (HealthScoutNews) -- A combination of positron emission tomography (PET) and computed tomography (CT) detects the spread of cancer better than PET alone.

That's the finding of a new study by researchers at Johns Hopkins Medical Institutions.

The research, presented today at the Radiological Society of North America's annual meeting in Chicago, found PET-CT was better able to distinguish cancerous from normal tissue and better able to locate where metastases have spread in the body.

The researchers used a scanner that fuses CT and PET technology. CT provides anatomical detail, while PET detects the metabolic activity of tumors.

They performed 10 PET and 33 PET-CT scans on 28 people with ovarian cancer that was suspected to have spread to the abdominal cavity. PET alone produced three true positive and two true negative results, while PET-CT produced 14 true positives and 10 true negatives.

The PET produced two false positives, while PET-CT produced no false positives. PET-CT produced five false negatives, and PET alone produced no false negatives.

PET-CT was able to distinguish cancer from non-cancer 100 percent of the time), compared to 50 percent for PET.

The researchers caution this was a limited study, and more research is needed to properly compare PET-CT to PET or CT alone.

More information

The University of Michigan has more about PET-CT scanners.

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WEDNESDAY, DECEMBER 4, 2002 

Cooling Body Helps Cut Heart Attack Damage

 

HealthScoutNews

Wednesday, December 4, 2002

WEDNESDAY, Dec. 4 (HealthScoutNews) -- Catheter devices can quickly cool the bodies of heart attack victims from the inside out while they receive angioplasty, and this cooling may help reduce heart attack damage.

That's the claim of a study that appears in today's issue of the Journal of the American College of Cardiology. It's the first to report the use of cooling in people with heart attacks. Previous research and experience suggests cooling may reduce heart damage caused by restricted blood flow to the heart muscle that occurs during a heart attack.

Researchers at nine centers in the United States, Germany and Australia cooled 20 heart attack patients by inserting heat-exchange balloon catheter devices into the patients' inferior vena cava.

Once a patient's body temperature was cooled to 33 degrees C (91.4 F) from the normal 37 degrees C (98.6 degrees F), doctors performed angioplasty, stenting or other conventional treatments that restore blood flow to the heart muscle.

The patients who received the cooling treatment were compared to a control group of 21 heart attack patients who didn't receive the cooling treatment.

The study says that scans indicated heart muscle scar tissue seemed smaller on average in the cooled patients than in the control group.

The trial design and small number of patients make it impossible to draw any definite conclusions about the effectiveness of this cooling. A larger trial is currently underway.

More information

Stanford University researchers are warm to cooling heart attack patients.

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Strapped Doctors Offer Less Charity Care

 

By Laura Meckler

Associated Press Writer

The Associated Press

Wednesday, December 4, 2002

WASHINGTON (AP) - The portion of doctors providing charity care is falling, a sign of tight times that make it harder for the uninsured to get health care. Most doctors do some charity care but in most cases it represents a small fraction of their work. The portion spending more than 5 percent of their time with these patients is falling, however.

"Physicians are under a lot of growing financial pressures," said Peter Cunningham, who wrote the report for the Center for Studying Health System Change, a health policy think tank that conducts the ongoing survey of doctors. "This may be making it more difficult to serve uninsured patients."

Its survey found that in 2001, 71.5 percent of doctors provided free care. That's down from 76.3 percent in 1997.

The results are similar to those found by the American Medical Association, which also saw a drop in charity care between 1994 and 1999 in a survey it conducted of doctors.

The result is less care for people who can't afford it.

A companion survey by the Center for Studying Health System Change found that between 1997 and 2001, the portion of uninsured people who had seen a doctor or who had a usual source of medical care dropped.

Specifically, in 1997, 51.5 percent of the uninsured had seen a doctor in the last year. That fell to 46.6 percent by 2001. Over the same period, the portion of patients with Medicaid and with private insurance who had seen a physician stayed even or rose.

The report suggested that doctors are facing the financial squeeze from several quarters, leading them to do less for free. Payments for Medicare, which serves the elderly, and Medicaid, which serves the poor, aren't keeping pace with the rising cost of health care, and health insurance companies have kept a tight rein on reimbursements through managed care.

Doctors also complain about the rising cost of malpractice insurance.

The situation for Medicaid may get even worse in coming months as states facing budget shortfalls look to Medicaid, which generally makes up one-third of state budgets.

The survey of doctors found that the portion seeing Medicaid patients dipped between 1997 and 2001, from 87.1 percent to 85.4 percent. But it also found an increase in the number of practices that derived more than 20 percent of their income from Medicaid, suggesting the Medicaid patients are concentrating among fewer doctors.

Not so for those providing charity care. In this case, the portion of high-volume providers fell, while the portion of low-volume providers rose. That means that doctors who do provide charity care were providing less of it — and fewer total doctors were providing any at all.

The survey also found that doctors who are heavily involved with managed care — receiving more than 75 percent of their income from health maintenance organizations and other plans that cap payments — are more likely to have closed their practices to new Medicaid and Medicare patients. These same practices were still taking new privately insured patients.

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The Best Way to Manage an Abnormal Heart Rhythm

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Wednesday, December 4, 2002

WEDNESDAY, Dec. 4 (HealthScoutNews) -- When the heart develops an abnormal and potentially dangerous rhythm, it seems logical that treatment should concentrate on restoring the normal heartbeat.

Not so, say two new major studies, one here and one in Europe. For many patients, it's better to focus on the rate at which the heart beats.

Atrial fibrillation is a condition that affects an estimated 2 million Americans. It occurs when the upper chambers of the heart -- called the atria -- begin to flutter rather than beat rhythmically. It's the most common heart rhythm abnormality, and its incidence increases with age, so that it occurs in at least 6 percent of people 80 and older.

The studies found that overly aggressive efforts to restore the normal rhythm of the atria can sometimes be damaging, and even fatal.

The American AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) study enrolled 4,060 patients, whose average age was just under 70. The death rate for those given rhythm-control medication was 23.8 percent, compared to 21.3 percent for those given medication aimed at controlling the rate at which the ventricles, the lower chambers of the heart, beat, says a report in tomorrow's issue of The New England Journal of Medicine (news - web sites).

"More patients in the rhythm-control group than in the rate-control group were hospitalized, and there were more adverse drug affects in the rhythm-control group as well," the journal report says.

The European study got comparable results for the 522 patients it enrolled. "Rate control is not inferior to rhythm control for the prevention of death and mortality," says a report in the same issue of the journal.

The two studies will go a long way toward settling "a controversy about how aggressive one should be in trying to maintain regular rhythm," says Dr. Robert O. Bonow, a professor of medicine at Northwestern University and president of the American Heart Association (news - web sites).

As Bonow interprets the studies, a cardiologist should still make an initial effort to restore normal atrial rhythm. If that doesn't work, the next treatment for patients with no underlying condition, such as valve disease or heart failure, would be "a simple approach to restoring normal heart rate," he says.

The problem with an aggressive effort that concentrates on atrial rhythm is that many of the drugs used for that purpose can have serious side effects, says Dr. Rodney H. Falk, a professor of medicine at Boston University School of Medicine and author of an accompanying editorial in the journal.

"In some cases they can cause weakness of the heart muscle, and in a small percentage of cases they can provoke a rhythm disturbance in the ventricle, so there is a small chance that they might kill the patient," Falk says.

Medications designed to restore the normal rate of beating of the ventricles, which can go over 100 beats a minute because of atrial fibrillation, have fewer side effects and are easier to manage, Falk and Bonow say.

"In many cases, it appears that slowing the heart rate may be the only thing needed, in terms of short-term and medium-term outcome," Falk says.

One more lesson to be taken from the U.S. study concerns an entirely different class of drugs -- anticoagulants, given to prevent blood clots that can block an artery to the brain, causing a stroke.

Atrial fibrillation can cause blood to pool in the heart, increasing the risk of such a clot, and doctors routinely prescribe anticoagulants to prevent that from happening.

However, the study showed that anticoagulant therapy often is not administered long enough, Falk says. In both groups of patients -- those given treatment for rhythm control and those treated for rate control -- most of the strokes occurred after the patients left the hospital, when anticoagulant treatment was stopped, the study found.

"There was a tendency to stop anticoagulant treatment too soon," Falk says. "This shows it needs to be continued longer than previously thought."

What To Do

A primer on atrial fibrillation is offered by the American Heart Association. For more on anticoagulant therapy, visit the European Stroke Initiative.

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Study Suggests Vegetarian Cheese Cuts Cholesterol

By Pat Hagan

Reuters Health

Wednesday, December 4, 2002

LONDON (Reuters Health) - Eating cheese made from vegetable oils rather than milk fat can reduce cholesterol levels in some people, a study from Finland shows.

After 4 weeks of eating a daily portion of vegetarian cheese, volunteers with moderately increased cholesterol saw levels drop by 5%, according to research carried out by the University of Kuopio and Oy Foodfiles Ltd, a private research body for the food industry. The research was sponsored by a producer of vegetable oils.

The cheese appears to work mainly by reducing levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol associated with increased risk of cardiovascular disease.

The results, published in the European Journal of Clinical Nutrition, suggest cheeses made from rapeseed oil could be a healthy alternative for those with slightly raised cholesterol levels.

Research leader Dr. Essi Sarkkinen and colleagues said in a report that rapeseed oil-based cheese might help people get their cholesterol levels down without losing out on the nutritional value of cheese in their diet.

"Our results have major practical implications," they write. "This single dietary modification has a clinically significant effect on serum, total and LDL cholesterol concentrations."

Cheese consumption in developed nations has been steadily increasing over the past 20 years. In the US, average annual consumption per head is 12.7 kilogrammes a year, while in Europe it's 17 kilos.

Although cheese provides valuable calcium, it is also high in saturated fat, which increases cholesterol levels.

Commenting on the report, Dr. Frankie Robinson of the British Nutrition Foundation said it was feasible that cutting out cheese rich in saturated fats could help lower cholesterol levels.

"By substituting it with polyunsaturated fats you might expect to see that kind of difference," said Robinson, who was not involved in the study. "But I very much doubt it contains any of the milk product that provides the calcium in cheese--there's not much calcium in rapeseed oil."

The Finnish researchers recruited 31 adults ages 25 to 65 with mild to moderately raised levels of cholesterol but no history of heart disease or other major illnesses.

All the volunteers were instructed to keep their alcohol consumption, smoking habits and medication the same throughout the study so as not to skew the findings. The same applied to their physical activity and consumption of vitamins and nutrients.

Half the group ate a daily portion of 65 grams of rapeseed-oil cheese, the other half a portion of ordinary cheese. After 4 weeks, the groups swapped over.

Laboratory tests on blood samples revealed that after 2 weeks of eating vegetarian cheese, total cholesterol levels were 6.7% lower than when they ate milk fat-based cheese. After 4 weeks, they were 5% lower.

Meanwhile, levels of LDL cholesterol in the same period were down 7% after 2 weeks and 6.4% after 4.

"Interestingly," the researchers note, "this single change in dietary habit resulted in a decline in total cholesterol concentration similar to reduction achieved by general dietary advice at population level."

Source: European Journal of Clinical Nutrition 2002;56:1094-1101.

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Eye Shadows

HealthScoutNews

Wednesday, December 4, 2002

(HealthScoutNews) -- During the winter months, the sun's rays can be just as strong and potentially harmful as they are in summer, particularly on the slopes. A good pair of sunglasses is an essential sun protection item, but choose wisely.

 John Hopkins School of Medicine offers these tips:

  • Choose a pair that blocks 99 percent of the sun's ultraviolet rays.
  • Don't be fooled by price -- some cheaper pairs of sunglasses absorb UV light better than more expensive ones.
  • Polarized lenses cut reflected glare, but don't block all of the UV light. Make sure the pair you pick offers enough UV protection.
  • If you're going boating or skiing where you'll be in the sun for a long period of time, consider large-framed wraparound glasses.

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Simpler Way to Treat Abnormal Heart Beat

 

By Stephanie Nano

Associated Press Writer

The Associated Press

Wednesday, December 4, 2002

The preferred way of treating common heart rhythm problems is actually no better — and perhaps even worse — than a simpler approach using cheaper drugs, according to new research that could affect millions of people.

Doctors have long assumed that the best way to treat the heart irregularity called atrial fibrillation is to get the heart back to a regular rhythm and maintain it, using electric shock or strong drugs. Restoring normal rhythm, or sinus rhythm, was thought to reduce the risk of strokes and death, make patients feel better and allow them to stop taking blood thinners.

"It just made a lot of sense. After all, God made you in sinus rhythm. So we should try to keep you there," said Dr. D. George Wyse of the University of Calgary in Alberta, the lead researcher for one large study.

If that method doesn't work, doctors turn to a second approach — using simpler, usually cheaper medications to slow down the heart rate and ease symptoms, which include palpitations, dizziness and shortness of breath. The abnormal rhythm continues and patients have to keep taking blood thinners to prevent blood clots.

But Wyse said doctors began questioning whether restoring a normal rhythm is really necessary. After all, the drugs do not work very well and can have serious side effects, including triggering a potentially fatal irregular heartbeat, he said. And new data showed blood thinners were effective in preventing strokes in patients with atrial fibrillation.

The two approaches were compared in studies reported in Thursday's New England Journal of Medicine (news - web sites).

In a study of 4,060 patients in the United States and Canada, researchers found there was no significant difference in survival in the two groups and a hint of better survival in the rate-control group. There was no difference in the number of strokes and the rhythm-control group had more hospitalizations and more serious side effects.

"So all the things that were thought to be benefits of rhythm control were not confirmed and, in fact, some of the things favored rate control," Wyse said.

A smaller study of 522 patients in the Netherlands showed similar results.

Atrial fibrillation affects more than 2 million Americans, mostly the elderly. It occurs when the upper chambers of the heart quiver instead of beating regularly. High blood pressure and heart disease are key causes. While the condition is not initially life-threatening, blood clots can form in the heart and cause strokes. Some people do not feel any symptoms and episodes can be sporadic.

Dr. Rodney H. Falk of Boston University School of Medicine said he has already changed his practice because of the latest findings, and he expects other doctors to reconsider their treatment method, especially for older patients like those in the studies.

"I think they'll think twice before using antiarrhythmics," Falk said.

If patients feel better after their heart rate is slowed down, "we shouldn't get too uptight as physicians and say, `But I want to make your electrocardiogram look nice and stable,'" he said. He added that restoring rhythm may be appropriate for some, including younger people.

The research also highlights the need for longer use of blood thinners, regardless of treatment, said Dr. Yves Rosenberg of the National Heart, Lung and Blood Institute, which sponsored the study. Most of the strokes occurred in patients who had stopped taking a blood thinner or were on a dose that was too low.

In the North American study, patients with atrial fibrillation were randomly assigned to one of the two treatment methods and followed for an average of 3 1/2 years. Doctors could choose from a number of drugs in each group and change drugs if necessary.

In the rhythm-control group, available drugs included amiodarone (sold as Cordarone or Pacerone), propafenone (Rythmol), and sotalol (Betapace). Drugs used to slow the heart rate were beta-blockers, calcium-channel blockers and digoxin. Both groups got blood thinners.

There was statistically no difference in the death rates: 356 deaths in the rhythm-control group and 310 in the rate-control group.

On the Net:

New England Journal: http://www.nejm.org

National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov

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Achilles Heel

HealthScoutNews

Wednesday, December 4, 2002

(HealthScoutNews) -- If the area between your heel and lower calf feels tender when you run, climb stairs, or walk on your toes, you may have Achilles tendonitis -- an irritation of the tendon on the back of your ankle and heel.

To relieve the pain and hasten recovery, the University of Illinois Health Center offers these tips:

  • Lay off all activities that cause pain, especially running, impact cardio classes and jumping.
  • Ice the area two to three times a day.
  • Take an over-the-counter anti-inflammatory medication to reduce inflammation.
  • Shoes that have a firm arch support and well-cushioned heel help reduce the tension in the Achilles tendon.
  • Stretch your calf muscles.

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Obesity Surgery May Be Most Risky for Heaviest Men

Reuters Health

Wednesday, December 4, 2002

NEW YORK (Reuters Health) - Men who are extremely obese may be at greatest risk of life-threatening complications from the weight-loss surgery known as gastric bypass, new research suggests.

Doctors at the University of California, Los Angeles (UCLA) found that among the more than 1,000 patients who had the surgery at their center in recent years, male patients and those who were "superobese" faced a particular risk of serious complications.

In addition, although older patients had about the same rate of life-threatening complications as younger ones, they were more likely to die, according to findings published in the November issue of the Annals of Surgery.

In general, severe, life-threatening complications from gastric bypass are relatively uncommon. In this study, about 6% of the 1,067 patients developed potentially fatal complications such as blood clots in the lungs or bowel obstruction. Fourteen patients died, with the risk being greater among patients older than 55. Their death rate was 3.5%, compared with just over 1% among younger patients.

And while older patients were more likely to die from a surgery complication, only male sex and "superobesity" were significant risk factors for developing a life-threatening complication in the first place, report Dr. Edward H. Livingston and his UCLA colleagues.

The researchers studied patients who had undergone an obesity surgery known as Roux-en-Y gastric bypass between 1993 and 2000. In this procedure, surgeons staple off a section at the top of the stomach to form a small pouch that can hold only a small amount of food. They also add a bypass that allows food to go around part of the small intestine, which limits the absorption of calories.

The procedure is intended for the severely obese--generally, people who are around 100 pounds overweight. These individuals are at high risk of obesity-related conditions like diabetes and heart disease, but often fail to take off pounds with diet, exercise or drugs. For them, gastric bypass or other weight-loss surgeries may be the only way to shed weight for the long haul.

Such surgery carries risks, however, and the new study suggests that men--particularly the largest men--may face a greater risk of serious complications.

For example, Livingston's team notes, a 200-pound woman in their study had a 4% risk of a life-threatening complication, compared with a 7% risk for a man of the same weight. The risk was 7.5% for a 600-pound woman, and 13% for a 600-pound man.

On the other hand, factors often thought to boost the risk of complications--such as diabetes and a history of smoking--were not tied to a higher risk in this study.

"Taken together," the researchers write, "our data suggest that very large men be counseled to lose weight before gastric bypass surgery to minimize the risk of adverse outcomes."

And, Livingston and colleagues add, although the death risk for older patients appears to be "within acceptable limits," they should be informed that their risk is higher than that of younger patients.

Blood clots in the lungs, while infrequent, were a common cause behind the 14 deaths, the authors point out. They urge "aggressive" preventive measures, such as clot-preventing medication, for gastric bypass patients.

Source: Annals of Surgery 2002;236:576-582.

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Study Hints Demographic Link to Cancer

 

By Margie Mason

Associated Press Writer

The Associated Press

Wednesday, December 4, 2002

SAN FRANCISCO (AP) - Suspicions that something in the environment is causing Marin County's high rate of breast cancer (news - web sites) have led to a big fund drive and public-awareness campaign. But some scientists say the people, not the place, are the reason for the cancer levels.

"It's not the geography; it's the demography," said Tina Clarke, an epidemiologist at the Northern California Cancer Center, which monitors cancer rates in the San Francisco Bay area. "It's the type of person living in Marin County."

Many studies have suggested that breast cancer more often strikes women who have children late in life or not at all, and women who have greater access to hormone supplements.

And Marin County — a mostly white, highly educated area where incomes are twice the national average and the median single-family home costs $530,000 — has an unusually high percentage of women with these and other risk factors among its population of 250,000.

Researchers have found similarly high rates of breast cancer in other pockets of upper middle-class white women, said Clarke, whose research has been funded by the National Cancer Institute (news - web sites).

The average number of new breast cancer cases reported in Marin County each year was 199 out of every 100,000 white females from 1995 to 1999, compared with 143 per 100,000 white females in the rest of urban California, a number that is on track with the rest of the nation, Clarke said.

Some community activists have pronounced Marin County "the breast cancer capital of the world" and are worried the air or the water is to blame.

Community groups have sought to raise awareness. One, the Marin Cancer Project, put out television shock ads showing women obliviously stepping over corpses in the supermarket aisles.

The project also mobilized 2,000 volunteers last month to go door-to-door throughout the county, gathering anecdotal information about cancer. The project has raised more than $140,000 so far.

Meanwhile, Rep. Lynn Woolsey and Sen. Barbara Boxer, both of Marin County, helped secure $900,000 in federal grants last month to look at environmental risk factors for cancer. The money will be administered by the National Institute for Environmental Health Sciences.

Members of the Marin Cancer Project want to investigate as possible sources such things as a San Rafael quarry, a plastic foam cup factory in Corte Madera, and the power lines that serve Marin County's many cul-de-sacs.

"Science is science, but grass-roots groups have an opportunity to work faster and gather anecdotal data that's profound and powerful," said Judi Shils, the group's founder.

Clarke agreed that more research is needed but said work focusing on socio-economic backgrounds and lifestyle choices would shed more light on Marin County's problems.

But even extensive research into environmental causes of high cancer rates has failed to solve similar mysteries. An $8 million, seven-year study by the National Cancer Institute that looked for now-banned pesticides in the blood and urine of people on New York's Long Island failed to find any definite link between breast cancer and environmental factors.

Ralph Coates of the Centers for Disease Control and Prevention (news - web sites)'s cancer division agreed that more research is needed. But he said there is a gap between what community organizers want and what scientists can do.

"One of the issues that needs to be dealt with in trying to figure out what's going on Marin County is how to do studies that will satisfy both the researchers and the community," Coates said.

On the Net:

Marin Cancer Project, http://www.marincancerproject.org/Index.htm

Northern California Cancer Center, http://www.nccc.org/

Centers for Disease Control and Prevention cancer info, http://www.cdc.gov/health/cancer.htm

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Coffee May Lower Women's Gallstone Risk

Reuters Health

Wednesday, December 4, 2002

NEW YORK (Reuters Health) - Women who down lots of coffee may get more than a buzz--new research suggests they may also be cutting their risk of gallstones.

The large study of US nurses found that women who drank at least four cups of caffeinated coffee each day were about 25% less likely to need surgery for gallstones than non-drinkers were. This pattern has previously been found in studies of men.

However, the risk reduction was not seen among women who drank decaffeinated coffee, suggesting that caffeine may be one potential source of protection against gallstones, according to the study authors, led by Dr. Michael F. Leitzmann of Harvard University in Boston, Massachusetts.

"These data suggest that consumption of caffeinated coffee may play a role in the prevention of symptomatic gallstone disease in women," Leitzmann and colleagues report in the December issue of the journal Gastroenterology.

Still, Leitzmann said in a statement, "women should not start drinking coffee just to prevent gallstone disease."

Instead, he added, this study suggests that if a woman is already a coffee drinker, it's "okay" for her to keep downing the brew, at least in terms of gallstone risk.

Gallstones are solid lumps consisting of cholesterol, calcium salts or bile that form in the gallbladder, the sac that stores bile from the liver. Small gallstones may produce no symptoms, but large stones can block the opening of gallbladder, causing pain and inflammation. Gallstone disease affects 20 million Americans and is responsible for 800,000 operations to remove the gallbladder each year. Women are about twice as likely to develop gallstones as men are.

In a previous study published in 1999, Leitzmann and his research team reported that men who drank at least four cups of coffee with caffeine each day had a 45% lower risk of developing gallstones.

In the current study, the researchers followed more than 80,000 middle-aged women over a 20-year period, tracking their consumption of coffee and other caffeinated beverages, and whether they had to get gallbladder surgery--a signal that they had symptomatic gallstones.

During the study period, 7,811 women underwent gallbladder-removal surgery. But the more coffee women consumed, the lower their risk of the surgery, with those who drank four or more cups a day showing the lowest risk, the report indicates.

The investigators did not discover the same potential protective effect from tea, although they note that they were unable to distinguish between tea that did or did not contain caffeine. And in contrast to the coffee findings, they found that women who drank the most caffeinated soft drinks appeared to have a higher risk of gallbladder surgery than did women who drank the least.

Consequently, although comparisons between long-term, heavy consumption of decaffeinated and regular coffee suggest that caffeine can protect against gallbladder problems, other ingredients may, in fact, be responsible, Leitzmann and his team note.

One limitation of the current research, the authors write, is that they could only measure gallstone problems by whether women underwent surgery, and therefore could miss some cases where women developed gallstones but showed no symptoms.

Source: Gastroenterology 2002;123:1823-1830.

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Possible Cancer Chemical Varies in Foods

By Lauran Neergaard

AP Medical Writer

The Associated Press

Wednesday, December 4, 2002

ADELPHI, Md. (AP) - The longer french fries and certain other starchy foods are fried or baked, the higher their level of a possible cancer-causing substance, new federal research suggests.

The substance, called acrylamide, made headlines last spring when Swedish scientists discovered that it forms in fries, potato chips and other high-carbohydrate foods cooked at high temperatures.

Several other European countries confirmed Sweden's discovery — and now the latest batch of tests, revealed Wednesday by the U.S. Food and Drug Administration (news - web sites), shows that acrylamide levels vary widely even within the same brand of food.

For example, FDA scientists bought french fries at four different Popeye's restaurants and found a three-fold difference between the batches with the highest and lowest acrylamide levels. In tests of 25 seemingly identical bags of Lay's Classic Potato Chips, only two bags contained the exact same acrylamide level.

Acrylamide forms during traditional cooking methods — whether you buy a ready-made food or fry or bake from raw ingredients in your own kitchen — and it seems that the longer certain foods are cooked at especially high temperatures, the more acrylamide appears.

What does all this mean for consumers?

Acrylamide causes cancer in test animals, but has never been proved to do so in people — meaning no one knows if higher levels in one food than another is a problem. FDA scientists stressed Wednesday that there's no reason yet for Americans to start avoiding certain foods for fear of acrylamide — a message echoed by the food and restaurant industries.

Instead, concentrate on eating "a variety of foods that are rich in high-fiber grains and fruits and vegetables," said FDA food safety chief Janice Oliver.

Because acrylamide forms during traditional cooking methods, dietary exposure "is something that's been going on a long time," noted FDA senior scientist Bernard Schwetz.

But the big variability suggests acrylamide levels can be lowered in foods, FDA scientists told a meeting of the agency's food advisory board.

Scientists in FDA chemist Steven Musser's laboratory bought frozen french fries that, before baking, contained almost no acrylamide. Baking them for 10 to 15 minutes as the package directs caused a very slight acrylamide increase — but none of the six scientists considered the fries done enough to be appetizing, so they stuck them back in the oven.

After 30 minutes of baking, the fries were golden brown — and contained 120 times as much acrylamide. After 45 minutes, the now extra-crispy fries contained 400 times as much acrylamide as a mere 15-minute baking produced.

It's not just an issue for french fries. Even toasting bread increased acrylamide levels six- to 10-fold, the FDA testing showed.

In contrast, microwaving frozen french fries produced no acrylamide, Musser said. Likewise, other scientists say the chemical doesn't appear to form when foods are boiled. Nobody knows why, but perhaps those cooking methods aren't hot enough to produce the chemical reaction thought necessary to form acrylamide.

Acrylamide is used to produce plastics and dyes and to purify drinking water. Although traces have been found in water, no one expected high levels to be in basic foods.

Now scientists know it apparently forms when a naturally occurring amino acid called asparagine is heated with certain sugars such as glucose. Potatoes are especially rich in both asparagine and glucose, although foods from grains to even asparagus also contain it. Indeed, roasting asparagus produced very high acrylamide levels.

In contrast, the FDA tested hundreds of food samples and found products from infant formulas and baby food to frozen vegetables and meats acrylamide-free — foods that either contain little asparagine or aren't cooked at super-high temperatures.

Food manufacturers insist their products aren't risky, but they're working with the FDA to understand acrylamide formation and to lower levels if possible, said Henry Chin of the National Food Processors Association.

It may not be easy, he cautioned.

For example, if frying temperatures are lowered too much potato chips turn out soggy. Also, levels of asparagine and glucose vary in different potato batches according to growing conditions and how long the tubers are stored raw, Chin said.

On the Net:

FDA: http://www.cfsan.fda.gov/dms/acrydata.html

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Group Warns of Methotrexate Overdosing Dangers

By Karen Pallarito

Reuters Health

Wednesday, December 4, 2002

NEW YORK (Reuters Health) - Clinicians should take special care to guard against accidental overdoses in prescribing or administering oral methotrexate, the Institute for Safe Medication Practices (ISMP) warned on Tuesday.

Methotrexate is generally given in low weekly or twice-a-week doses for treating conditions like rheumatoid arthritis, asthma and psoriasis, but is given in much higher, daily doses for fighting cancer. Mistakes occur all too frequently when the drug is accidentally administered daily, when weekly dosing was intended, the ISMP observed.

The nonprofit ISMP, an independent reviewer of medication errors, issued a special "Medication Safety Alert" after learning of two new cases of methotrexate mix-ups in the past month, resulting in one fatality and one permanent disability.

Over the years, ISMP has repeatedly warned about the potential for errors with oral methotrexate. "Because of the number of fatalities...clinicians should consider it a higher alert medication regardless of the indication," the group cautioned.

Recently, an 86-year-old patient who was supposed to receive 2.5 milligrams (mg) of the hair re-growth treatment minoxidil four times a day actually received methotrexate. In another case, a 79-year-old patient died after receiving nine doses of 15-mg methotrexate daily instead of weekly.

"We're just very concerned...and it isn't just methotrexate," said ISMP President Michael Cohen. "The docs and the pharmacists are just so used to one tablet daily," he said. "If they're not really focusing on what they're doing, they do it almost automatically."

The outcome can be tragic, particularly for elderly patients, but it's also a mistake that is easily preventable in most cases, Cohen told Reuters Health.

The group's Safety Alert identifies several safeguards to help reduce the risk of methotrexate errors. For one, doctors should indicate within the prescription the reason why the drug is being prescribed, it advises. It also recommends building alerts into electronic prescribing systems and pharmacy computers to check the indication and dosing frequency. Other steps include counseling patients, providing written information on weekly dosing and advising of the dangers of extra doses.

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Mammograms May Detect Heart Disease

By Lindsey Tanner

AP Medical Writer

The Associated Press

Wednesday, December 4, 2002

CHICAGO (AP) - Mammograms are designed to detect breast cancer (news - web sites), but new research suggests they may also reveal signs of an even greater threat to women: heart disease.

Mammogram images can detect calcifications in breast arteries that may indicate an increased chance of developing heart disease, according to the Mayo Clinic study of 1,803 women.

Women with breast-artery calcifications were 20 percent more likely to have heart disease than those without calcifications, the researchers found.

The abnormalities show up as distinct white lines on mammogram images and should not be confused with other types of breast calcifications that may be insignificant or, in some cases, malignant, the researchers said.

"Pretty much every radiologist can tell the difference; it's not a difficult distinction," said lead author Dr. Kirk Doerger, a Mayo Clinic radiology resident.

Still, radiologists generally are thinking cancer — not heart disease — when they analyze mammograms.

"The reason why mammograms are done is for cancer detection. This is just an extra piece of information that could help discover women who are at increased risk of having narrowing in the arteries supplying their heart," Doerger said.

His research was to be presented Wednesday in Chicago at the Radiological Society of North America's annual meeting.

More than 350,000 U.S. women die of heart disease each year, compared with about 40,000 who die from breast cancer. Yet many women believe breast cancer is a greater risk and may not know they have heart disease, underscoring the need for better detection methods, the researchers said.

They reviewed mammograms for patients who'd also undergone angiograms — imaging tests to detect heart disease — at the Mayo Clinic from 1991 to 2001. Participants were aged 65 on average and already at increased risk for heart disease based on their age.

The calcifications detected are calcium deposits that may form in diseased arteries narrowed by fatty plaque. Heart and breast arteries are of similar size and are thought to respond similarly to factors such as high cholesterol, Doerger said.

The risk from calcifications is not as strong as conventional factors linked to heart disease, such as high blood pressure and elevated cholesterol, but it should not be ignored, Doerger said.

He said such calcifications should be noted in radiologists' mammogram reports and that afflicted women should be referred to their regular doctors for further assessment.

"This is quite a dramatic observation," said Dr. Linda Warren Burhenne, a mammography specialist in Vancouver, Canada. "The literature is quite sparse in this field."

Burhenne said radiologists frequently see such calcifications, which often show up as skinny parallel lines where calcifications have formed inside artery walls.

"Unless it's really dramatic, we just don't pay attention to it ... because it has not been determined to be of any importance" until now, she said.

"It kind of makes sense to think that if there's calcification in the breast arteries there might be calcification in the other arteries," said Dr. Gene Solmos, a mammogram specialist at Chicago's Rush-Presbyterian-St. Luke's Medical Center.

"It's a very interesting concept and it may pan out," Solmos said.

Dr. Robert Bonow, president of the American Heart Association (news - web sites), called the results intriguing but preliminary.

The women studied were already at high risk for heart disease. Whether breast-artery calcifications in lower-risk women would be meaningful remains to be seen, Bonow said.

Still, he said the findings could potentially be significant because so many women die of heart disease, and because mammograms are so routine.

"Here's a test many women are having anyway for screening for breast cancer," he said. "If this holds true, it could be an important additional piece of information."

On the Net:

Radiological Society: http://www.rsna.org

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Mouse Genome Will Offer Keys to Human DNA Function

By Todd Zwillich

Reuters Health

Wednesday, December 4, 2002

WASHINGTON (Reuters Health) - Scientists on Wednesday unveiled the first-ever published map of the mouse's genetic code, a development they said would greatly speed animal-based medical research and accelerate their understanding of the genetic causes of human disease.

Researchers said that the nearly complete draft of the mouse genome--which in all is about 14% shorter than the human code but remarkably similar in content--would greatly improve their ability to develop mouse models for hundreds of human diseases.

It will also for the first time allow scientists to compare the human DNA code directly to that of a related mammal, a potential boon to the continuing hunt for undiscovered disease-causing genes in humans, they said.

Several referred to the new map as a "Rosetta stone" for the human genome (news - web sites), a reference to the ancient stone tablet discovered in Egypt by Napoleon's soldiers in 1799. The tablet contained both Egyptian hieroglyphics and a Greek translation, allowing the first translation of ancient Egyptian writing into modern languages.

Researchers already have over 1,000 mouse models for human illnesses, making it one of the most popular animals for basic medical studies.

"Now I think we can say this mouse is empowered," said Dr. Francis Collins, the director of the National Human Genome Research Institute, the US government agency that coordinated the international Mouse Genome Sequencing Consortium.

Collins called the publication of the sequence on the Internet and in Wednesday's issue of Nature "a quantum leap forward" in the study of genetic diseases.

Officials at Maryland-based Celera announced that they had completed a mouse genome map in April 2001, though the map was not revealed to the public or made available to scientists outside the company.

The code's most immediate impact will be improved laboratory models of human diseases, since researchers anywhere can now use the information to quickly look for gene mutations in lab mice that contribute to diseases also seen in humans, said Dr. Eric Lander, director of the Whitehead Institute/MIT Center for Genome Research in Cambridge, Massachusetts, one of three centers making up the consortium.

New gene searches, which until recently took years, can now be accomplished with a few computer keystrokes, Lander said. Comparing mouse genes to suspected human disease genes takes more effort.

"That doesn't mean you're going to see new cures come out of this instantly," he added.

But the research process is expected to accelerate further soon when researchers finish mapping the DNA codes of rats, chimps, dogs and a few fish species.

With each new code, investigators can use computers to simultaneously scan an animal and human code, making comparisons and instantly revealing which human sequences represent active genes and which are less useful genetic "noise," Lander said. The mouse sequence was generated at Whitehead and at two other centers, one in the US and one in England. The project was officially started in 1998 and cost approximately $100 million in US federal funds to complete.

Researchers said that they were surprised by the accuracy of the mouse sequence, which in its current form is about 96% complete. The project revealed a total of approximately 2.6 billion DNA base pairs in the mouse, slightly fewer than the 3 billion pairs that make up the human genetic code.

The mapping process revealed that about 80% the mouse's genes correspond directly to similarly functioning genes in humans. The other 20% are in "families" that correspond to human sequences, though less directly.

"At the big scale, the mouse (genome) has the same chapters," Lander said. The main difference is that those "chapters," or large sections of DNA sequences, are in different orders and locations in the mouse and human genomes.

In all, about 5% of total genetic material in humans and mice is identical, preserved from when the two species split from a common ancestor some 75 million years ago, said Dr. Robert Waterson, director of the Genome Sequencing Center at the Washington University School of Medicine in St. Louis.

Mice appear to have roughly 30,000 protein-encoding genes, about the same number as humans.

But project scientists said they were most excited by discovery of approximately 250,000 DNA sequences that do not code directly for proteins in mouse cells but still have a likely role in gene regulation and activity.

The sequences were mostly undetectable in humans until now because scientists had no way to tell where one sequence ended and another began.

"It's pointing out to us how much we didn't know. "There's a lot more that matters in the genome than the protein-coding genes," Lander said.

Researchers disclosed the first draft human genome sequence in February 2001. They are now finalizing the completed sequence with the intention of unveiling it in April 2003, the 50th anniversary of the discovery of DNA.

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Nuclear Imaging Said to Aid Heart Tests

By Eric Fidler

Associated Press Writer

The Associated Press

Wednesday, December 4, 2002

CHICAGO (AP) - Nuclear-imaging technology already in place at many U.S. hospitals can help emergency room doctors do a better job of ruling out heart attacks in patients with chest pain, a study found.

The study looked at sestamibi imaging, which is normally used in non-emergency settings as part of a stress test. The patient is injected with an isotope that lets doctors monitor the heart's pumping ability and see how much blood is flowing to it.

"We're just taking available technology and using it in a new way," said the study's lead author, Dr. James Udelson of Tufts-New England Medical Center in Boston.

More than 6 million people each year go to emergency rooms with chest pain, and many are admitted to the hospital or an observation unit because doctors are unable to rule out a heart attack.

If the patients have abnormal readings on electrocardiograms, doctors can diagnose their heart attacks with certainty and start treatment. Often, however, patients have normal electrocardiograms. These people are frequently admitted for observation.

The research appears in Wednesday' Journal of the American Medical Association (news - web sites).

The study found that 52 percent of patients who were not given the test were admitted with what turned out to be neither a heart attack nor unstable angina (news - web sites), a common precursor to a heart attack. The rate was 42 percent among patients who were given the test.

Dr. Robert Bonow, president of the American Heart Association (news - web sites) and chief of cardiology at Northwestern University Medical School, said that number could fall once doctors using the test develop confidence in it.

Bonow said the imaging could save money, because an overnight stay in the hospital would probably be more expensive than the test.

The study looked at 2,475 patients at seven hospitals, ranging from large, academic medical centers to smaller community hospitals. Of the patients, 1,260 were assigned to receive standard care and 1,215 to undergo the imaging.

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Gene May Play Key Role in Lifespan: Study

By Linda Carroll

Reuters Health

Wednesday, December 4, 2002

NEW YORK (Reuters Health) - Researchers may have discovered an important regulator of lifespan in mammals, according to a report out Wednesday.

Mice engineered to have only one copy of the gene that encodes a receptor for insulin-like growth factor type 1 (IGF-1) live 26% longer than normal mice, according to the study, published in the advance online edition of the journal Nature.

Nevertheless, mice that lack one copy of the gene appear to be largely normal in size, metabolism, appetite, physical activity, fertility and reproduction, according to the study.

When the researchers looked at the effects of deleting one copy of the gene in male and female mice, they found that the impact was different for the sexes. Males with one copy of the IGF-1 receptor lived 16% longer than normal male mice, while their female counterparts lived 33% longer than normal females.

Although the scientists have some understanding of what IGF-1 does in the body, they're not sure why animals that have only one copy of the receptor for IGF-1 live longer.

"This is what we would like to find out now, and I'm sure other researchers will also try," the study's lead researcher, Dr. Martin Holzenberger of the Hopital Saint-Antoine in Paris, said in an interview with Reuters Health. "For the time being we can only say that part of the additional longevity could be explained by their increased resistance to oxidative stress."

Oxidative stress causes damage to cells in a process that is similar to the formation of rust on metal. And studies have shown that oxidative stress is implicated in the aging process, Holzenberger said.

Holzenberger and his colleagues subjected cells from normal mice and mice with only one copy of the IGF-1 receptor gene to oxidative stress. They found that more of the cells from the mutant mice survived, suggesting that having one copy of the gene conferred some protection from oxidative stress, said Ramesh Raghupathi of the University of Pennsylvania School of Medicine in Philadelphia. Raghupathi, who was not involved in the study, has researched IGF in the treatment of brain-injured patients.

However, while it might appear that blocking the IGF-1 receptor could lead to longer life, this approach probably wouldn't work, Raghupathi said. That's because the receptor is important to both mice and humans.

Mouse embryos that have only one copy of the receptor don't flourish and grow, Raghupathi pointed out. And the new study showed that male mice that had only one copy of the IGF-1 receptor gene didn't deal well with high levels of blood glucose (sugar).

This means that males with only one copy of the gene probably are more likely to develop diabetes, Raghupathi said.

Source: Nature advance online 2002;10.1038/nature01298.

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Study: Early Pill Use Can Up Cancer Risk

By Paul Recer

AP Science Writer

The Associated Press

Wednesday, December 4, 2002

WASHINGTON (AP) - Taking the pill at an early age or before 1975 significantly increases the risk of breast cancer (news - web sites) for women with a gene mutation that already places them at high risk of the disease, a new study shows.

The study, in the Journal of the National Cancer Institute (news - web sites), found that among women with the BRCA1 gene mutation, taking oral contraceptives years ago increased the lifetime risk of breast cancer by 33 percent to 42 percent when compared with mutation carriers who did not take the pill.

Dr. Steven A. Narod, chairman of breast cancer research at the Centre for Research on Women's Health at the University of Toronto, said the study does not mean that modern birth control pills are dangerous for women with the breast cancer gene, but it does add a caution about how they should use the pill.

"In this data, the only women who had an increased risk started taking the pill before 1975. Also, they had to take it when they were young, under the age of 25," said Narod, the first author of the study. He said the increased risk for the gene mutation carriers is "mostly women who took the pill when they were young a long time ago."

Modern birth control pills have only a fraction of the hormones that were present in birth control pills routinely used before 1975, he said.

Narod said the study also showed the risk increased if women started the pills before the age of 25 or if they took the oral contraceptives for longer than five years.

The study is based on an analysis of the health histories of more than 2,600 women in 11 countries, all of whom have mutations of the BRCA1 or BRCA2 genes. Half of the women studied had taken birth control pills and half did not. The study compared the breast cancer histories of the two groups and found there was an increased risk for the pill takers.

Earlier studies have shown that mutations of the BRCA1 or BRCA2 genes increase the lifetime risk of breast cancer by about 60 percent, and even higher in some cases. The mutations are relatively rare, occurring in one of 250 women in the general population, and account for less than 10 percent of all breast cancer cases.

Narod said the new study shows that early birth control pill use increases the lifetime breast cancer risk up to about 85 percent for women with the BRCA1 mutation when compared to women without the mutation. Oral contraceptive use was not found to increase the risk among BRCA2 mutation carriers, however, said Narod. Why there is a difference in risk between the two mutations, he said, is not known.

Debbie Saslow, director of breast and gynecological cancer control for the American Cancer Society (news - web sites), said the study suggests that women with the BRCA mutations should approach oral contraceptive use with caution, but that the research need to be verified by other studies before the findings can be generally applied.

"We don't make broad policy decisions based on just one paper," she said.

Saslow said decisions about oral contraceptive use among mutation carriers is complex because the pill is protective, to some degree, against ovarian cancer, a much more difficult to detect type of deadly cancer.

"I think women who have this BRCA1 mutations need to talk to their doctors because there is a trade-off," she said.

Narod said researchers are gathering data to determine if mutation carriers were placed at even greater risk of breast cancer after menopause if they took hormone replacement therapy.

"Based on what I see for birth control pills, I am certainly concerned that giving hormones to women with these mutations might increase the risk," he said. The results from that study will not be ready for about a year, said Narod.

On the Net:

Journal of the National Cancer Institute: http://jncicancerspectrum.oupjournals.org/

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US Study Describes New 'Tennis Elbow' Treatment

Reuters

Wednesday, December 4, 2002

CHICAGO (Reuters) - "Tennis elbow" and other tendon and ligament injuries that sometimes do not respond to standard therapy show promise of healing with ultrasound-guided needle treatment, a researcher said Wednesday.

"It's an option for patients with tendon and ligament injuries who are at a crossroads--unwilling to give up the sport or activity they enjoy and not yet ready for surgery, which carries risks," said Levon Nazarian of Thomas Jefferson University in Philadelphia, Pennsylvania.

Instead of standard initial treatment using medications, a brace, physical therapy or rest, the new technique uses ultrasound to provide doctors with an image to precisely guide a hypodermic needle.

The needle can be used to inject corticosteroid at the site of the inflammation, to scrape the bone adjacent to the tendon to smooth it out, to eliminate calcification rubbing against the tendon or to "rough up" tissue around tears to promote healing, Nazarian said.

He told the annual meeting of the Radiological Society of North America that 65% of 306 patients reported improvement following the procedure after not responding to more conservative therapy.

The patients in his study suffered from various tendon, muscle and ligament injuries including tennis and golf elbow, knee, hamstring and rotator cuff injuries and Achilles tendon problems.

"It is simple in concept, and it's helping bring patients along the path to recovery," Nazarian said.

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Tired? Your Spark Plugs May Be Misfiring

HealthScoutNews

Wednesday, December 4, 2002

WEDNESDAY, Dec. 4 (HealthScoutNews) -- A breakdown in the system that helps the body respond to stress may play a role in chronic fatigue syndrome, says a study in the November/December issue of Psychosomatic Medicine journal.

The research shows that subtle changes in a hormonal stress response system called the hypothalamus-pituitary-adrenal (HPA) axis could be a factor in chronic fatigue syndrome.

The HPA axis uses three hormones to help the body remain stable during physiological and psychological stress. The hypothalamus secretes a hormone that stimulates the pituitary gland to secrete a second hormone, which then prompts the adrenal gland to produce cortisol.

A problem anywhere along that chain can result in a variety of diseases, and that may include chronic fatigue syndrome, the researchers say.

People with chronic fatigue syndrome experience debilitating fatigue and may also have muscle aches, low-grade fever and sleep disturbances.

This study included about 40 people between the ages of 30 and 50. Half of them suffered from chronic fatigue and the other half were healthy. All the study participants filled out questionnaires that measured fatigue, depression and coping skills.

The participants were given stress tests and then had blood, cardiovascular and saliva tests to check on their HPA axis.

The study found that people with chronic fatigue syndrome had significantly lower response levels of one of the HPA hormones called ACTH before and during the stress tests.

More Information

The Centers for Disease Control and Prevention (news - web sites) has more about chronic fatigue syndrome.

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Skin of Newborns Has Natural Antibiotic Barrier

By Pat Hagan

Reuters Health

Wednesday, December 4, 2002

LONDON (Reuters Health) - Newborn babies are equipped with an antibacterial skin defense that protects them against infection in the very early stages of life, researchers have found.

This barrier is made up of so-called peptide antibiotics and is present in the skin of all babies, as well as the vernix caseosa--the white creamy substance they are coated with in the womb. These natural antibiotics seem to be activated by a common but poorly understood infant skin rash called erythema toxicum.

Peptide antibiotics are part of the body's surface protection against microbial intruders. They act as a rapid, first line of defense that is separate from the immune system.

Although they are found in the skin of adults, little has been known about their presence in young infants. The findings, reported in the December issue of the British Journal of Dermatology, suggest they also play a vital part in protecting babies during the transition from the sterile environment within the womb to a world full of microbes.

To see if they were present in newborns, researchers studied four babies who developed erythema toxicum hours after being born and compared them with four babies who did not have the rash.

They took samples of skin tissue to see if they could detect signs of two particular peptide antibiotics, called LL-37 and HBD-1. The results showed that in all four babies with the skin inflammation, there was a high concentration of cells producing the LL-37 peptide. Infants without the rash had no such cells. Similar evidence was found for the presence of HBD-1.

In their article the researchers from Sweden's Karolinska Institute, led by Dr. Giovanna Marchini, said: "The human newborn is equipped with an antimicrobial skin defense system that is much more than just a mechanical barrier.

"This defense system is active prior to birth and is seen in the vernix caseosa and strengthened during the first days after birth by an acute cellular inflammatory skin response known as erythema toxicum."

A separate analysis of vernix caseosa from six healthy babies born by Caesarean section found all the samples contained the LL-37 antibiotic peptide.

"The vernix was found to exhibit a clear antibacterial activity, showing that microbicidal polypeptides are already present at elective concentrations during fetal life," the researchers write. "The fetus has the capacity to secrete these peptides, perhaps in order to prepare for microbial colonization."

Source: British Journal of Dermatology 2002;147:1127-1134.


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Bypass Bests Angioplasty for Some With Blocked Artery

 

HealthScoutNews

Wednesday, December 4, 2002

WEDNESDAY, Dec. 4 (HealthScoutNews) -- Bypass surgery to restore blood flow for certain people with a single blockage in a coronary artery may produce better long-term results than angioplasty using a stent.

So concludes a study in today's issue of the Journal of the American College of Cardiology.

The study found that bypass surgery offered better results for people with high-grade artery lesions. However, the study didn't compare bypass surgery to newer stents.

Dutch and Italian researchers studied 102 people with a single B2 or C lesion in a coronary artery. The patients were randomly assigned to receive either angioplasty or bypass surgery.

Those who received angioplasty had a catheter threaded into the narrowed artery to restore blood flow. A wire mesh stent was then left in place to keep the artery open.

The bypass surgery patients had a "keyhole" type of operation. The surgeon worked through a small incision in the chest and grafted a bypass vessel around the blocked artery.

Three years after the procedures, the researchers counted the number of patients who had died, suffered a heart attack or stroke, and those who needed a second procedure because of a clog in the same artery.

The study found that 23.5 percent of the people who received angioplasty had a heart attack, stroke or needed a second procedure, compared to 9.8 percent of the people who had bypass surgery.

However, there were no deaths in the angioplasty group, compared to two deaths in the bypass surgery group.

The study also found that people in the bypass surgery group were less likely to have a return of angina (news - web sites), needed much less medication, and were in better condition than the angioplasty/stent group.

More information

The American Heart Association (news - web sites) has a full explanation of coronary bypass surgery.

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TUESDAY, DECEMBER 3, 2002 

Nurse Interviews Cut Hysterectomy Rates

 

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- Women with heavy menstrual bleeding are less likely to opt for a hysterectomy if they have a chance to talk it over with a nurse before they see a doctor.

In a study of nearly 900 English women who were referred to a specialist for heavy menstrual bleeding, 38 percent of those who had discussed their treatment preferences with a nurse had a hysterectomy within two years of their initial doctor's visit, compared to 48 percent of the women who saw their doctor without a prior nurse consultation.

"The interviews helped women clarify their preferences for outcomes for different procedures, and it could be that given good evidence-based information on alternate treatments, women will opt for procedures with the least risk," says Andrew Kennedy, a statistician at England's Brunel University and the lead author of the study.

The results of the study, supported by a grant from the United Kingdom's National Health Service (NHS), appear in tomorrow's issue of the Journal of the American Medical Association (news - web sites).

In the study, 894 women who reported heavy menstrual bleeding were divided into three groups: those who received written and video material about their condition and treatment options before their doctor's appointment; those who received the materials and who also had a 20-minute interview with a nurse before their doctor's appointment; and a control group who received no informational materials and who simply went to the specialist.

Interestingly, those in the first group who received the informational materials but who did not have an interview showed no differences in treatment preferences from the women who did not receive additional information.

"The women seemed to need the added structure of an interview to use the information they got in order to come to a firm decision about the treatment they wanted," Kennedy says.

"The information and the interview together may help women validate their preferences. Without them, a woman might be influenced more readily by a doctor who would negate their own values," says Kennedy.

In the highly structured interview, the women were asked questions to elicit how involved they wanted to be in their treatment decisions, what their treatment preferences were and how those treatments related to their lifestyles.

These questions included whether they wanted a hysterectomy, didn't want an operation, wanted drug therapy, and a ranking of what lifestyle issues were important to them, like how important it was to have minimum pain, resume sex, how long they wanted to stay in the hospital and whether they planned a pregnancy.

Kennedy says that you could have this kind of interview intervention and still not see any treatment changes, because women could still be sure of the treatment they wanted. That didn't happen here, though.

"We found that you can change patterns of care," he says.

In the United States, where the rate of hysterectomies is twice that of England, such information could be useful, says Dr. Michel Rivlin, a gynecology professor at the University of Mississippi Medical Center.

"It was news to me that having a nurse interview would drop the surgery rate," he says, adding that other studies have shown that the more information given about procedures, the less likely it is that people will choose the more high-risk option.

Up to one third of menstruating women report heavy bleeding, Kennedy says, and it is a common reason for consulting a doctor. Although not life-threatening, it affects a woman's quality of life. Treatment options include advice and reassurance, addressing possible causes, drug therapy, or surgery.

Further, many of the treatment options depend on a woman's personal situation and lifestyle, Kennedy says. "You can't say which treatment is best because it's value-driven," he says, and the authors hoped to identify how to help women reach decisions with which they were comfortable.

"I think this works very well," he says.

But why aren't doctors asking these questions already?

Not enough time, says Kennedy.

"In England, women get eight minutes with specialists in an outpatient setting," he says, and the appointment includes giving information, getting information, and doing a physical exam. There simply isn't the time for an in-depth interview.

What To Do

For information on heavy menstrual bleeding, you can visit Medline. An interesting discussion on the ethics of informed consent can be found at the University of Washington School of Medicine.

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Contraceptive Said a Risk for Some Women

By Paul Recer

AP Science Writer

The Associated Press

Tuesday, December 3, 2002

WASHINGTON (AP) - Women with certain gene mutations have more than a 60 percent lifetime risk of developing breast cancer (news - web sites). Now a new study suggests the risk is even greater for these women if they used oral contraceptives at an early age or before 1975.

The study, in the Journal of the National Cancer Institute (news - web sites), found that among women with the BRCA1 gene mutation, taking the pill years ago increased the chances of developing breast cancer by 33 to 42 percent when compared to mutation carriers who did not take it.

Dr. Steven A. Narod, chairman of breast cancer research at the Centre for Research on Women's Health at the University of Toronto, said the study does not mean that modern birth control pills are dangerous for women with the breast cancer gene, but it does add a note of caution about how they should use the pill.

"In this data, the only women who had an increased risk started taking the pill before 1975. Also, they had to take it when they were young, under the age of 25," said Narod. He said the increased risk for the gene mutation carriers is "mostly women who took the pill when they were young a long time ago."

Modern birth control pills have only a fraction of the hormones that were present in birth control pills routinely used before 1975, he said.

Narod said the study also showed the risk increased if women started the pills before the age of 25 or if they took the oral contraceptives for longer than five years.

The study is based on an analysis of the health histories of more than 2,600 women in 11 countries, all of whom have mutations of the BRCA1 or BRCA2 genes. Half of the women studied had taken birth control pills and half did not. The study compared the breast cancer histories of the two groups and found there was an increased risk for the pill takers.

Earlier studies have shown that mutations of the BRCA1 or BRCA2 genes increase the lifetime risk of breast cancer by about 60 percent, and even higher in some cases. The mutations are relatively rare, occurring in one of 250 women in the general population, and account for less than 10 percent of all breast cancer cases.

Narod said the new study shows that early birth control pill use increases the lifetime breast cancer risk up to about 85 percent for women with the BRCA1 mutation when compared to women without the mutation. Oral contraceptive use was not found to increase the risk among BRCA2 mutation carriers, however, said Narod. Why there is a difference in risk between the two mutations, he said, is not known.

Debbie Saslow, director of breast and gynecological cancer control for the American Cancer Society (news - web sites), said the study suggests that women with the BRCA mutations should approach oral contraceptive use with caution, but that the research need to be verified by other studies before the findings can be generally applied.

"We don't make broad policy decisions based on just one paper," she said.

Saslow said decisions about oral contraceptive use among mutation carriers is complex because the pill is protective, to some degree, against ovarian cancer, a much more difficult to detect type of deadly cancer.

'I think women who have this BRCA1 mutations need to talk to their doctors because there is a trade-off," she said.

Narod said researchers are gathering data to determine if mutation carriers were placed at even greater risk of breast cancer after menopause if they took hormone replacement therapy.

"Based on what I see for birth control pills, I am certainly concerned that giving hormones to women with these mutations might increase the risk," he said. The results from that study will not be ready for about a year, said Narod.

On the Net:

Journal of the National Cancer Institute: http://jncicancerspectrum.oupjournals.org/

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Parasite Drug for Children

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- The drug Alinia (nitazoxanide) has been given the go-ahead for the treatment of childhood diarrhea and other symptoms caused by two types of parasites.

The parasitic infections, cryptosporidiosis and giardiasis, are often spread through contact with, or ingestion of, contaminated water. Approved for use in children up to age 11, Alinia prevents enzyme reactions that are necessary for the parasites to survive.

In clinical trials, the The U.S. Food and Drug Administration (news - web sites) said that Alinia proved up to 88 percent effective in treating symptoms of the infections, which, besides diarrhea, could include abdominal cramps, low-grade fever, nausea and vomiting. The infections are fairly common in developing countries, though the U.S. Centers for Disease Control and Prevention (news - web sites) estimates 4,000 Americans may be infected with cryptosporidiosis.

For people with weakened immune systems, either infection could become life-threatening, the FDA says. While clinical trials proved the drug's effectiveness in children, there was little or inconclusive data among adults, particularly those with AIDS (news - web sites)-causing HIV (news - web sites), the agency says. More testing among adults and AIDS patients is required, the FDA adds.

It is fairly rare for the FDA to approve a medication for use in children before it approves the drug for adults, experts say. Alinia is manufactured by Romark Laboratories of Tampa, Fla.

Here is the FDA Talk Paper describing Alinia. For more about cryptosporidiosis and giardiasis, visit the Centers for Disease Control and Prevention.

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Extramarital Sex Hazardous to Health, Doctor Says

 

Reuters

Tuesday, December 3, 2002

HAMBURG (Reuters) - Extramarital sex can increase your risk of having a heart attack, a British cardiologist has told a congress on sexual health in the German city of Hamburg.

Graham Jackson, a heart specialist at St. Thomas's Hospital in London, found couples in long-term relationships were far less likely to have heart attacks while having sex than those having affairs or one-night stands.

"We found that 75% of the cases of sudden death during sexual activity involved people who were taking part in extramarital sexual intercourse," Jackson told the European congress late Monday.

He added the danger of having heart failure during extramarital sex was exacerbated even further when there was a significant difference in age between the partners.

Jackson said that even though heart rates accelerate considerably during all sexual activity, his research found "couples in long-term relationships in general hardly faced any risk of heart failure."

He said measurements on blood pressure and heart rates found sex is generally comparable to a brisk 20-minute walk, with an orgasm putting a strain on the heart similar to an ensuing walk up a flight of stairs.

"All in all, only 1% of all heart attacks are triggered by sexual activity," Jackson said.

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Hospitalized Patients Fare Better With Specialists

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- Doctors who specialize in hospital care provide better patient results than general internists who traditionally manage patients' hospital stays, says new research.

A University of Chicago study in today's issue of the Annals of Internal Medicine found that "hospitalists" lower short-term death rates, reduce the length of patient hospital stays and cut costs.

Those benefits improved as hospitalists -- a relatively new type of specialty doctor -- gained more experience. For instance, in the first year of this two-year study, patients under the care of hospitalists stayed in hospital about a third of a day less than patients cared for by interns.

By the second year of the study, that gap had increased to a half day, which resulted in average savings of $782 per patient.

The study also found that patient deaths fell by 37 percent by the second year. Six percent of patients under the care of internists died within 30 days, compared to 4.2 percent of patients cared for by hospitalists.

The study included 6,511 people admitted to the general medical service of the University of Chicago hospitals between July 1, 1997, and June 30, 1999. Every fourth day, new patients were assigned to the care of one of two hospitalists. Other patients were assigned to one of 58 internists.

A larger, multi-center study compared hospitalists and internists is now underway.

More information

The National Association of Inpatient Physicians has more information about hospitalists.

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Additive-Free Cigarettes No Safer for Smokers: Study

 

By Alan Mozes

Reuters Health

Tuesday, December 3, 2002

NEW YORK (Reuters Health) - Additive-free cigarettes such as the "American Spirit" brand are no safer to smoke than conventional filtered cigarettes, researchers have found.

"With some of these non-conventional cigarettes the perception is that they are safe, and younger smokers are maybe more likely to see them as viable alternatives--but our results suggest that this is not true," said study co-author Jennifer L. Malson, a graduate student at University of Maryland, Baltimore County.

Malson and her colleagues at the National Institute on Drug Abuse in Baltimore focused on the physical and psychological reactions of 10 healthy smokers when smoking a variety of cigarettes: their conventional filtered brand; the unfiltered American Spirit brand; and both a flavored and non-flavored version of imported Indian hand-rolled cigarettes known as bidis, which have become increasingly popular among US smokers in recent years.

The authors note that the American Spirit cigarettes are made with whole leaf natural tobacco and are described by the manufacturer as "additive-free"--containing no chemical additives, preservatives or reconstituted tobacco.

Over a series of 90-minute sessions during which each smoker smoked just one of the four types of cigarettes, the researchers recorded the number of puffs taken per cigarette and collected blood samples to record nicotine absorption. In addition, they measured exhaled levels of carbon monoxide and blood pressure levels.

All participants were asked how satisfied they were with each cigarette in terms of taste, enjoyment, reduction of any cigarette craving and how it may or may not have made them feel calm, irritable, dizzy, awake, hungry or nauseous.

Malson and her team found that both versions of the bidi cigarettes--though smaller and lower in tobacco content then conventional cigarettes--delivered levels of nicotine and carbon monoxide equal to or larger than amounts from conventional filtered cigarettes.

Bidis' nonporous leaf wrapping and packing density may explain their nicotine effect, they theorize. The researchers suggest, therefore, that if smoked daily, bidis could promote nicotine dependence just as surely as conventional cigarettes.

The unfiltered American Spirit cigarettes were found to raise nicotine levels in the smokers' blood to significantly higher levels than the conventional filtered cigarette.

The participants were also observed to have spent more time smoking--and taken more puffs--with both the non-flavored bidis and the American Spirit cigarettes. Nevertheless, the smoking group appeared to prefer their conventional cigarettes in terms of satisfaction and enjoyment levels, overall.

Noting that both the American Spirit cigarettes and bidis contain carcinogenic compounds, the investigators point out that such non-conventional cigarettes pose a substantial health risk to smokers. And they emphasize that adolescents appear to be particularly vulnerable to becoming dependant on such brands.

"I think kids are looking to these alternatives, because they are cheaper and easier to buy," Malson told Reuters Health. "And the bidis also come in a wide variety of flavors, which I think are more geared toward adolescents. So I guess it's not surprising that younger smokers are attracted to the bidis, which have very candy-like flavors.... But neither the American Spirit nor the bidis are safer than conventional cigarettes."

Based on a brief review of a study summary, Rick Sanders--president and CEO of the Santa Fe Natural Tobacco Company, which manufactures American Spirit cigarettes--took issue with some of the researchers' conclusions.

Sanders noted, in particular, that the study stacked a non-filtered American Spirit product--which he said accounts for only 1.5% of the company's sales--against filtered conventional cigarettes. He likened this comparison to a study of "apples and oranges."

Sanders told Reuters Health that, in any event, American Spirit cigarettes are not marketed as a safer alternative to conventional cigarettes but rather as a tastier option.

Sanders pointed out that American Spirit packaging and ads contain the following explicit health warning: "We make no representation--expressed or implied--that these cigarettes are any less hazardous than any other cigarettes."

"I certainly don't dispute anything I've seen," he added. "But our whole purpose is that we offer a very different taste signature."

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A Better Test for Heart Attacks

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- A test that measures blood flow to the heart can avoid unnecessary hospitalizations for people brought to the emergency room with chest pain.

The test is called myocardial perfusion imaging. It is done routinely for non-emergency patients who undergo stress tests. In a study of nearly 2,500 patients who came to emergency rooms with suspected heart attacks, the test reduced unnecessary hospital admissions by 16 percent, says a report in tomorrow's issue of the Journal of the American Medical Association (news - web sites).

"By incorporating this information, the emergency room physician can make a decision about who should be in the hospital and who should go home," says Dr. James E. Udelson, associate chief of cardiology at Tufts-New England Medical Center in Boston and leader of the study.

The study included 2,475 people who came to New England emergency rooms with chest pain or other symptoms of a possible heart attack, but whose electrocardiograms and blood enzyme tests gave no clear-cut indication of a heart attack. Half got the usual evaluation of their condition, and the other half had myocardial perfusion imaging.

"The patient is injected with an isotope in the emergency room and then is taken to the nuclear medicine department where a camera takes a picture showing what blood flow to the heart is," Udelson says.

The test did not bar hospitalization for those patients who needed it -- 97 percent of patients who had heart attacks and got the test were admitted, compared to 96 percent who did not get the test. However, for those people who were eventually found not to have had heart attacks, 42 percent who had myocardial perfusion imaging were hospitalized, compared to 52 percent who did not have the test.

Dr. Raymond J. Gibbons, a professor of medicine at the Mayo Clinic and author of an accompanying editorial in the journal, calls the study "an important step forward."

"This is not a trivial bit of evidence," Gibbons says. "It is a study that has been very carefully done and that gives new information on a very important topic. It offers substantial evidence in favor of this option in treating patients."

However, the study raises "a lot of issues that have to be thought about," Gibbons says, such as what happens with patients who come to the emergency room at night or those who come to small hospitals.

"The logistics of the nighttime use of perfusion imaging are formidable for most hospitals," he writes in the editorial. "This approach also cannot be easily implemented in hospitals that do not currently have on-site nuclear imaging facilities."

It's also not clear that using the test would be cost-effective, Gibbons adds.

In the study, 11.3 patients had to undergo perfusion imaging to prevent one hospital admission, he calculates. A hospital admission would have to cost more than $5,500 for the test to pay for itself, Gibbons says. And "the magnitude of the cost savings is uncertain, as some of the unnecessary admissions were less-expensive stays in a chest pain unit, with costs that were likely well below this break-even point," he says.

Udelson says money is just one of the issues to be weighed.

"The situation gets beyond cost-benefit analysis," he says. "Even a few beds taken up by people who don't need them can compound a problem. Emergency rooms are increasingly crowded, hospitals are crowded. If a patient doesn't need a hospital bed, wouldn't it be nice to find that out faster?"

Gibbons says myocardial perfusion imaging "certainly will have a positive effect in reducing admissions. But one cannot assume that it will save money. That may not be the case."

What To Do

To learn about the tests used to diagnose a heart attack, visit the American Heart Association. For more information on heart attacks, check the National Library of Medicine.

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Nuclear-Imaging Can Help Heart Diagnosis

 

By Eric Fidler

Associated Press Writer

The Associated Press

Tuesday, December 3, 2002

CHICAGO (AP) - Nuclear-imaging technology already in place at many U.S. hospitals can help emergency room doctors do a better job of ruling out heart attacks in patients with chest pain, a study found.

The study looked at sestamibi imaging, which is normally used in non-emergency settings as part of a stress test. The patient is injected with an isotope that lets doctors monitor the heart's pumping ability and see how much blood is flowing to it.

"We're just taking available technology and using it in a new way," said the study's lead author, Dr. James Udelson of Tufts-New England Medical Center in Boston.

More than 6 million people each year go to emergency rooms with chest pain, and many are admitted to the hospital or an observation unit because doctors are unable to rule out a heart attack.

If the patients have abnormal readings on electrocardiograms, doctors can diagnose their heart attacks with certainty and start treatment. Often, however, patients have normal electrocardiograms. These people are frequently admitted for observation.

The research appears in Wednesday' Journal of the American Medical Association (news - web sites).

The study found that 52 percent of patients who were not given the test were admitted with what turned out to be neither a heart attack nor unstable angina (news - web sites), a common precursor to a heart attack. The rate was 42 percent among patients who were given the test.

Dr. Robert Bonow, president of the American Heart Association (news - web sites) and chief of cardiology at Northwestern University Medical School, said that number could fall once doctors using the test develop confidence in it.

Bonow said the imaging could save money, because an overnight stay in the hospital would probably be more expensive than the test.

The study looked at 2,475 patients at seven hospitals, ranging from large, academic medical centers to smaller community hospitals. Of the patients, 1,260 were assigned to receive standard care and 1,215 to undergo the imaging.

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Do You Have Metabolic Syndrome?

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- Researchers have found that middle-aged men with a collection of conditions known as metabolic syndrome have an increased risk for both cardiovascular disease and death.

Metabolic syndrome, which is also known as insulin resistance syndrome, is characterized by insulin resistance and elevated blood sugar levels, obesity marked by a pot belly, abnormal blood lipids, and high blood pressure. According to the study authors, metabolic syndrome is likely caused by some combination of obesity, a sedentary lifestyle, diet and genetic factors.

Given the worldwide epidemic of obesity, the syndrome represents a serious public health issue.

The report appears in tomorrow's issue of the Journal of the American Medical Association (news - web sites).

One problem in assessing the prevalence and severity of metabolic syndrome is that there has been no consistent definition as to what exactly it is. To help ameliorate this, the National Cholesterol Education Program (NCEP) and the World Health Organization (news - web sites) (WHO) recently published definitions that are for the most part similar but vary in their particulars.

Four of these definitions were used in this study, which looked at men involved in the Kuopio Ischaemic Heart Disease Risk Factor Study in Finland. The 1,209 men, all Finnish, were 42 to 60 years old at the beginning of the study and were followed for about 11 years. None of the men with metabolic syndrome had cardiovascular disease or diabetes when the study commenced.

Depending on the definition used, the prevalence of metabolic syndrome in the sample population was 8.8 percent to 14.3 percent.

Men with metabolic syndrome as defined by the NCEP were 2.9 to 4.2 times more likely to die of coronary heart disease than healthy men. Those with metabolic syndrome as defined by the WHO were 2.9 to 3.3 times more likely to die of coronary heart disease, after adjusting for other factors.

Mortality from cardiovascular disease was 2.6 to 3 times higher among men with metabolic syndrome as defined by the WHO. Death from any cause was 1.9 to 2.1 times higher in this group. The NCEP definition was less helpful in predicting death from cardiovascular disease and other causes.

This is grim news for the United States, in particular, where, according to the NCEP definition, about one-third of middle-aged men and women have the syndrome. The CDC has estimated that up to 47 million Americans may suffer from metabolic syndrome.

Certain characteristics of metabolic syndrome, including high blood pressure and elevated cholesterol, are known to be risk factors for heart disease, says Dr. Daniel Fisher, a cardiologist with New York University Medical Center in New York City. Abdominal obesity and insulin resistance may be risk factors, but are less clear-cut.

"Doctors treat individual risk factors and don't necessarily put a label on it," Fisher says. "Putting the label may help to raise awareness that risk of heart disease is raised in these people."

What To Do

Read more about the condition at the Centers for Disease Control and Prevention, which also has a page on obesity.

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Fetal Cocaine Exposure May Not Stunt Development

 

By Charnicia E. Huggins

Reuters Health

Tuesday, December 3, 2002

NEW YORK (Reuters Health) - Contrary to many experts' predictions, infants born to mothers who used cocaine heavily during pregnancy do not seem to have developmental delays in early life, new study findings show.

During the cocaine epidemic in the US, in the late 1980s and early 1990s, many expected that children exposed in the womb to their mother's cocaine use, or "crack babies," would suffer lasting developmental impairment.

However, the idea that these children are "doomed at birth" is not consistent with the present study findings, which looked at children up to the age of 2 years, or with previous research, lead study author Dr. Deborah A. Frank of Boston University's School of Medicine in Massachusetts, told Reuters Health.

"This stereotype does as much harm, if not more, to children as the actual physiological impact of prenatal exposure," Frank added. "The negative expectations of these children are in itself very harmful."

Frank and her colleagues studied 203 mother-infant pairs, including mothers who were heavy cocaine users, meaning they had used cocaine on more than 62 days during their pregnancy; light users; non-users and their full-term infants. The infants' psychomotor and mental development was tested at 6, 12 and 24 months of age. Psychomotor function involves physical activity that is linked to mental processes, for example learning to grasp an object or to crawl or walk.

Overall, infants who were exposed to high levels of cocaine did not have a higher risk of mental or psychomotor developmental problems, the investigators report in the December issue of Pediatrics. But they did have slightly lower scores if they were also lower birth weight infants, the report indicates.

In general, lower birth weight infants--regardless of their cocaine exposure--did not perform as well on tests of their mental abilities as their normal-weight peers, but those who were also exposed to high levels of cocaine scored lower on mental and psychomotor tests.

The reason for this may be due to social factors, including the infants' home environment, study findings suggest.

Infants who were heavily exposed to cocaine were more likely to have been taken out of their mother's custody and placed with unrelated foster parents, the authors note. Those who were cared for by another family member, however, had more developmental problems at later ages than did infants who were left in the care of their biological mother.

Related caregivers are not always properly evaluated and monitored--as are foster parents and biological mothers with a history of drug use--and may not have the necessary support and resources necessary to provide the best care for the infant, Frank explained.

In other findings, all of the infants scored lower on their developmental tests as they got older. "That's the sad news," Frank said. "Poverty corrodes child development.

"But for everybody, early intervention helped to decrease the magnitude of that decline," she added.

Early speech, physical therapy and other intervention services seemed to protect heavily cocaine-exposed infants against problems in their mental and psychomotor development, study findings indicate.

In fact, the heavily exposed infants who received early intervention performed better in tests of their mental development than less-exposed or non-exposed infants. This may be because infants exposed to high levels of cocaine were more likely to get such help earlier--before their first birthday--than their peers, the researchers speculate.

In general, the development of cocaine-exposed infants "very much depends on what happens to them after they are born," Frank said, citing the importance of appropriate caregivers and intervention.

Further, cocaine-exposed infants can benefit from the same types of intervention programs that every impoverished child at risk for developmental problems needs, Frank said. "People need not be scared to enroll these children in the same programs." The cocaine-exposed children "didn't need anything extraordinary," she added.

Finally, to ensure that cocaine-exposed infants placed in the care of a relative receive the same quality of care as their peers, pediatricians should "advocate for measures to decrease caregiver burden, increase resources, and enhance supervision for caregivers providing kinship care to the level of that provided for unrelated foster parents," the researchers write.

"You have to support the children, and you have to support the caregiver, whoever it is," Frank said.

Grants from the National Institute of Drug Abuse and the National Center for Research Resources funded the study.

Sorce: Pediatrics 2002;110:1143-1152.

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Study Looks at American Indians, SIDS

By Jack Sullivan

Associated Press Writer

The Associated Press

Tuesday, December 3, 2002

WASHINGTON (AP) - American Indian mothers who drank alcohol while pregnant increased the risk their babies would die of sudden infant death syndrome, but that risk declined when the mothers were visited by public health nurses before or after giving birth.

A National Institutes of Health (news - web sites) study, published in Wednesday's Journal of the American Medical Association (news - web sites), evaluated data from infants who died of SIDS within the Indian Health Service region covering North Dakota, South Dakota, Nebraska and Iowa.

American Indians in that area had the highest SIDS rate in the health service's 12 regions, at 3.5 deaths for every 1,000 live births from 1996 to 1998.

Researchers found that a mother's alcohol use — even before she knows she is pregnant — may increase the risk of her child dying of the syndrome. However, the risk of SIDS fell 80 percent in homes where a public health nurse visited, compared with homes that did not have visits, the study said.

Researchers say the findings suggest that strengthening public health programs and working to reduce alcohol use among women of childbearing age on Indian reservations could cut SIDS deaths.

The researchers did not conclude what it was about the nurses' visits that helped reduce the risk, but those visits typically involve information about SIDS, including advice that putting infants to bed on their backs is the best way to reduce the risk of death from the syndrome, said Dan Dailey, community health director on the Standing Rock Indian Reservation, which straddles the North Dakota-South Dakota border.

The Indian Health Service has run SIDS information campaigns for at least 10 years and health workers try to visit each pregnant woman at least once on Standing Rock, Dailey said.

"It's pretty rare for someone to go through a pregnancy without a visit," Dailey said.

Overall, the risk of SIDS among American Indians is 1.5 deaths per 1,000 live births, more than double the rate of 0.7 deaths for every 1,000 live births among whites.

Indian babies had six times the risk of dying from SIDS if their mothers drank alcohol in the three months before and the three months after conception, the study said. And Indian babies had eight times the risk of dying from SIDS if their mothers drank more than five drinks at one sitting during the first trimester of pregnancy, researchers said.

The study found "as soon as (women) found out they were pregnant, the drinking rate went down significantly," said Leslie Randall, one of two lead researchers.

Experts do not know what causes SIDS, which kills about 3,000 infants a year, although theories include brain stem defects and heat stress.

The study published Wednesday also found infants dressed in more than a single layer of clothing when they were put to bed were six times more likely to die of SIDS, which suggests overdressing can result in potentially dangerous overheating, Randall said.

While small, the study could lead to a larger review that pinpoints more SIDS risk factors, Randall said.

Reducing risk factors can lower but not eliminate SIDS deaths, she said.

"There's obviously something that we're not catching," she said.

On the Net:

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

Indian Health Service: http://www.ihs.gov

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Gene Therapy Treats Rare Liver Disease in Rat Study

 

By Stephen Pincock

Reuters Health

Tuesday, December 3, 2002

AMSTERDAM (Reuters Health) - Dutch researchers have shown that gene therapy for fetal mice engineered to have a rare but deadly human liver disease appears to help ease symptoms of the disease after the animals are born.

In the condition, Crigler-Najjar type I, the liver does not produce an enzyme that allows the bile pigment bilirubin to be excreted by the body. Patients develop jaundice as infants and must spend up to 16 hours each day in special light therapy beds to avoid deadly complications of the disease. Liver transplantation can be an effective treatment, but the number of donor organs is limited and life-long immune suppression is required to prevent organ rejection.

In preliminary research, Dr. Jurgen Seppen and colleagues from the liver research center in Amsterdam's Academic Medical Center used a genetically engineered virus to correct the lack of the enzyme in rats.

The enzyme normally links bilirubin to glucuronic acid, making it water-soluble so it can be excreted. The researchers injected a virus carrying a gene to make the enzyme into individual rat fetuses at day 19 of the normal 22-day gestation period and allowed the gestation to continue to term. Seppen said they used in utero gene therapy because they suspected it might overcome some of the problems that have plagued the field of gene therapy.

He noted in an interview with Reuters Health that it is difficult to transduce, or induce genetic transformation, in a large number of live cells. "That is one reason that we used in utero gene therapy," he explained. "Because of the small size of the organisms you have to inject and also because the tissues might be more amenable to transduction at that stage."

Also, in utero therapy would avoid the potential for the development of an immune reaction to a "missing" protein that is restored through gene therapy once the immune system has developed, he said. "Obviously if you express this protein already in utero there would be no immune response."

The researchers examined the rats for serum bilirubin levels and the distribution of the viral carrier.

"There was a correction of about 50% of the serum bilirubin that has been sustained for as long as we have studied, which is about 7 months or so now," Seppen said. "All animals were corrected by about 50%."

"The next question becomes where does the virus end up--and this is I think where the problems start." Distribution was variable from rat to rat, and the researchers could not rule out the possibility that germ cells such as sperm and eggs had been genetically modified, meaning the gene change would be passed along to the next generation.

"We don't know yet whether there was germ line transmission, but since it looks like it can basically end up anywhere this might be a potential problem," he said. "In the end the conclusion might be that this is simply too dangerous to use in humans because you might make germ-line modified people in this way."

On the other hand, part of the problem might have been the difficulty in targeting the vector to the liver in the rat model, Seppen pointed out. The best way would be to use intravenous injection, but this is impossible in a rat fetus. The researchers tried to aim for the liver but this in itself was difficult.

"It would be easier if you were using larger animal models. Depending on funding and manpower I think the next logical step would be to try this in larger animals," the researcher said.

The researchers plan to publish their work shortly.

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Study Casts Doubt on Full-Body CT Scans

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, December 3, 2002

Full-body CT scans — widely promoted in advertisements as a way to give yourself peace of mind — frequently find harmless abnormalities that lead to invasive, anxiety-producing follow-up tests, researchers say.

And they may be a waste of money for patients under 40, who run a low risk of serious disease, the study suggests.

"This got pushed to the public before any of the research was done," said Dr. Giovanna Casola of the University of California at San Diego. "They're saying do it for your peace of mind, do it for your wellness, for your family. Nobody's saying, `Half the time we're going to find things that you're going to worry about,'" sometimes needlessly.

The increasingly popular scans — widely promoted in radio and TV ads and on billboards — give doctors a view into the body from the neck to pelvis with CT scan machines. The scans typically are offered at private, for-profit centers, cost several hundred dollars or more and usually are not covered by insurance.

"It's really fun to be able to sit with people and give them a tour of their insides," said Dr. Max Rosen, medical director of a scanning center in Boston. "They're riveted by it."

Casola and colleagues studied 1,192 patients ages 22 to 85 who had full-body scans at private, for-profit imaging centers. They presented their findings Tuesday in Chicago at the Radiological Society of North America's annual meeting.

Forty-six percent of the scans showed abnormalities, most in the lungs, kidneys or liver. About 25 percent were suspected cancer; 15 percent were other significant ailments such as emphysema; and just 1 percent were strongly believed to be cancer or some other life-threatening disease. Thirty-seven percent of the participants were advised to have follow-up tests.

No one under 45 had scan results that strongly suggested cancer, and patients younger than 40 had very few findings requiring further tests, Casola said.

Other research has shown that follow-up tests usually determine that scan-detected abnormalities are insignificant. Casola said that is probably the case with many of the study participants, though data on subsequent testing generally was unavailable.

"Many of these for-profit centers don't follow up on their patients to see what happens to them," she said.

Most people in Casola's study got the scans on their own and were not referred by their doctors. Many physicians are skeptical of the scans because they have not been well-studied, said Dr. Stephen Swensen, the Mayo Clinic's chief of radiology.

And the scans are not foolproof.

Judie and John Roth of Morris, Ill., discovered that about a year ago when they gave each other full-body scans as anniversary presents. Results for both turned up nothing suspicious, but a month later John Roth, an obstetrician-gynecologist, was diagnosed with bladder cancer.

"It was just kind of a shock," said Judie Roth, 60.

"I didn't get any really good answers when I called the scan people back," she said. "What they pretty much said was, maybe because of the size of the tumor" it was missed.

Swensen said people should not have the scans unless they have consulted their own doctors and are referred by someone who doesn't have a financial interest in the tests.

"There's no medical society in the world that recommends this," Swensen said.

But Rosen said discouraging patients from getting the scans is "really doing them a disservice."

"A lot of people say I'm hoping seeing the images of my lungs will help me stop smoking," said Rosen, a Harvard Medical School (news - web sites) radiologist. "A lot of people want this and are using it to make lifestyle changes."

Dr. Edward Bluth, chairman of radiology at the Ochsner Clinic in New Orleans, said that more research is needed but that it will probably show the scans are useful. In the meantime, he said, people who want them and can afford them should be able to get them.

"I really do think this is the future," Bluth said.

Radiological Society: http://www.rsna.org

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Accreditor Issues Draft Human Research Standards

 

By Karen Pallarito

Reuters Health

Tuesday, December 3, 2002

NEW YORK (Reuters Health) - A national accrediting body on Tuesday released draft standards for ensuring that research institutions have the appropriate checks in place to properly inform and protect volunteers in clinical trials.

The National Committee for Quality Assurance said the standards are available at its Web site, www.ncqa.org. It is accepting comments through January 16 and expects to finalize the standards in February.

NCQA, better known for its accreditation of managed care plans, is one of two national outfits that have created voluntary programs for assuring that research institutions have rigorous processes for ensuring the safety of human subjects.

The Association for the Accreditation of Human Research Protection Programs Inc., formed in April 2001, will conduct its first site visits this month and expects to announce its first accreditations in April 2003, a spokesman for that group said.

The programs were developed to allay growing fears about patient safety amid an explosion in the volume of clinical trials and other studies involving human subjects.

NCQA said its draft standards are based on a mandatory accreditation program it developed last year for the Department of Veterans Affairs (news - web sites). It said the new program is designed to guard against research risks at institutions involved in human subject research, such as hospitals, medical schools and pharmaceuticals companies, as well as institutional review boards (IRBs), which review research protocols.

NCQA said it has organized the draft standards into four categories representing major functions performed as part of a human research protection program. Those categories cover organizational responsibilities for assuring participants' rights, safety and well being; IRB structure and operations; requirements for balancing risks and benefits; and duties for obtaining and documenting informed consent.

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Israel Fortifies Wheat With Vitamin B12

By Eli Fried

Associated Press Writer

The Associated Press

Tuesday, December 3, 2002

JERUSALEM, Israel (AP) - Israel has become the first country to fortify bread and other wheat products with vitamin B12, a health official said Tuesday, reflecting a survey that shows many Israelis don't get enough.

"Only 60 percent of people have the recommended levels of vitamin B12. This is one-third less than the corresponding figure in the United States," said Dr. Dorit Nitzan-Klosky of the Israeli Health Ministry.

Studies have indicated that a shortage of the vitamin might be linked to degenerative mental illnesses like Alzheimer's and dementia, as well as anemia and other disorders. Many U.S. experts recommend vitamin B12 supplements for older people, because absorption lessens with age.

Those most susceptible to the deficiency are vegetarians and vegans, because vitamin B-12 is found in meat, eggs, fish and poultry, Nitzan-Klosky said. The average Israeli diet, characterized by grilled meat and poultry and egg dishes, appears to include large quantities of such foods, but the study showed otherwise.

As a result, the ministry decided to start fortifying bread with the vitamin, she said. Several bakeries have been adding it to their bread for the past year, she said.

In many countries, including Israel and the United States, bakers add folic acid to bread products to assist in the prevention of neonatal defects, Nitzan-Klosky said. However, the folic acid can have the effect of masking a person's vitamin B12 deficiency, leading to irreversible neurological disorders, she said. To avoid this risk, Israel decided to add the B-12 supplement as well.

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It's My Party

 

HealthScoutNews

Tuesday, December 3, 2002

(HealthScoutNews) -- The holiday season is here and it's party time. If you're hosting a shindig, you may actually be held responsible if your guests over drink.

Harvard University Medical Center recommends you:

  • Don't make drinking the focus of your party.
  • Don't push alcohol on anyone.
  • Offer plenty of food and non-alcoholic drinks.
  • Avoid too many salty snacks, which will make your guests thirsty.
  • Stop serving alcohol about 90 minutes before the end of the party. Instead, serve dessert and specialty coffees.

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US Falling Behind in Stem Cell Research: Scientist

 

By Alicia Ault

Reuters Health

Tuesday, December 3, 2002

WASHINGTON (Reuters Health) - With the Bush administration's refusal to fully fund embryonic stem cell research, the US is falling behind in the effort to find a cure for a range of diseases, one of the nation's leading scientists and entrepreneurs said on Tuesday.

William Haseltine, CEO of Human Genome (news - web sites) Sciences and founder of the Society for Regenerative Medicine, told reporters at a conference on stem cell and other regenerative therapies that the administration's policies are severely delaying the development of treatments for diseases like Parkinson's.

Stem cells are immature "master" cells with the potential to develop into any type of cell in the body. Researchers believe they can be used to replace the diseased tissue that marks degenerative conditions like Alzheimer's, Parkinson's and heart disease. Last year, the Bush administration put restrictions on federal funding for stem cell research, which some US groups oppose because harvesting the cells from human embryos destroys the embryo.

The prospects for additional government funding of stem cell research are "dim under the current political context," Haseltine said, adding that he believes that the issue of providing money for experiments that take cells from human embryos has been "inappropriately tied to abortion politics.

"It is a dismal situation," Haseltine said, adding that with government funds drying up, more researchers will go overseas where the climate is less hostile.

"We will see many of our best scientists leave our shores," he predicted. Stem cell research is the most exciting area of exploration for biologists, he said, asking, "Are we going to shut that out for a whole generation of scientists?"

Haseltine said withholding funds from American scientists "will not stop the progress" of stem cell research in other countries.

He argued that the US, whose scientists have already invested so much time and energy in stem cell research, should be the global leader in the field.

Private investors have not stepped into the breach, Haseltine noted. Venture capitalists like a quick return on their investment, and much of stem cell technology's promise is years away from the market, he said.

And there are other factors that prevent companies from moving ahead quickly, including the bad economy, difficult hurdles at the Food and Drug Administration (news - web sites) and management problems, according to Haseltine.

Conference chairman Ian Wilmut agreed that much of the still-needed early work has to be done in universities, with government funding. But, the technology is also not far from being bankable, added Wilmut, who led the team that created the world's first cloned animal, Dolly.

Large companies need visionaries to see stem cells' promise, and to put their money up, he said.

"I think this technology needs a Steve Jobs (news - web sites)," Wilmut said, referring to the iconoclastic founder of Apple Computer.

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Geared Up

HealthScoutNews

Tuesday, December 3, 2002

(HealthScoutNews) -- Every winter, you should stock your car with a cold weather survival kit. Getting stuck or stranded in extremely cold weather is always a possibility.

 The U.S. Centers for Disease Control and Prevention (news - web sites) suggests you include these items:

  • Blankets and a first aid kit.
  • A can and waterproof matches to melt snow for water.
  • A windshield scraper, collapsible shovel and booster cables.
  • Road maps, a compass, a flashlight and extra batteries.
  • Canned compressed air with sealant for emergency tire repair.
  • A tool kit.

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Asbestos-Linked Cancers Show Unexpected Decline

 

By Karin Nordin

Reuters Health

Tuesday, December 3, 2002

STOCKHOLM (Reuters Health) - The incidence of asbestos-related lung cancer seems to have leveled off in Sweden, according to a report that suggests rates of the disease elsewhere in Europe could also peak sooner than expected.

Researchers collected data on the cancer, pleural mesothelioma, from the Swedish Cancer Registry between 1961 and 2000. In Sweden the use of asbestos rapidly diminished in 1976, but due to the disease's long latency time, the peak in pleural mesothelioma cases did not occur until 1993, they report in a letter to the January 1, 2003, issue of the International Journal of Cancer. But the researchers note that this is earlier than previously expected.

"The previous estimates have been called optimistic but this shows that they are rather pessimistic," Professor Kari Hemminki at the department of biosciences at Novum, Karolinska Institute, told Reuters Health.

Some estimates of the lag-time between exposure and mortality have been around 50 years, and models have predicted that the incidence of the disease would not reach a maximum until between 2015 and 2030 in Western Europe.

It is expected that Sweden would be among the first to see numbers peak, since use of asbestos was reduced here much earlier than in other countries.

"This would be good news to other Western European countries," the researchers write in their article. According to Hemminki, it can now be expected that the leveling off in Western Europe will happen between 2003 and 2013, assuming that exposure levels have been the same as in Sweden.

During the study period there were 2,190 cases of mesothelioma in men, 2,030 of which could be related to asbestos exposure, according to the study. For women, the number of asbestos-related cases was 350.

Source: International Journal of Cancer 2003;103:145-146.

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Less Invasive Cancer Screen May Save Lives

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- A less demanding method of looking at the intestines than the currently recommended technique might be a more practical way to screen for the early, preventable signs of colorectal cancer, an Italian study suggests.

Early results from a trial that includes more than 34,000 adults indicate that a single examination using sigmoidoscopy "can be an acceptable and safe screening strategy for colorectal cancer," says a report in tomorrow's issue of the Journal of the American Cancer Institute.

The idea is to detect polyps, abnormal growths that can be removed before they develop into cancer. The American Cancer Society (news - web sites) now says the ideal screening program would have every adult undergo an examination called a colonoscopy at the age of 60, and preferably every 10 years after that. It recommends a sigmoidoscopy every five years, preferably accompanied by a test for bleeding caused by polyps.

However, a colonoscopy is not easily done. It requires a dietary preparations starting the day before, an enema taken in the evening to clear out the intestine and nothing but clear fluids before the examination, which usually requires sedation. A physician can then insert a lighted, flexible tube that allows the entire intestine to be examined for polyps.

Sigmoidoscopy is much less demanding because it uses a shorter tube that inspects only part of the intestine. The Italian study's potential advantage is that the relative ease of having a sigmoidoscopy will lead many more people to have a screening test and thus save lives even though the examination does not detect as many precancerous growths.

"This strategy is expected to reduce the risk of colorectal cancer by 40 to 50 percent, which is less than would be achieved by colonoscopy," says Dr. Nereo Segnan, a lecturer in epidemiology at the University of Turin and leader of the study group. "We hope to show that this strategy is adaptable for use in large populations."

The journal paper is a preliminary report on the study. Among those participants who had sigmoidoscopies -- half did not -- the number who were found to have polyps (10.8 percent) and who had cancers (5.4 percent) were in line with predictions based on overall incidence of the condition. Tellingly, more than 80 percent of those who had the examination said the pain was as mild or milder than they expected.

It is still too early to draw any conclusions, Segnan says, because the study has another three years or more to run. Only if the final results show a significant reduction in cancer illness and deaths will it be possible to recommend any change in screening strategy, he says.

"On the other hand, there is a lot of observational information on the effectiveness of sigmoidoscopy in reducing the incidence and mortality of colorectal cancer," Segnan says.

The Italian study is being watched closely, says Dr. Durado Brooks, director of colorectal cancer for the American Cancer Society. It is the second most common form of cancer in the United States, with 148,300 new cases and 56,600 deaths expected this year.

"The idea that one-time screening at 55 or 60 using sigmoidoscopy might be sufficient is not a new concept," Brooks says. "This is the largest study ever to look at it."

One encouraging finding is that more than half the cancers detected in the study were found at the earliest, most treatable stage, when the survival rate is about 90 percent, he says. Only 37 percent of the cancers detected in colorectal screening programs in the United States are at that early stage, Brooks says.

"But it will be important to see whether there will actually be a large number of people dying of cancers that are out of the reach of sigmoidoscopy," he says. "Sigmoidoscopy is a useful screening test. Whether it is optimal remains to be seen."

What To Do

A guide to colorectal cancer, its symptoms, screening tests and treatment, can be found at the American Cancer Society. Meanwhile, the National Institute of Diabetes and Digestive and Kidney Diseases explains a sigmoidoscopy.

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Teen's Tattoo May Signal Risky Behavior: Study

 

By Charnicia E. Huggins

Reuters Health

Tuesday, December 3, 2002

NEW YORK (Reuters Health) - The bright red rose or cute dolphin tattooed on an adolescent's ankle or arm may hint at his or her penchant for smoking, fighting, and other risky behaviors, new study findings suggest.

"This study demonstrates that tattooing is a common behavior among adolescents and is strongly related to a wide variety of behaviors that put adolescents at risk for morbidity and mortality," write lead study author Dr. Timothy A. Roberts, of Golisano Children's Hospital at Strong in Rochester, New York, and his colleagues.

"Tattoos can serve as a marker for adolescents who are at higher risk for involvement in risky behavior," Roberts told Reuters Health.

His study is based on information from more than 6,000 adolescents who participated in the National Longitudinal Survey of Adolescent Health.

Overall, nearly 5% of respondents said they had a permanent tattoo, Roberts and his colleagues report in the December issue of Pediatrics.

These adolescents were four times as likely as their non-tattooed peers to say they had ever had sexual intercourse, and were nearly three times as likely to say they had joined a gang, the report indicates. They were also about twice as likely to say they had skipped or were failing school, or that they had been involved in fighting and other violent behavior.

Tattooed adolescents were also twice as likely to report smoking, marijuana use and binge drinking, and were more likely to say that their friends engaged in substance use. Nearly two thirds (63%) of these teens reported smoking during the past month, for example, in comparison to 26% of their non-tattooed peers. Further, while slightly more than one third of the youth who did not have tattoos agreed that none of their three best friends smoked daily or had used alcohol or marijuana during the previous month, only about 6% of the tattooed youth were able to say the same.

It is not known why adolescents who reported having a tattoo also showed more unhealthy behaviors, but Roberts' theory is that "adolescents who are willing to risk parental disapproval, engage in minor illegal activity to obtain a tattoo, and accept the risks of obtaining a tattoo from a friend or other non-professional may also be willing to engage in other risk behaviors," he said.

On the other hand, for teenagers who just spontaneously decide to get a tattoo on a whim, that impulsiveness "may be a signal for impulsive decision-making in general, which would place the adolescent at higher risk for engaging in risk behavior," he added.

Altogether, 17- to 21-year-olds were more likely to report having a tattoo than younger adolescents, the report indicates. Also, youths from lower-income families were more likely to say they had a tattoo, as were those who lived in a one-parent home.

Yet, despite the findings, parents should not think that their tattooed junior- or senior-high schooler is necessarily taking part in risky health behaviors, the researchers note.

"Wanting to get a tattoo or actually having a tattoo should not be a cause for alarm, but should be a signal to talk to your teen about the choices they are making about sexuality, substance use, school work, and violence," Roberts said.

Previous reports have indicated that anywhere from 3% to 9% of the general population, and 10% to 16% of 12- to 18-year-olds, have at least one permanent tattoo.

Source: Pediatrics 2002;110:1058-1063.

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Dealing With Breast Cancer

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- The stress of being diagnosed with breast cancer (news - web sites) may make the disease worse, but women who have good coping styles may help their treatment and outcome.

That's the claim of a new report in the December issue of the Annals of Behavioral Medicine.

American researchers reviewing the mind-body connection in women with breast cancer found that stress, mental state and coping style all combine to affect biological factors such as immune function and hormone levels.

The study says that healthy coping has been shown to improve immune function and hormone balance while stress, depression, anxiety and post-traumatic stress disorder lead to reduced immune function and altered hormone balance.

It's estimated that 30 percent to 40 percent of women with breast cancer have symptoms of anxiety and depression at the first diagnosis of the cancer. About 3 percent to 10 percent suffer post-traumatic stress disorder and virtually all women with breast cancer have some level of stress and distress.

The researchers found that previous studies show that people who adopt active coping strategies improve their immune system function and lower their cortisol levels, while the opposite is true for people who have passive coping strategies.

Active coping refers to taking a direct and rational approach to dealing with a problem. Passive coping involves avoidance, withdrawal and wishful thinking.

More information

The American Cancer Society (news - web sites) has information about coping with breast cancer.

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Rubella Vaccine Okay 1 Month Before Pregnancy

 

By Alison McCook

Reuters Health

Tuesday, December 3, 2002

NEW YORK (Reuters Health) - Women who receive a vaccination against rubella 1 month before becoming pregnant should not worry that they have endangered the health of their fetus, according to experts.

Previously, doctors were told that women given a vaccine against rubella less than 3 months before becoming pregnant were at risk of becoming infected by rubella and passing it onto their children. This fear stems from the fact that the vaccine contains a so-called "live" form of the virus, which, in a few cases, can actually give the patient the disease.

Rubella--also known as German measles--has largely been eradicated in the US thanks to widespread use of the vaccine, first introduced in 1969. However, doctors still administer the rubella vaccine, primarily to ensure that pregnant women will not contract the infection. When a pregnant woman becomes infected with rubella, especially during the first trimester, she can pass the infection on to the fetus. This can cause a miscarriage, stillbirth or congenital rubella syndrome (CRS)--a collection of severe birth defects that includes mental retardation, heart disease, deafness and cataracts.

In many instances, the rubella vaccine is combined with the measles and mumps vaccines.

In October 2001, the US Centers for Disease Control and Prevention (news - web sites) (CDC) shortened the interval between the rubella vaccine and pregnancy from 3 months to 1 month. Dr. Laura Riley of Massachusetts General Hospital in Boston told Reuters Health that this change came out of a number of cases in which women mistakenly became pregnant less than 3 months after receiving a rubella vaccine, and then gave birth to healthy babies.

"If you happen to get a vaccine, you only have to wait one month before trying to get pregnant," Riley said.

Now, in a statement released Friday by the American College of Obstetricians and Gynecologists (ACOG), a committee reaffirms the CDC's recommendations, shortening the safe window from vaccine to pregnancy from 3 months to 1 month. Riley, chair of ACOG's committee on obstetric practice, said she felt it was important to issue a separate recommendation, since many doctors may have missed the first CDC report.

"I don't think that (the CDC publication) is always read by certain subspecialties," she said.

Most women who grow up in the US are vaccinated against rubella during their childhood, but some who immigrate here from other countries may not have been. In addition, she noted, some parents opt out of vaccinating their children for various reasons, while some women may have been vaccinated before, but still did not become immune to the disease.

In cases where women are vulnerable to contracting rubella, they should not receive the vaccine if they are already pregnant, Riley said, and should instead wait until they have delivered the baby.

The researcher noted that all pregnant women are tested to see if they are vulnerable to rubella during their first prenatal exams, so they will know right away if their fetus is at risk of the disease. However, if they know they have not received the vaccine, and are thinking about becoming pregnant, the wisest thing is to schedule the vaccine and wait an additional month before trying to conceive, Riley said.

"Go ahead and figure out if you're rubella-immune" before getting pregnant, Riley said.

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HRT Raises Risk of Lobular Breast Cancer

 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- The National Institutes of Health (news - web sites) pulled the plug on a massive study earlier this year after women taking combined hormone therapy were found to have an increased incidence of breast cancer (news - web sites).

Now a new study has identified which type of breast cancer may be associated with the combined hormone replacement therapy, or that which includes estrogen and progestin.

Research appearing in the Dec. 15 issue of the journal Cancer finds that women on combined hormone therapy are at an increased risk for lobular breast cancer.

Lobular and ductal breast cancer are two of the more common forms of breast cancer. Although lobular carcinoma is less aggressive than ductal, it has been on the rise since the 1980s. The use of combined hormone replacement therapy increased during the same time period, leading some to speculate that it might be responsible for the increase.

"It's kind of a bad news/good news thing," says Janet Daling, lead author of the study and a professor of epidemiology at Fred Hutchinson Cancer Research Center in Seattle. "[Lobular carcinoma] is a little more difficult to diagnose because you don't pick it up as often on mammograms, but it has a good prognosis. It appears to be highly related to the continuous combined hormone therapy."

Hormone replacement therapy (HRT) is taken by women to relieve symptoms of menopause. While the hormone estrogen is actually responsible for ameliorating hot flashes and vaginal dryness, it also increases the risk of cancer of the uterine lining. Adding progestin to the mix effectively eliminates that risk. HRT is given one of two ways: continuous (meaning every day or almost every day of every month) or sequential (less often than every day).

This study, called the Women's Contraceptive and Reproductive Experiences (CARE) Study, looked at about 4,500 postmenopausal women aged 35 to 64 who had been diagnosed with their first incidence of breast cancer. They were compared to a control group of postmenopausal women who had no history of breast cancer.

In interviews, all the women were asked to recall information on various aspects of their medical history, including type of hormone therapy used, pattern of use, dose and total duration.

Women who used combined hormone replacement therapy for six months to five years were 1.6 times more likely to get lobular carcinoma. Women who used it for more than five years were twice as likely to be diagnosed with the cancer, compared with women who never used it.

The risk was also greater with continuous hormone therapy, or that which is delivered daily for 25 or more days each month. Women on this type of hormone replacement therapy for five years or more had a 2.5 times greater risk of lobular breast cancer. After adjusting for the age at which menopause began, the increase rose to 3.2 times.

Sequential combined hormone replacement therapy was associated with a 1.5 times greater risk for lobular cancer. "There was very little risk with sequential HRT," Daling says.

Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York City, cautions against giving too much weight to the findings. This latest research was a case-control study in which women were asked to remember details of their history, and there was no actual control over the dispensing of the medication. The gold standard in medical research remains the prospective randomized trial. "This is the highest standard because presumably bias doesn't influence who takes or doesn't take the medicine," Hudis says.

The results of this study apply only to women under the age of 65. Daling has just finished another study looking at women aged 65 to 79 and, in this group, sequential HRT seemed to play a larger role.

Estrogen alone did not appear to affect the risk of breast cancer.

What To Do

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

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Study Supports Using Camera Pill to Explore Bowels

 

Reuters

Tuesday, December 3, 2002

CHICAGO (Reuters) - A pill-sized camera that can be swallowed and can explore parts of the small intestine that other diagnostic techniques miss allows for better detection of inflammatory bowel disorders, researchers reported Tuesday.

Researcher Amy Hara of the Mayo Clinic in Scottsdale, Arizona, said tests on 52 patients using the camera--a technique called capsule endoscopy--did a far better job of detecting bowel abnormalities than did computed tomography in conjunction with ingested barium, a standard method known as CT.

In a report released at the annual scientific assembly of the Radiological Society of North America, Hara said the camera shows the most promise for diagnostics if used with CT.

"As the camera tumbles through the intestine, you don't know exactly where the mass is located. CT, by contrast, provides a very good global view of the body and specialized parameters can be employed to localize lesions," she said.

Endoscopy, in which a fiber-optic scope explores the intestines, can reach only the upper and very lower portions of the small intestine. The camera pill, by contrast, can explore its entire length, up to 25 feet.

The camera is inside a pill the size of a large vitamin capsule. Developed in Israel and approved for use in the United States last year, it is swallowed by the patient after an 8-hour fast and eliminated about 8 hours later. During its trip through the intestines it transmits a continuous stream of digital images to a small belt worn around the patient's waist.

The camera pill used in the study was developed by Given Imaging Ltd., of Yokneam, Israel.

Inflammatory bowel diseases, which include Crohn's disease and ulcerative colitis, cause chronic inflammation in the intestines leading to pain, diarrhea and other problems.

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New Test For Parkinson's Shows Promise

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 3, 2002

TUESDAY, Dec. 3 (HealthScoutNews) -- U.S. physicians will have to continue to rely on their physical assessment skills to make a diagnosis of Parkinson's disease (news - web sites).

In Europe, a new test is making the diagnosis more definitive in at least 80 percent of cases, advocates say, but the DaTSCAN is unlikely to reach this side of the Atlantic anytime soon.

The United States lacks a manufacturer of the radioactive isotope needed, and the isotope must be used within 13 hours of being processed, making importing it impossible, says Dr. David Tuite, a radiology resident at Adelaide and Meath Hospital in Dublin, Ireland.

"As they have no manufacturing facility in North America, this prohibits its use in the U.S.A.," Tuite says.

Tuite presented the findings of an ongoing study of the DaTSCAN today at the Radiological Society of North America's annual meeting in Chicago.

"We're the first to use it in our country," Tuite says. "I imagine in time it will become the standard."

The DaTSCAN is "a radio pharmaceutical which labels dopamine in the brain," Tuite says. Patients with Parkinson's begin to have symptoms of the disease after losing 80 percent of the dopamine in their basal ganglia, a brain region involved in motor control and movement, he explains.

"The technique requires nuclear medicine facilities" and can be used to differentiate Parkinson's disease from essential tremors, another disorder that resembles the tremors of Parkinson's but whose cause is unknown.

Many people with essential tremors are placed on medication that doesn't help them and don't receive the medication they should when they are mistakenly thought to have Parkinson's, Tuite says.

About 1 million to 1.5 million Americans are diagnosed as having Parkinson's. But in post-mortems -- the only definitive way to diagnose the disease in the United States -- only 75 percent of them are found to have it, Tuite says.

"One-quarter have been misdiagnosed" and actually have essential tremors, Alzheimer's disease (news - web sites) or something else, he says.

For his study, Tuite and his fellow researchers used DaTSCAN on 50 patients thought to have Parkinson's, but whose physicians weren't sure this was the correct diagnosis. The test proved valuable in confirming that many patients had the disease and some did not, based on dopamine levels that were detected. The test was 80 percent accurate at identifying Parkinson's when a person had it. And it was 30 percent accurate at giving a negative result if a person did not have Parkinson's, Tuite says.

The test was most useful in distinguishing whether patients with tremors had Parkinson's or essential tremors.

Tuite says he has received many requests from patients for the test.

Dr. Abraham Lieberman, medical director of the National Parkinson Foundation, says that while the DaTSCAN test may prove valuable, he doesn't consider it "earth-shattering."

It's not entirely conclusive, he says, although it can be used to verify a diagnosis of Parkinson's in people who have tremors. As Lieberman notes, this leaves out many people with Parkinson's because "about 30 percent of those with Parkinson's don't have tremors."

Dr. Kenneth Marek is president of the Institute for Neurodegenerative Disorders. He says the DaTSCAN test is "part of a larger approach to improving diagnosis" of Parkinson's disease and potentially halting its progression.

Marek says the production of high-grade iodine for radioactive isotopes is limited in North America. Although he uses it for research, he gets his limited supply from Vancouver, Canada. "This isn't a readily available source of radioactive iodine."

He says he's heard that companies that manufacture the isotope in Europe aren't anxious to open a plant in North America due to a lack of financial incentives. If the isotope and DaTSCAN were available in the United States, Marek believes it would be a valuable tool "to settle the diagnostic question."

What To Do

To learn more about Parkinson's disease, visit the Parkinson's Disease Foundation Inc. or the National Parkinson Foundation.

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MONDAY, DECEMBER 2, 2002 

More Women Breast-Feeding Than Ever Before 

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- Breast-feeding in the United States is at a record high.

Not only are more women starting to breast-feed soon after giving birth, but more are continuing to nurse their infants to six months of age.

The results of a recent survey by the Ross Products division of Abbott Laboratories (a maker of infant formula) shows that 69.5 percent of new mothers started breast-feeding last year, and 32.5 percent continued to nurse at six months. These are the highest percentages documented by the company since they started surveying breast-feeding practices in 1954.

Furthermore, the greatest increase was found among groups of women historically less likely to nurse their infants: women who are black; those younger than 20; those with little education; those working; and women who participate in the Supplemental Nutrition Program for Women, Infants and Children (WIC).

WIC is a state-administered nutrition program funded by the U.S. government that provides pregnant women and children with education, health referrals and supplemental nutritious food if they are at 185 percent of the poverty level or below.

"As a nation, we see an increase in breast-feeding in all groups," says Alan Ryan, a senior clinical scientist with Abbott. While this is great news, he cautions that the push to educate women about the benefits of breast-feeding must continue. Affluent, better-educated women are still those most likely to start and continue breast-feeding, he says: "More emphasis must be placed on babies in certain populations."

The company conducts the surveys annually. The researchers, whose findings appear in the December issue of Pediatrics, compared the rates over the years, but particularly from 1996 to 2001. Ryan says that if the 2 percent annual increase in mothers who initiate breast-feeding continues, the federal government's Healthy People 2010 goal of 75 percent of women initiating breast-feeding will be met.

Questionnaires are mailed monthly to a representative sample of women. In 2001, 1.4 million questionnaires were sent and 500,000 came back, Ryan says. "That's very good for a mail-back survey," and the sample is representative of about 25 percent of all babies born each year in the United States, he notes.

Not all women breast-feed exclusively. The questionnaire asks about any breast-feeding, and includes mothers who supplement nursing with cow's milk or formula, Ryan says. For example, while in 2001 32.5 percent of women reported still breast-feeding six months after delivery, only 17.2 percent were breast-feeding exclusively.

Solely breast-feeding is recommended by the American Academy of Pediatrics, says Mary Hurt, a public relations spokeswoman for La Leche League International. She would like to see more women breast-feeding at six months and doing so exclusively, but she was pleased to hear the overall incidence of breast-feeding is rising. "I think it's very encouraging news. In many under-serviced areas, it's becoming more of a reality," she says.

She acknowledges, as does Ryan, that certain groups of women continue to breast-feed more than others. These are women who are white, older, college-educated, mothers of more than one child, those who are not part of WIC, and females living in the Mountain and Pacific areas of the United States.

Ryan says the geographic differences are a "cultural phenomenon" and that women in these areas probably receive more peer support for their desire to nurse.

As to the rise in breast-feeding across all sectors, Ryan says that more women are getting the message that mother's milk is best: "I think there are a lot of [educational] programs in place now."

Hurt thinks certain barriers to breast-feeding may be falling by the wayside. Unaccommodating work environments have typically held women back, she says, and that may be changing.

Women may also be recognizing the health benefits of nursing, for mother as well as infant. "In some of the newer research, health benefits for mothers are becoming more highlighted," such as the news that breast-feeding lowers a woman's risk for ovarian and breast cancer (news - web sites), she says.

Whatever the reasons, breast-feeding may finally be getting the recognition it deserves, she says. Like many other good things in life, "it's free, so we have a hard time seeing its value."

What To Do

To find out more about the benefits of breast-feeding, visit the University of Michigan and La Leche League.

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Brain cells victims of video violence  

By Peggy Peck
UPI Science News
From the Science & Technology Desk
United Press International

Monday, December 2, 2002

CHICAGO, Dec. 2 (UPI) -- Hours of playing violent video games can affect the way the brain works on a cellular level, causing misfiring of signals between nerve cells or slowing brain activity, researchers reported Monday.

The researchers said the adverse effects are most apparent among teens that are diagnosed with a condition called disruptive behavior disorder or DBD. These kids, according to Dr. Vincent P. Mathews of the University of Indiana Medical School in Indianapolis, are the ones most likely to "act out by harming animals or property or fighting with other kids."

When he used a high tech scanning device called functional magnetic resonance imaging to track brain function in adolescents with DBD, he discovered "less activity in the frontal lobes." The frontal lobe is the area of the brain that controls emotions and impulses as well as attention span. Moreover when the DBD kids were exposed to violent video games, "there was even less activity," Mathews said.

He presented his findings at the 88th Scientific Sessions and Annual Meeting of the Radiological Society of North America.

The study suggests repeated exposure to the violent video games is "desensitizing the brain ... the result is that the child can no longer understand the real effect of violence," said Dr. Carol Rumach, professor of radiology and pediatrics at the University of Colorado School of Medicine in Denver, who was not involved in the study.

Mathews said he tested 19 teens that were diagnosed with DBD and compared their brain scans to 19 normal teens. Both groups were shown segments of a non-violent car chase video game and a violent James Bond spy video game while having their brains scanned by the MRI device. The device measures brain activity by increased blood flow in the scanned areas, said Mathews.

Even normal teens who said they frequently watched violent television and movies as well as regularly playing violent games had decreased activity when exposed to the violent video, Mathews said. Moreover, the brain changes were most apparent among "heavy users, meaning those who played for several hours every day," he said.

Mathews backed off from making any blanket statements about the danger of violent videos, but he said, "I think this information gives credence to what has become a growing concern about what is perceived as increased violence among adolescents."

With the holiday shopping just underway, video games -- and violent video games in particular -- are expected to be big sellers.

NPD Funworld, a trade publication that tracks the video game industry, reported last week the video game industry will post sales of more than $10 billion in 2002, and the fastest growing segment of the game market are games rated mature for violence. Mature video games are now responsible for 13 percent of sales, compared to 6 percent last year.

The market leader is the mature-rated video, "Grand Theft Auto 3," by Rockstar Games. It was rated the best selling video game of 2001 with U.S. sales already topping 4.2 million copies.

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Panel Softens Prostate Screening Stance 

By David B. Caruso

Associated Press Writer

The Associated Press

Monday, December 2, 2002

PHILADELPHIA (AP) - A government advisory panel has dropped its objection to routine prostate cancer (news - web sites) screenings for millions of middle-aged and elderly men, saying it is possible the tests save lives.

The U.S. Preventive Services Task Force stopped short of recommending the exams, citing continuing uncertainty about their value. But it abandoned a 1996 opinion that said they are not effective enough to justify their cost.

Studies done over the past 10 years indicate that some and probably most tumors discovered during the screenings are so small and slow-growing they are unlikely to do any harm to patients, the panel said in Tuesday's issue of the Annals of Internal Medicine.

Some studies have indicated that when dangerous tumors do turn up, the death rates are generally the same among men who had regular screenings and those who didn't go to a doctor until they developed symptoms. Other studies have said that those who get the screenings have a higher survival rate.

Based on those mixed findings, the task force said there is not enough evidence to recommend either for or against routine screenings every year or two.

"Men should be informed of the gaps in the evidence, and they should be assisted in considering their personal preferences and risk profile before deciding whether to be tested," the group said.

A number of groups, including the American Cancer Society (news - web sites) and the American Medical Association, already recommend that doctors discuss the pros and cons of screenings with their patients, and decide whether or not to do them on a case-by-case basis.

Doctors have argued over the screenings for a decade. Some say prostate cancer caught early can be treated before it spreads. Others believe the tests have led to thousands of unnecessary operations with side effects that can include impotence and urinary leakage.

Physicians have been embroiled in a similar debate over other types of cancer screenings. Several recent studies have raised questions about the effectiveness of breast self-examinations and mammography, noting that death rates among women who had the screenings and those who didn't appear to be similar. Other studies have reached the opposite conclusion.

About 57 percent of men over 50 had a blood test for prostate cancer last year, according to the Centers for Disease Control and Prevention (news - web sites). About 56 percent had a rectal examination for the disease, the CDC said.

The blood test looks for levels of a substance called prostate specific antigen, PSA. Men who test positive for cancer during a PSA test or a rectal exam usually undergo a biopsy to confirm the diagnosis.

A PSA test costs less than $100. But a biopsy and follow-up examinations can run thousands of dollars more.

Dr. Leonard Gomella, chairman of urology at Jefferson Medical College in Philadelphia, said he believes the benefits of aggressive detection outweigh its costs.

"We know we are over-treating many men with prostate cancer," he said. "But something is going on over the last 10 years where we are seeing the death rate from prostate cancer go down consistently, and the easiest thing to ascribe this to is the screenings."

About 189,000 men are diagnosed with prostate cancer each year, and about 30,200 die of the disease, making it the second leading cancer killer for men, according to the American Cancer Society. More than 75 percent of cases are diagnosed in men older than 65.

The most common treatment for prostate cancer that has not yet spread is surgery. Other treatments include radiation, hormone therapy and "watchful waiting" — doctors wait to see whether the tumor grows before deciding what to do.

The task force said black men, men between the ages of 50 and 70, and men with a history of prostate cancer in the family are the most likely to benefit from screening.

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Bone 'structure' strengthened by estrogen  

By Peggy Peck
UPI Science News
From the Science & Technology Desk
United Press International

Monday, December 2, 2002

 CHICAGO, Dec. 2 (UPI) -- Researchers reported Monday that a high tech imaging device to detect microscopic flaws in car engines also can be used to provide proof estrogen works at a cellular level to keep aging bones stable and strong.

The imaging technique is a high-powered version of computerized tomography or CT scan, but with an important difference -- size. The tiny version of CT "is too small for even a human arm to fit inside but it can provide microscopic, three-dimensional images of bone fragments," said Dr. Harry Genant, a professor of radiology at the University of California, San Francisco. Genant said Detroit developed the tiny CT units to examine the molecular strength of metals, but researchers now are testing them for other uses.

Genant said he used the "micro-CT" to image bone biopsies taken from the pelvic area of 20 women before beginning estrogen treatment and again after two years of estrogen replacement. All women had been diagnosed with osteoporosis, a bone-wasting disease that increases the risk for fracture.

A look inside the cellular structure of bone revealed a matrix of rods and plates. Younger bones have more plates, which are thicker, "more spongy bone that is more stable," Genant said. With age and osteoporosis, many of the plates begin to erode in a process called resorption, he said, until eventually they are worn down to a matrix dominated by rods.

All of the women in this study had some evidence of bone resorption before starting estrogen.

"But after two years on estrogen, the bones retained their baseline structure and in some cases increased the number of plate structures. It is this effect on bone structure that appears to make their bones less subject to fracture," Genant said. This differs with the traditional theory that estrogen "increases muscle mass. It actually just stabilizes the existing bone structure," he said.

Genant presented his findings at the 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America.

Dr. Thomas Link, associate professor of radiology at the Technical University of Munich, Germany, said, "Bone is really like the Eiffel Tower -- there is really not much structure there but it is very stable because of the way it is put together rather than because of the mass involved. If you changed the structure even slightly the Eiffel Tower would fall. That's what happens with bone when osteoporosis takes hold."

Link, who was not involved in the research, said Genant's findings suggest all "new osteoporosis drugs should be assessed using micro-CT so that we can see if they are really effective at the structural level."

Although Genant said the study provides additional proof of estrogen's value to bone health, Link said the findings "don't address the larger controversy surrounding hormone replacement."

The largest ever study of hormone replacement treatment in healthy women was halted abruptly last summer when researchers discovered hormone replace with estrogen and progestin increased the risk for breast cancer, stroke, heart disease and blood clots. A smaller part of that study -- tracking the effect of estrogen alone in women who have had hysterectomies -- still is underway.

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Twins' Death Rate Sharply Lower With Older Moms

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- Older mothers-to-be often face additional health risks, but a new study offers some encouraging news for those pregnant with twins.

Twins born to women over 35 had a sharply lower mortality rate than twins born to moms under 25 in the study, which appears in the December issue of Pediatrics. This surprising finding may also show the need for extra education and support for younger mothers of twins, according to the researchers.

"These findings were somewhat unexpected," says the study's lead author, Dawn Misra, an associate professor in the School of Public Health at the University of Michigan in Ann Arbor. "In singleton births, the extremes of age -- the very young and the older mothers -- had the highest mortality," she explains. "But with twins, the older you got, the better off your twins were."

While the researchers didn't investigate the causes of death, Misra says that older mothers probably have a higher education, more money and more resources to help them cope with having two babies at once.

Most of the infant deaths for the younger mothers of twins occurred when the babies were between one and 12 months old. Misra says the leading causes of death in that age group are sudden infant death syndrome and accidental injury. She says prevention strategies are available that might help reduce the number of these deaths.

For the study, Misra and her colleagues gathered data on more than 22 million single births and more than 500,000 twin births that occurred during three different time periods: 1985-86, 1990-91, and 1995-96.

For mothers between 15 and 19 years old, the rate of twin births was 1.5 percent or less during the time of the study, compared to 2 to 3.6 percent for mothers over 40. The rate of having twins rose 67 percent for mothers over 40 during the time of the study.

In single births, the youngest mothers -- those between 15 and 19 -- had the highest infant death rate, 11 per 1,000 babies born, compared to mothers over 40 who had an infant death rate of 8.9 per 1,000 births. The group with the lowest infant mortality was mothers between 30 and 34, with six deaths per 1,000 births.

With twins, the death rate rises dramatically. Mothers under 19 had a mortality rate of 73 for every 1,000 births, while those 20 to 24 had an infant death rate of 47 for every 1,000 births. The rate dropped steadily with every age group in the study, and did so consistently throughout the three different time periods. For mothers over 40, the infant death rate in twins was 20 per every 1,000 live births.

Dr. Mark Werner, an obstetrician and gynecologist at William Beaumont Hospital in Royal Oak, Mich., says that the study results are somewhat surprising, but that they do make sense.

"Twins are fun, but they're also stressful and overwhelming," he says. And, he says, older women may be more motivated to attend their prenatal visits and follow the doctor's instructions. They also may be more financially stable and able to take off from work and get the necessary rest, he adds.

"Rest plays a big part in getting to full-term with twins," he explains. "The longer you're pregnant, the bigger your baby. The bigger your baby, the healthier the baby is."

Misra says these study findings point to the need for more research and may indicate the need for more education and support for younger mothers pregnant with twins.

What To Do

For more information on having twins, read this from the American College of Obstetricians and Gynecologists or this from ePregnancy.com that details the risks of being pregnant with twins.

To learn more about preventing sudden infant death syndrome, go to the American SIDS Institute.

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Biological clock of scum unraveled  

From the Science & Technology Desk
United Press International

Monday, December 2, 2002

 NASHVILLE, Dec. 2 (UPI) -- Scientists have discovered how a key cog in a biological clock operates by unraveling a protein of green pond scum, they reported Monday.

The new findings in bacteria promise to help discover new drugs for humans to treat such conditions as jet lag and sleep disorders, the scientists said. Such pills someday also could help keep people working late shifts from getting drowsy.

"Such medication could really help reduce industrial accidents like those at Three Mile Island and Chernobyl, where alertness or lack thereof might really have played a role," researcher Carl Johnson, a biologist at Vanderbilt University in Nashville, told United Press International.

Discoveries on how to rework biological clocks also could help farmers, Johnson explained. Treatments that tinker with plant timers "could suppress plants from flowering too soon, enhancing leafy production. This would help with crops like basil."

In humans, biological clocks run the wake-sleep cycle and influence fundamentals of life such as body temperature. When a person's clock is out of sync with the environment, the condition known as jet lag results. Plants have biological clocks too, measuring day and night to determine the time of year to control seasonal flowering.

For years, no one thought bacteria had biological clocks, however, because microbes typically reproduce in less than 24 hours, becoming whole new life forms in the process. But Taiwanese scientists accidentally discovered otherwise in green pond scum in rice paddies.

Cyanobacteria, or blue-green algae, remove nitrogen from the air and affix it chemically so plants can use it as a nutrient. Photosynthesis and nitrogen fixation are biochemically incompatible, and the researchers found the germs solved this problem by saving nitrogen fixation for after dark.

"When those of us who work in biological clocks saw their results, we realized that the algae must have a clock," Johnson said. Although the researchers suspect the bacterial clock is quite different from those in humans and plants, he said discoveries in how one work already have helped understand how the others operate.

As reported in the Dec. 2 online version of the Proceedings of the National Academy of Sciences, Johnson and colleagues from Texas A&M University and the University of Nagoya in Japan previously had sequenced genes that code for three critical clock proteins -- KaiA, KaiB and KaiC. The team now has visualized the structure of KaiC, the largest of the three proteins.

"This is exciting because this is the first time structural information on a clock protein was shown," physiologist Yi Liu of the University of Texas Southwestern Medical Center at Dallas said.

Electron microscopy has revealed the clockwork protein even looks cog-like, with a shape like a hexagonal ring. "It looks a little like a bulbous doughnut," Johnson said. The shape is similar to other proteins that act on DNA. "DNA can thread through the middle of ring-structure proteins like this," Johnson said.

The researchers confirmed KaiC binds to DNA. Johnson speculates the protein unwinds the bundles of DNA that make up the bacterium's chromosome, exposing it to cellular machinery so the microbe can express genes. He said they now plan to find out how KaiC is structured molecularly, to know what "causes the clock to run faster or slower or stop entirely in mutations."

The rough picture Johnson's team currently has from electron microscopy is not detailed enough to understand how exactly KaiC binds to DNA, Liu explained.

"This goes together very well with work from other labs that will give us a total picture of a clock complex that keeps time," molecular biologist Susan Golden of Texas A&M University in College Station told UPI. "We want to integrate all that information on how the proteins interact as quickly as we can to get a view of the whole clock, kind of like taking the back off a pocket watch to look at all the gears."

Golden's team also reports in the Proceedings of the National Academy of Sciences to have solved half the molecular structure of KaiA. She explains KaiB, the littlest of the three proteins, remains hard to investigate because nothing from its molecular sequence yet provides a clue as to how it works.

 (Reported by Charles Choi, UPI Science News, in New York)

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Prostate Cancer Deadlier for Black Men-US Study 

Reuters

Monday, December 2, 2002

CHICAGO (Reuters) - Black men in the United States suffer and die from prostate cancer (news - web sites) at higher rates than white men, but could be cured just as easily as whites if the disease is caught and treated early, researchers said on Monday.

"The good news is that when diagnosed early, prostate cancer is frequently curable in African Americans," said William Barrett, lead investigator for the study.

"Our findings underscore the need for more screening among African-American males so the cancer is detected early, when it's most treatable," said Barrett.

His study, released at the annual meeting of the Radiological Society of North America, compared 12 black patients with 161 whites, all of whom underwent a treatment in which radioactive seeds are implanted in the gland.

None of the black men experienced a recurrence of the cancer although 5.6% of the whites did--a difference that was statistically insignificant, the investigator said.

According to the study, black men in the United States suffer from prostate cancer at a rate of 234.2 per 100,000 population compared with 144.6 per 100,000 for whites. The death rate for blacks is 53.1 per 100,000 compared with 22.4 for whites.

"There has long been debate about the usefulness of prostate cancer screening because some forms of the disease are slow-growing and they will never be an issue for the patient," Barrett said.

"But because prostate cancer in African Americans is generally not slow-growing, the combination of early diagnosis and effective treatment should be particularly beneficial," he added.

The study did not address what role economic or cultural differences might play in the current higher prostate cancer death rate among black men.

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Study: When Death Looms, Nursing Homes Fall Short

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- Most nursing homes in the United States can't make the transition from rehabilitating elderly patients to preparing them for death, says a new study.

The difficulty stems partly from over-regulation of nursing homes, partly from their lack of resources and funding, and partly from America's reluctance to accept death, according to a report in a recent issue of the Journal of Palliative Care.

"We're a death-denying culture. It's the one thing that's going to happen to each of us and yet no one wants to talk about it," says study author Debra Parker-Oliver, an assistant professor of social work at the University of Missouri.

As a result, doctors and nurses often fail to make the integral shift in care from trying to get people well to providing them comfort and support in the last months of their lives. This occurs even after a string of recent studies have concluded that Americans want to die at home, surrounded by family and friends, and without pain, Parker-Oliver says.

"The philosophy and goals of rehabilitation are often in direct conflict with the needs of dying people," Parker-Oliver says. "Nursing homes don't think to change their goals of care when patients reach that threshold. So, Americans are saying they want one thing while medicine is giving them something else."

Such concerns about end-of-life care are becoming increasingly important as more and more people die in nursing homes. One-quarter of Americans die in nursing homes, one-quarter at home and half in hospitals. However, 40 percent of deaths will occur in nursing homes by 2020, Brown University researchers found in a study two years ago.

While a third of patients admitted to nursing homes die within their first year there, less than 5 percent of them get hospice care when they die, Parker-Oliver says.

Unlike most nursing homes, hospices approach the end of a patient's life with teams of nurses, social workers and chaplains to resolve common end-of-life issues, such as family conflicts, loneliness, support for grieving caregivers and spiritual questions. Hospices are more willing than nursing homes to give patients enough pain medication to make their last days, weeks and months pain-free, Parker-Oliver says.

In her study, Parker-Oliver interviewed 69 health-care professionals at 24 hospice programs in Missouri. In critical areas, such as assessing and managing a person's end-of-life pain and communicating about changing care goals, hospice workers said nursing homes failed to meet the patient's needs.

In her prior survey, though, nursing home workers blamed the problem on doctors, Parker-Oliver says.

"Physicians are oriented toward cures," she says. "They're afraid to give bad news. And quite frankly, I think doctors can have trouble identifying when a person is dying."

Others argue that it isn't a lack of knowledge about the kind of care a person should get at the end of his or her life, but whether poorly funded nursing homes have the resources to shift strategies at the right time.

"The problem with a nursing home is that they don't have enough resources and skills to pull it off. They're just able to do what they can do, and making the changes necessary for the end of life is very difficult," says Dr. Michael Preodor, president of the nonprofit Horizon Hospice in Chicago.

An even greater culprit is the rigid set of regulations placed on nursing homes. Such rules were initially established to protect the elderly from poor care, but the rules have crippled the industry, Preodor says.

As recently as a decade ago, nursing homes, fearing lawsuits, sent all patients to die in hospitals. Major medical advances have been made since then, Preodor says, but the nursing home industry and regulators have a long way to go in accepting that patients need different care before death.

"Right now the regulation is overwhelming. Nursing homes fear that a regulatory agency will criticize them if they don't make every effort possible to rehabilitate patients," Preodor says.

Parker-Oliver agrees.

"Nursing homes are the most regulated industry in the country, surpassing recently nuclear power, and yet they're a terrible place to die," she says. "All of the regulatory focus is on rehabilitating these older people, and ignoring the fact that many of them are going to die."

Bruce Rosenthal is a spokesman for the American Association of Homes and Services for the Aging, which represents 1,700 nursing homes in the United States.

He says nursing home organizations aren't shying away from their responsibility to those nearing death. "There is definitely a role for hospice care in nursing homes," he says.

Commenting on Parker-Oliver's study, Rosenthal agrees that improving end-of-life care is primarily the responsibility of nursing homes. To that end, the association has recently focused on improving pain assessment and management, using new federal standards and its own "quality first" guidelines.

And while he thinks excessive government regulation has stymied some efforts by nursing homes, he says industry authorities are getting closer to agreeing on standards about when rehabilitative care should be replaced with end-of-life care for patients.

"I think it's great to have this national dialogue about care for the dying. It's important," Rosenthal says.

What To Do

To learn how your state fares in end-of-life care, check this report card by the Robert Wood Johnson Foundation. Or for more resources about aging, visit the U.S. Administration on Aging

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Nutrients Are Key to Preventing Cancer

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, December 2, 2002

WASHINGTON (AP) - Can a diet rich in a particular nutrient really prevent cancer? The government is recruiting 32,000 middle-aged men to see if selenium or vitamin E can prevent prostate cancer (news - web sites), the biggest clinical trial yet to address such dietary questions.

It's just a first step toward what could become a major change in nutrition: Preliminary but intriguing genetic research suggests certain nutrients may prove more cancer-protective for one person than the next — suggesting that one day doctors might write prescriptions for diets to prevent tumors in certain people.

"The future is tailored recommendations," John Milner of the National Cancer Institute (news - web sites) says about this fledgling new science, "nutrigenomics." "That's the excitement."

Cancer doesn't just arise overnight. A few tiny cells gone wrong slowly grow over decades. Whether the result is a life-threatening tumor depends on genes and environment — including food.

Up to 35 percent of cancers are related to dietary habits, says Milner, chief of NCI's research into nutrition and cancer prevention.

That doesn't mean an occasional cheeseburger or doughnut is dooming. But study after study links lifelong diets high in plant foods to lower cancer rates.

Also, people who eat lots of fruits and vegetables generally are skinnier. Obesity increases risks of cancers of the uterus, gallbladder and possibly colon and prostate, while a large weight gain after reaching adulthood is linked to breast cancer (news - web sites).

Armed with such provocative evidence, scientists now are trying to tease out which of the myriad nutrients and chemicals in different foods are most protective — and why, at a genetic level, they do the job.

It's exceedingly complex research. Not everybody gets equal benefit from nutrient-rich diets, a discrepancy that probably points to genetic variability. For example, scientists studying lung cancer rates in part of China found people with the lowest cancer risks also were genetically deficient in an enzyme that metabolizes certain nutrients in cruciferous vegetables.

In other words, those lucky people's genes seemed to make broccoli better for them.

Similar links to cancer are being explored with genes that metabolize alcohol, folate from grains and other food chemicals.

"In five years, we'll have a lot of information on how your gene profiles influence your response" to different foods, Milner predicts.

But first, scientists need hard proof of which of the many nutrients commonly considered protective truly are, and at what levels. Small studies promoting 12 cups a day of tea or three whole garlic cloves daily aren't too practical for many people.

Until now, most food and cancer research has focused on animals or merely monitoring people's diets and their later health, which gives only clues, not proof. Plus, too much of some nutrients can be dangerous.

Top of the federal research list: selenium, a trace element found in grains and meat. Previous studies suggest that eating 200 micrograms of selenium a day, about twice the national average, might lower the risk of prostate, lung and colorectal cancer, perhaps by slowing abnormal cell growth or activating tumor suppressor genes.

To prove the prostate benefit, NCI is recruiting 32,400 healthy men in their 50s to take for the next seven years either selenium; 400 milligrams of vitamin E, another nutrient linked to lower prostate risk; both; or a dummy pill.

Too much is toxic, so don't pop lots of selenium supplements, cautions NCI researcher Cindy Davis.

Lycopene, the chemical that makes tomatoes and watermelon red, is another top prospect. Cooking tomatoes with a little oil — think spaghetti sauce — significantly increases lycopene absorption. In one study, it decreased prostate cancer by 35 percent. The NCI has begun small clinical trials to find lycopene's maximum safe dose and see if giving it to prostate cancer patients before surgery helps stem their disease.

Despite lots of hype, research is much more mixed on other foods. Soy, for instance, is widely touted as protective against breast cancer, but women seem to get the benefit only if they eat soy before puberty, says NCI researcher Harold Seifried.

It will take years to sort out what are truly anticancer diets. For now, the American Cancer Society (news - web sites)'s best advice: Eat a wide variety of foods, including at least five servings of fruits and vegetables a day, and slim down.

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

On the Net: www.clinicaltrials.gov

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Bypass Surgery Made More Passable

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- When it comes to heart bypass surgery, small veins and arteries can take on the work of big blood vessels, but it's not easy to move them from one part of the body to another. Now, doctors across the country are using a technique that makes it easier than ever before to harvest an artery from a valuable appendage: your arm.

"We hope that this will reduce potential complications," said Dr. Fardad Esmailian, an associate professor of cardiothoracic surgery at the University of California at Los Angeles, who performed his first "minimally invasive" endoscopic arm artery operation last week.

Patients need heart bypass operations when their arteries become blocked and prevent their hearts from properly delivering blood to the body. About half a million Americans undergo the surgery each year.

Doctors typically remove blood vessels from the leg, arm or chest and reconnect them around the heart in a way that allows blood to go around the blockages.

"It's like a detour after an accident. It directs traffic -- or blood -- away from the blockage," said Dr. Eric Eichhorn, medical director at the Cardiopulmonary Research and Technology Institute in Dallas.

Legs and arms can easily survive the loss of a vein or two, Eichhorn said, although some patients might experience some swelling. And veins can carry the heavy-duty blood volume of an artery, he added, noting "veins are actually pretty tough."

But removing a vein or small artery isn't always a simple or painless procedure.

"The leg vein had been traditionally removed by making a long incision in the leg from the groin to ankle level," Esmailian said. "This would cause tremendous amount of pain and discomfort, swelling, high risk of infection, and poor healing in the patients."

About five years ago, Esmailian said, he introduced a surgical method at UCLA that is easier on the patient. Surgeons make two or three one-inch incisions in the leg and use a video monitor to insert surgical tools and remove a vein through the incision.

The harvesting method for leg veins has become routine at UCLA and elsewhere, but some hospitals have yet to adopt it, Esmailian said. The method doesn't work for about 5 percent of patients who undergo it, meaning their veins have to be harvested the traditional way.

Along with doctors in other parts of the country, Esmailian has begun using the harvesting method on arms. In last week's surgery, a quintuple bypass of six blocked vessels on a 72-year-old man, he took out part of the so-called radial artery by making a small cut in the wrist.

The incision is so small that it can be covered by a watch wristband. "The other artery of the forearm should be able to take over the work of the artery that is being removed," Esmailian said.

There are some limitations, however. Surgeons cannot remove arm arteries from 20 percent of heart bypass patients because of limitations on blood flow to their arms, Esmailian said.

The potential side effects are pain, temporary loss of sensation in the thumb and index finger, and potential for loss of the hand if the remaining artery can't take up the slack. But ultrasound tests before surgery eliminate the risk of hand loss, Esmailian said.

UCLA harvests arm arteries in about 60 percent of heart bypass operations, according to Esmailian, who said he and his colleagues probably do them more often than doctors elsewhere.

Eichhorn, the Texas cardiologist, cautioned that the arm artery operations are complex. "You'd want to have somebody who's gotten pretty good experience," he said.

What To Do

For more information on coronary artery bypass surgery, check out the Web sites for Heart-Surgeon.com or the American Heart Association.

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Vigorous Exercise May Cut Preterm Birth Risk

By Juhie Bhatia

Reuters Health

Monday, December 2, 2002

NEW YORK (Reuters Health) - Vigorous leisure activity in the first two-thirds of a woman's pregnancy may help lower her risk of delivering early, researchers suggest.

Preterm birth, meaning delivery at less than 37 weeks gestation, is the leading cause of newborn deaths in North America and Europe, and a major predictor of newborn and infant morbidity, notes Dr. Kelly R. Evenson of the University of North Carolina-Chapel Hill, the study's lead author. The United States has higher rates of preterm birth than many other industrialized countries.

"We don't have a full understanding of the reasons behind preterm birth or what to do to decrease its risk," Evenson told Reuters Health. "There's been a question as to whether or not pregnant women should do vigorous activity because it causes biological changes that could potentially trigger an early birth."

To investigate, the researchers recruited 1,699 women pregnant with a single fetus from prenatal clinics in North Carolina between 1995 and 1998. They interviewed the women by telephone to determine the type and duration of any regular vigorous leisure activity the women did in the 3 months before pregnancy and during their first and second trimesters.

Such activities included jogging or bicycling at a moderate to fast speed, swimming laps, aerobic dance or other fast dancing.

The researchers found 22% of the women engaged in vigorous leisure activity before pregnancy, 14% did so during the first trimester and 8% exercised vigorously during the second trimester. Among the women who exercised before pregnancy, half worked out for at least 4 hours a week, while half of those who were active during pregnancy exercised for at least 3 hours a week.

While vigorous leisure activity before pregnancy didn't affect the risk of preterm birth, exercise during the first and second trimesters did appear to reduce preterm birth risk somewhat. Women who reported such activity in their first trimester were 20% less likely than women who did not to give birth prematurely, while women who exercised vigorously during the second trimester had a 48% reduced preterm birth risk.

Vigorous exercise did not influence whether or not women gave birth late, at or after 42 weeks, the authors note in the November issue of Epidemiology.

Researchers don't know why exercise might reduce the risk of preterm birth. However, Evenson points out that self-selection may play a role--women who feel good may choose to do vigorous leisure activity, while women with less healthy pregnancies don't.

"To build on our research we need to do a randomized clinical trial where we can assign women to structured activity and control what they do," she said. "There may also be other reasons for the results, but it's too early to say."

Source: Epidemiology 2002;13:653-659.

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Veggies, Nuts and Grains Can Beat Heart Disease

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- Here's yet more evidence that you should eat your veggies and other healthy kinds of food.

A Canadian study found a combination diet of vegetables, nuts, soy proteins, and oats and barley can cut bad cholesterol by 29 percent, a reduction that matches the results of some drug treatments for high cholesterol.

That means this combination diet may be a drug-free alternative for fighting high cholesterol.

The study appears in the December issue of Metabolism.

Researchers at the University of Toronto and St. Michael's Hospital measured the cholesterol levels of 13 people who went on the combination diet for a month. The diet included vegetables such as broccoli, carrots, red peppers, tomato, onions, cauliflower, okra and eggplant.

The diet also included: oats, barley and psyllium; vegetable-based margarine; soy protein from products such as soy milk and soy sausages, cold cuts and burgers; and almonds.

Scientists have know for years that, individually, each of these food groups could lower cholesterol by 4 percent to 7 percent. However, this is the first study to look at this type of combination diet.

The Canadian researchers plan to examine the effects of this combination diet over a period of six months. That will include determining how well people can incorporate the combination diet into their daily lives.

More information

The American Heart Association (news - web sites) has more about healthy food choices.

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Mountain Biking Linked to Infertility

By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, December 2, 2002

CHICAGO (AP) - Frequent mountain-biking may reduce fertility in men, according to a small Austrian study that adds fodder to a debate over cycling and male sexual function.

The research suggests frequent jolts and vibration caused by biking over rough terrain may cause abnormalities, including small scars within the scrotum and impaired sperm production.

The abnormalities were found in professional mountain bikers and other "extreme" bikers who logged at least 3,000 miles yearly — or an average of more than two hours a day, six days a week.

Dr. Ferdinand Frauscher, a urology-radiology specialist at University Hospital in Innsbruck, Austria, said he studied about 55 avid mountain bikers and found nearly 90 percent had low sperm counts and scrotal abnormalities.

Only 26 percent of the 35 non-bikers he studied had similar damage, according to research presented at this week's annual meeting of the Radiological Society of North America.

Whether the abnormalities were severe enough to make fathering a child difficult is uncertain, though some of the bikers studied had already experienced difficulty conceiving, Frauscher said.

Participants were aged 17 to 44.

His study looked at fertility rather than impotence, which was linked to recreational cycling in research heavily publicized in 1997. The earlier findings, by Boston University impotence specialist Dr. Irwin Goldstein, were construed by many cycling aficionados to suggest that men should avoid any cycling sports.

Some doctors thought Goldstein's findings were overstated, but the issue has prompted a mini-industry of bicycle seats designed to avoid the compression of penile arteries that Goldstein said occurs during cycling.

Such problems may occur on narrow, racing-type seats, Frauscher said. Some newer, wider designs feature holes or gaps to avoid pressure, but these likely would have no effect on the scrotal damage found in the Austrian study, which may be caused by jolting over rough terrain rather than artery compression, Frauscher said.

Frauscher said men shouldn't avoid mountain biking because of the study, but should perhaps consider investing in bikes with shock absorbers or suspension systems designed to reduce the jolting.

Stanford University urologist Dr. Robert Kessler said he was skeptical of Frauscher's findings. Scrotal varicose veins, which were among the abnormalities Frauscher linked to mountain biking, are usually congenital and not linked to trauma, Kessler said.

"It doesn't make sense," Kessler said.

Dr. Eduardo Randrup, a urologist at Ochsner Clinic in New Orleans, said the link is plausible but not necessarily cause for alarm. The damage Frauscher found "may well be reversible" and likely would not occur from recreational cycling, Randrup said.

Dr. Sangili Chandran, a sports medicine specialist at Christ Hospital and Medical Center in the Chicago suburb of Oak Lawn, said other studies have found similar results but, like Frauscher's, have been too small to be conclusive.

"The theory is there, the proof I'm still looking for," Chandran said.

Even if the results are corroborated in future studies, very few mountain biking enthusiasts are logging enough miles to worry about any fertility impairment, Chandran said.

On the Net:

Radiological Society: http://www.rsna.org

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New Link to Colon Cancer Found

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- A common human virus may be associated with colon cancer.

So says a study in the December issue of Cancer Research.

Temple University researchers say they found evidence that the JC virus (JCV) may play a role in development of intestinal tract tumors.

JCV infects more than 90 percent of humans, usually during early childhood. It most likely infects people through the upper respiratory tract and remains latent in most people throughout their lives.

However, in some people with weakened immune systems, JCV can become active and may cause brain cancer.

Along with infecting people through the upper respiratory tract, JCV may get into people through contaminated food and water. That takes the virus into different areas of the body, including the intestinal tract.

The researchers found genetic evidence of JCV in samples of large intestine tumors. However, more research is needed to determine if JCV actually causes those tumors or plays a different role.

More information

The U.S. National Cancer Institute (news - web sites) has more about colon cancer.

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Man's Age May Play Role in Pregnancy Complication

By Jacqueline Stenson

Reuters Health

Monday, December 2, 2002

NEW YORK (Reuters Health) - The age of a woman's mate can be a factor in whether she develops high blood pressure during pregnancy, new research suggests.

Little is understood about pregnancy-induced high blood pressure, a condition known as preeclampsia. It affects about 7% of pregnant women, and poses a risk to both the mother and fetus. In severe cases, preeclampsia can lead to maternal seizures and, rarely, to death.

"This study is a little step forward in a huge puzzle of why women get preeclampsia," said Dr. Susan Harlap, a research professor of obstetrics and gynecology at New York University School of Medicine.

Compared with pregnancies involving fathers aged 25 to 34, the risk of preeclampsia was 24% higher if men were 35 to 44 and 80% higher if they were 45 and older, Harlap and colleagues reported in a recent issue of Epidemiology. They took into account the mother's age and other known risk factors.

A possible explanation for the findings is that sperm are damaged because of genetic mutations that occur with aging or from environmental causes such as radiation, heat and pesticides, Harlap told Reuters Health. Such defects may somehow raise the risk of preeclampsia, she suggested.

"We don't know what causes preeclampsia but we have a pretty good idea that it has something to do with genetics," Harlap said. Prior studies, for example, have indicated that a woman's risk of preeclampsia is increased if her mother or her father's mother developed the condition, she said.

The study examined the incidence of preeclampsia in 81,213 deliveries from 1964 to 1976 in the ongoing Jerusalem Perinatal Study in Israel. Preeclampsia occurred in 1,303 cases.

The researchers estimated that up to 12% of these preeclampsia cases might be attributable to the added risk associated with fathers being 35 or older, compared with about 50% of cases that might be related to excess risk from older mothers.

Unexpectedly, the risk of preeclampsia was 25% higher in women with partners in the youngest age category, 15 to 24, than those in the 25 to 34 group.

"I don't know how to explain that," Harlap said. "It doesn't quite fit." However, she noted, many of the men in this age group were in the military and may have been exposed to noxious chemicals or other factors that could affect sperm quality. They also may have worn tight briefs, which can cause overheating of the testicles that can damage sperm, she added.

Source: Epidemiology 2002;13:660-667.

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Claritin Goes Over-the-Counter

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- The U.S. Food and Drug Administration (news - web sites) has approved the nation's most popular antihistamine, Claritin, for over-the-counter use without a prescription.

The agency says the ground-breaking non-drowsy allergy drug met its three criteria for OTC approval:

  • That the drug treats a condition that people can diagnose and manage themselves;
  • That the drug is safe enough to be used without a doctor's supervision;
  • That the drug's label explains any side effects and contains clear instructions for use.

Claritin received FDA approval in 1993 as one of the first non-drowsy prescription drugs to treat seasonal allergies. In granting over-the-counter approval, the agency also gave manufacturer Schering-Plough the conditional right to market the drug for the treatment of hives, provided some focus-group studies are concluded and subsequent labeling changes are made, the company says. The company's major patent expires Dec. 19, and a number of competitors are planning on introducing their own versions of the drug.

The OTC doses of Claritin, which will match those previously available by prescription, should reach the stores by mid-December, adds Schering-Plough.

Allergies and asthma affect between 20 percent and 30 percent of the nation, experts say, a figure that has doubled in the last 20 years. These conditions lead to as many as 11 million doctor visits a year, along with 2 million trips to the emergency room and a half million hospitalizations. Their economic toll amounts to 30 million missed days of work and school and upwards of $13 billion in direct and indirect costs annually.

Here is the FDA Talk Paper announcing Claritin's approval for OTC use, and here is the announcement issued by Schering-Plough. For more information on seasonal allergies, visit the National Institutes of Health.

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More U.S. Teens Seek Massages, Facials

By Martha Irvine

AP National Writer

The Associated Press

Monday, December 2, 2002

DEERFIELD, Ill. (AP) - There's nothing like a good massage or even an eyebrow waxing to relieve a little teenage angst. So says 17-year-old Jessica Schwartz, who frequents a day spa in her suburban Chicago hometown every other week.

"It's something we do to de-stress ourselves from homework, boys, things like that," she says. "There's a lot going on in the world."

With more disposable income than any young generation before them, a growing number of teens — like Schwartz and her friends — are pampering themselves with spa services traditionally sought by adults.

Mary Bemis, editor-in-chief of American Spa magazine, says it's a trend that's been building in the last three years. And many spa owners say their teen business has really taken off in the last year, post-Sept. 11.

"Everybody's scared right now with what's going on in the world," says Anna Pamula, owner of Renu Day Spa in Deerfield, Ill., which has become Jessica's regular retreat.

Jessica's mother, Betty Schwartz, sometimes pays for her daughter's visits, which can top $100 each. But more often, Jessica uses money from her after-school job, often opting for a massage or facial over dinner out with friends or concert tickets.

"I think it's really decadent, but it's probably cheaper than psychology," her mother quips.

According to a survey this year, more than a third of International Spa Association members now offer services for young people — including group parties, date specials and mother-daughter nights.

Belle Visage Day Spa in Studio City, Calif., where more than half the clientele is younger than 21, offers "teen clean" facials to help clear up acne.

And this past summer, Canyon Ranch, a health resort with facilities in Tucson, Ariz. and Lenox, Mass., started a three-week summer camp for teens.

Some spa managers have seen children as young as 5 coming in for parent-supervised massages and other services.

Parents say it's an attempt to help their children find a little inner peace early in life. And sometimes tony surroundings aren't always required: Girl Scouts, for instance, can now earn "stress less" badges.

Alison Schmitt, a 12-year-old cadet from Rutherford, N.J., says yoga and breathing exercises help calm even her biggest fears.

"Like terrorism and the possibility of war," the seventh-grader says, noting that her father worked two blocks from the World Trade Center when the towers were destroyed last year. (He made it home safely.)

But when it comes to teenage girls frequenting spas, not everyone thinks stress is the reason.

"I think it's more vanity than anything else — and being able to be 'chichi-foufou' and say they went to a spa," says Nancy Ganzon, administrative manager at the Murrieta Day Spa in Murrieta, Calif.

She's noticed a marked increase in teen clients in the last 18 months. Many come in for such teen-only services as "The Princess" — a facial, Swedish massage, and manicure for $115.

While not every teen can afford such luxuries, a surprising number can. Last year, the average teen spent $104 per week, according to a study by Teenage Research Unlimited.

That kind of spending power got the attention of Seventeen magazine, which licensed its name to the Seventeen Studio.Spa.Salon, geared specifically, though not exclusively, to teens.

The first, complete with "pedicure pits" and "manicure bars," opened in Plano, Texas, earlier this year. And president and CEO Susan Tierney says the company plans to open 36 more in high-income areas nationwide with big teen populations.

They'll be looking to lure people like 15-year-old Jennifer Ernst from Highland Park, Ill., also home to Michael Jordan and family.

Jennifer's parents got her a spa certificate two years ago for getting good grades. In May, she got a massage and facial to help her relax before a national classical guitar competition in which she placed third.

"It's a great thing to do every once in a while," Jennifer says, "as long as you keep a level head and don't get conceited about it."

On the Net:

Seventeen spa tour: http://www.seventeenspa.com/storetour.htm

International Spa Association: http://www.experienceispa.com

Martha Irvine can be reached at mirvine@ap.org

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Coffee Lowers Women's Risk of Gallbladder Problems

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- Women who drink four cups of regular coffee daily have a lower risk of getting gallstone disease than non-coffee drinkers.

That's the conclusion of a new study in the December issue of Gastroenterology.

Although the lowered risk associated with frequent coffee drinking was significant, the study's lead author hastens to add that he's not promoting coffee drinking as a way to maintain gallbladder health.

"We're not advocating that people in general start drinking coffee," says Dr. Michael F. Leitzmann, an investigator at the National Cancer Institute (news - web sites) who conducted the research while at Harvard Medical School (news - web sites).

The investigation, part of the Harvard Nurses' Health study launched in 1976, followed more than 80,000 women for 20 years, tracking their coffee consumption and whether they had surgery to remove their gallbladder. In all, 7,811 women had gallbladder surgery during the follow-up period.

The rate of gallbladder surgery was about 25 percent less for those who consistently drank four or more cups a day, compared to those who drank no coffee. When the research team took into account risk factors for gallstone disease, such as obesity, coffee's beneficial effects were not modified.

In previous research, Leitzmann also found an association between coffee drinking and lowered risk of gallstone disease in men.

Statistically, women are at higher risk than men for gallstone disease, according to the American College of Gastroenterology, the professional organization for physician specialists who treat disorders of the gastrointestinal tract. Up to 20 percent of American women and 10 percent of American men get gallstones by age 60, the college estimates.

Women who have had multiple pregnancies and those who are overweight have a higher risk than other women.

The gallbladder is a pouch located beside the liver. It stores bile, a green-yellow fluid produced by the liver. After you eat, the gallbladder releases bile into the small intestine. There, the bile helps digest fats.

Some of the fatty components of bile, such as cholesterol, can build up and not dissolve, perhaps leading to problems, including gallstones. Sometimes, gallstones are "silent" and require no treatment.

However, if jaundice, inflammation of the gallbladder and severe abdominal pain occur, surgery or medical treatment can relieve the symptoms. About 800,000 surgeries for gallbladder removal are done each year in the United States, Leitzmann says.

Exactly how the coffee helps prevent gallstone disease isn't known, Leitzmann adds.

"The main mechanism is probably that the caffeine actually stimulates the gallbladder contractions," he says. "We don't have evidence for that," but previous research has shown that may be the case. The contractions, in turn, cause the gallbladder to empty more completely, keeping it healthier.

Another gallbladder expert calls the new research "an excellent study." However, he has a caveat.

"It's not a message to drink more coffee," says Dr. Ronald S. Siegel, a gastroenterologist at Santa Monica-UCLA Medical Center in Santa Monica, Calif.

"If a person comes in to see me and drinks four cups a day and has no adverse effects, great," he says. "If they drink two, I wouldn't tell them to drink four [based on this study]."

As to how the coffee lowers risk, Siegel adds, "The caffeine may affect contractibility [of the gallbladder], but I doubt it's just one mechanism. And there is no evidence that coffee will make gallbladder problems better."

Likewise, Leitzmann says he is not encouraging women or men to boost their coffee intake to ward off gallbladder disease just because he found a link between moderate daily coffee consumption and lowered gallstone disease risk.

Those who want to reduce their risk of gallstone disease should pay attention to their weight, Leitzmann says. Being overweight or obese have been linked to increased risk of gallstone disease.

What To Do

For more information on gallbladder disease, see the American College of Gastroenterology or the National Institutes of Health.

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Flu Shots Urged for Kids 6 Months to 2

By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, December 2, 2002

CHICAGO (AP) - The American Academy of Pediatrics is encouraging flu shots for all healthy children from 6 months up to 2 years old.

Siblings, parents and other caretakers also should get the shots if possible, the academy says.

Its policy echoes new government recommendations issued in September and is based on recent data showing that young children are hospitalized with influenza at least as often as adults over 50, for whom yearly flu shots are recommended.

Tens of thousands of youngsters under age 2 become so sick each year with flu that hospitalization is needed, said Dr. Cody Meissner, a member of the academy committee that wrote the new policy.

While the flu vaccine isn't licensed for babies under 6 months, they too are at risk for hospitalization. The academy recommends shots for their families and caretakers as well, said Meissner, chief of pediatric infectious disease at Tufts-New England Medical Center in Boston.

The new policy says shots should be given whenever feasible but stops short of saying they are absolutely essential because of concerns over vaccine shortages, which have occurred in recent years, and with flooding pediatricians' offices with youngsters needing shots every fall, Meissner said.

"The logistics of this need to be carefully worked out," he said.

Unlike most childhood vaccines, flu shots are needed every year because the virus changes so often. The shots also are generally recommended before flu season hits, which is usually from November through April.

Youngsters should get two doses four weeks apart to make sure they're adequately protected. One shot yearly is recommended for older children, who are likely to have been exposed previously to the flu virus and are presumed to have developed some immunity, Meissner said.

Previously, the academy and government said the only children who needed flu shots were those in high-risk categories, such as those with chronic diseases.

On the Net:

Academy: http://www.aap.org

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Family Violence Carries from Youth to Adulthood

By Alan Mozes

Reuters Health

Monday, December 2, 2002

NEW YORK (Reuters Health) - Boys and girls who grow up either witnessing or being subjected to violence in their childhood homes appear to be more likely to suffer from or bring such violence into their own homes as adults--perpetuating, researchers say, a cycle of violence.

"Child abuse perpetration and partner abuse perpetration and victimization...increases the risk for adulthood family violence," said lead author Dr. Richard E. Heyman of the State University of New York at Stony Brook.

Heyman and his colleague Amy M. Smith Slep examined data on more than 6,000 American men and women collected by the 1985 National Family Violence Survey.

All the participants were heterosexual and over age 18. More than 80% were married at the time of the survey, while the rest were cohabiting, widowed, divorced, separated or single with a child younger than 18.

The participants were asked whether and how often they had witnessed serious physical abuse between their parents or had themselves been abused by a parent in childhood. In addition, study participants were asked whether they had engaged in any violent behavior "with a high potential for harm" directed at either their spouse/partner or their child.

The researchers found clear evidence for a "cycle of violence" among men and women--with childhood exposure to family violence increasing the likelihood of either instigating or being the victim of violence as an adult. However, in the current issue of the Journal of Marriage and Family, the authors point out that gender appeared to affect how this cycle played out.

Women who had both witnessed violence between their parents and were victims of parental abuse themselves were twice as likely to abuse their partner or children than mothers exposed to only one or the other.

Women appeared to be most greatly influenced by their mother's behavior. The likelihood a woman would abuse her child rose, they noted, with every witnessed incident in which their mother had attacked their father. Also, the investigators found that each incident increased the likelihood that a woman would abuse her partner by 6%.

In the case of men, however, Heyman and Slep observed that while exposure to childhood violence was also associated with current partner and child abuse, the likelihood of such abuse was not diminished if the father had witnessed only one form of parental abuse.

On the other hand, exposure to multiple forms of childhood violence did increase the likelihood that men would become victims of partner abuse. Each act of abuse by the man's father and mother raised the likelihood of being the victim of current partner abuse by about 10%.

This violence association held for women as well, with every act of abuse by the woman's mother raising the likelihood of being the victim of current partner abuse by 35%, the report indicates.

Men appeared to be most greatly influenced by their father's behavior. Each time a man had witnessed his father attacking his mother, the likelihood he would abuse a child or partner rose by 13% and 8%, respectively.

The researchers stressed, however, that despite the possibility of cyclical family violence, most boys and girls exposed to childhood violence don't grow up to be victims or instigators of violence themselves.

"We don't know whether childhood exposure to parental violence and childhood physical victimization are causal variables, or whether they are just part of a constellation of factors that may be increasing risk--such as poor parenting (or) family conflict," Heyman told Reuters Health. "Future studies should investigate both exposure to parental violence and physical victimization when investigating the 'cycle of violence."'

Source: Journal of Marriage and Family 2002;64:864-870.

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Breastfeeding Can Aid Weight Loss

HealthScoutNews

Monday, December 2, 2002

(HealthScoutNews) -- Are you feeling weighed down by the extra pounds you're carrying since you gave birth? If you're breastfeeding, take heart. Women who breastfeed actually lose weight faster than those who don't. But don't starve yourself in your attempts to trim down. Your baby needs nutritious breast milk.

The Medical College of Wisconsin suggests some ways to lose weight without jeopardizing your baby's health:

  • Eat lots of fruits and vegetables.
  • Cut your fat intake.
  • Stick to skim milk and avoid processed cheeses.
  • Limit the amount of bread you consume.
  • Try to go for a half hour walk at least twice a day.

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Vitamin Supplements Won't Prevent Dementia: Study

By Juhie Bhatia

Reuters Health

Monday, December 2, 2002

NEW YORK (Reuters Health) - Taking certain antioxidant vitamin supplements will not prevent dementia in old age, new study findings suggest.

While some previous reports have suggested that vitamin C and E may be protective against the development of dementia, the current study indicates that use of vitamin C and E supplements, taken separately or together, do not alter the risk of the disease. The findings are published in the November 13th issue of the Journal of the American Medical Association (news - web sites).

Dementia is caused by the progressive death of brain cells. Roughly 5% of the US population over the age of 65 suffers from some form of dementia, and the risk increases with age, Dr. Lenore Launer of the National Institute on Aging and senior investigator of the study told Reuters Health. Alzheimer's disease (news - web sites) is the leading type of dementia in old age.

Researchers have suggested that formation of free radicals, which is blocked by antioxidant vitamins such as C and E, may be involved in the development of Alzheimer's disease and other dementias, Launer said.

The new study is based on data first collected in 1965 on Japanese-American men who were born in the early 1900s. Now named the Honolulu-Asia Aging Study (HAAS), it asked 2,369 of these men about their consumption of vitamin supplements in 1998 and through 1991-1993. Cases of dementia were then identified in two different assessments of the men, one in 1994 to 1996 and the other from 1997 through 1999.

The investigators found that compared with those taking no supplements, men using both vitamin C and E (either long- or short-term) were not at a reduced risk of developing dementia. There was also no association found between supplement use and dementia when the vitamins were taken separately.

"These results do not support the use of antioxidant vitamin supplements, particularly vitamin C and vitamin E, to reduce the risk for dementia," Launer said. "But other studies have shown mixed results and two recent studies showed that dietary intake of these vitamins did affect dementia but supplemental intake didn't."

Launer suggested that studies in other population groups at high risk of dementia be conducted to better determine if giving supplements for an extended length of time can actually prevent dementia.

Source: The Journal of the American Medical Association 2002;288:2266-2268.

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Eye Injuries

HealthScoutNews

Monday, December 2, 2002

(HealthScoutNews) -- Eye injuries, particularly when something gets stuck or splashed in the eye, often need medical attention.

If liquid gets into your eye, the American Academy of Family Physicians (news - web sites) recommends you flush it gently with water for at least 15 minutes, then call the poison center or your doctor for further advice. Don't rub or touch it, and don't apply any medication.

If an object gets trapped in your eye, cover the affected eye with a paper cup or eye shield until you can get to a doctor.

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Cell Powerhouses May Hold Genetic Key to Aging

By Dana Frisch

Reuters Health

Monday, December 2, 2002

NEW YORK (Reuters Health) - Centenarians have less genetic variation in a particular gene than do patients with Parkinson's disease (news - web sites), researchers have found.

In a study of 64 Japanese centenarians, 96 young obese adults and 96 patients with Parkinson's disease, the patients with Parkinson's disease had 22 different variations in a gene in the mitochondria, or powerhouse of the cell, compared with only 9 variations in the centenarians.

Mitochondria, which have their own DNA that is inherited from the mother, are hotspots for aging research because byproducts of energy production can damage mitochondrial DNA and are thought to lead to symptoms and diseases associated with aging.

Lead author Dr. Masashi Tanaka, a researcher in the department of gene therapy at the Gifu International Institute of Biotechnology in Japan, told Reuters Health that he expected to find some genetic variation in the patients with Parkinson's disease. What he found surprising was that the centenarian's variations were not harmful.

The study was published in the November issue of the Journal of Neuroscience Research.

Dr. Bard Geesaman, vice president of informatics at Centagenetix, a Cambridge, Massachusetts-based company founded to identify genetic variance associated with diseases of aging, said that the idea that centenarians have a group of genes that protects them from diseases of aging is not a new one. However, said Geesaman, who was not involved in the study, the particular finding in this study is new. He added that more research is needed on a larger population to further investigate this idea.

Geesaman said that while looking at variations in the mitochondrial DNA is important, he expected typical, or nuclear, DNA, to play a far greater role since mitochondria are maternally inherited and there is little support of any maternal trend to longevity.

Source: Journal of Neuroscience Research 2002;70:347-355.

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Brain Structure Difference Linked to Disruptive Teens

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- In two of the first studies of their kind, scientists have discovered that aggressive adolescents with disruptive behavior disorders (DBD) may have different brain structure than other adolescents.

Two preliminary reports, being presented today in Chicago at the Radiological Society of North America (RSNA) annual meeting, found that the aggressive teens had different activity patterns in the frontal lobe portion of their brain while playing violent video games, differences that might be explained by different structures.

The frontal lobe section of the brain is involved in impulse control, attention and other cognitive activities.

"These are very important studies," says John P. Murray, professor of developmental psychology in the School of Family Studies and Human Services at Kansas State University in Manhattan, Kan. "Adolescents with DBD have long been suspected of having frontal lobe abnormalities, and these studies confirm unusual patterns of activation and structural differences in aggressive adolescents."

Disruptive Behavior Disorders refer to a group of often-dangerous behavioral problems affecting both children and adolescents. They can include oppositional defiant disorder (or ODD, characterized by hostility and hyperactivity, among other things) as well as conduct disorder (which can encompass substance abuse, weapon use and other antisocial behaviors). According to the study authors, ODD affects an estimated 5-to-10 percent of children, while conduct disorder affects about four percent of teens aged 13-to-16.

In the first study, the researchers used functional magnetic resonance imaging (fMRI) to look at patterns of brain activity of the adolescents with DBD and aggressive behavior while they played a violent (James Bond) video game and while they played an exciting but nonviolent video game (a car race game).

Overall, the aggressive adolescents had less activation in the frontal lobes and less overall brain activation than their normal counterparts.

According to Dr. Vincent Mathews, the principal investigator in the study, this is the first evidence that adolescents with aggression and DBD have different brain activation patterns.

The researchers also found differences depending on how much previous exposure the adolescents had to violent television, movies, video games and the media.

"It didn't exactly mimic the differences between controls and aggressive subjects, but there were some differences," says Mathews, a professor of radiology and chief of neuroradiology at Indiana University School of Medicine in Indianapolis.

In the second study, a different group of aggressive, DBD teens underwent magnetic resonance diffusion tensor imaging (DTI) to map the structure of the brain. As it turned out, these adolescents had abnormal development of the white matter in the brain's frontal lobes compared with the controls. The brain's white matter covers the brain's nerve cells, acting as an insulator and catalyzing the transmission of nerve signals.

"Both the studies showed differences in the frontal lobes of the disruptive behavior disorder adolescents who also had aggressive features and the normal controls," Mathews says. "There were differences in the structure of white matter and also differences in brain activation while playing the video game."

But Mathews cautions that both of these studies were also observational, meaning that no firm conclusions can be drawn regarding whether the frontal lobe differences actually affect behavior.

Previous studies have suggested that differences in frontal lobe function might explain behavioral problems.

What To Do

For more information on the impact of various forms of media on kids, click on Children Now or the Center for Media Education.

For even more information, including research studies on how television violence affects the brain, visit John Murray's web site.

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Canada Cannot Fund Health Increase: Minister

Reuters

Monday, December 2, 2002

OTTAWA (Reuters) - Canada cannot inject all of the C$15 billion of new funding into its creaking state-funded health care system that was called for in an official report last week, Finance Minister John Manley said on Monday.

The health care report, written by former Saskatchewan premier Roy Romanow, recommended the federal government spend C$3.5 billion more on health care next April, adding C$5 billion in April 2004 and C$6.5 billion in April 2005.

Romanow said Ottawa--which shares the cost of paying for health care with Canada's provinces--should guarantee to pay at least 25% of primary health costs by the 2005-06 fiscal year.

Without that extra funding the federal government would likely pay around 15% of primary health costs in 2005-06.

"Taken just on its face, without other changes, I don't have the full fiscal room in the near term, in the first couple of years, to fully fund everything that's (in the report)," Manley told reporters in response to a question on how he would implement Romanow's spending recommendations without posting a deficit.

"The provinces have a lot to say about this and we'll have to look at over what time frame we can implement the recommendations," he said.

Manley is in the midst of preparing his first budget, due next February or March, after taking over the finance portfolio in June from Paul Martin, who was sacked from cabinet for running an unofficial campaign for the party's leadership.

Prime Minister Jean Chretien laid out 22 new spending initiatives in September's Speech from the Throne, of which propping up health spending was one. Chretien is due to retire in February 2004.

Manley has said he would reallocate existing funds and in September he said he would rather jump off Parliament's Peace Tower than increase the hated goods and services tax to fund new initiatives.

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New Treatment for Psoriasis Works Well

HealthScoutNews

Monday, December 2, 2002

MONDAY, Dec. 2 (HealthScoutNews) -- A new therapy that targets immune cells in the skin may offer another choice for people with psoriasis.

That's the finding of a new study in the January issue of Nature Medicine.

European researchers say this treatment seems to work as well as the current therapies for psoriasis, which is an autoimmune disease that causes skin rashes and lesions.

The study included 20 people with moderate to severe psoriasis. They injected themselves with a compound called interleukin-4, which affects specific types of immune cells in the skin.

The people in the study were compared to people with psoriasis who received photochemotherapy, considered to be one of the best current treatments for psoriasis. Photochemotherapy uses ultraviolet light in combination with the drug psoralen.

The study found the overall effectiveness of the interleukin-4 was comparable to that of photochemotherapy.

After their treatment with interleukin-4, 18 people in the study group remained stable or their psoriasis continued to improve when they received other treatments that had been ineffective for them previously.

About 7 million Americans have psoriasis, and about a quarter of those have moderate to severe cases of the disease.

More information

Here's where you can learn more about psoriasis.

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SUNDAY, DECEMBER 1, 2002

Leaving Tumors in the Cold

 

HealthScoutNews

Sunday, December 1, 2002

SUNDAY, Dec. 1 (HealthScoutNews) -- Cryoablation, a treatment that uses extreme cold, provides an alternative to surgery for fibroadenomas, the most common form of benign breast tumor, says an American study in the November issue of the American Journal of Surgery.

The procedure can be performed in a doctor's office. Under ultrasound guidance, a small needle is placed into the center of the tumor, where the freezing tip delivers extreme cold to the tumor and destroys it.

The patient is given a local anesthetic for the cryoablation treatment and can go back to her normal activities immediately after the procedure.

In this study, doctors used cryoablation to treat more than 50 fibroadenomas. After 12 months, the patients' fibroadenomas had regressed by an average of 92 per cent.

Each year, about 500,000 fibroadenomas are diagnosed and about two-thirds are surgically removed. Women often develop multiple fibroadenomas and have to endure several operations and resulting scars.

The researchers say their study shows that cryoablation offers an alternative that allows women to be treated without surgery, general anesthesia or stitches.

More Information

The American Cancer Society (news - web sites) has more about benign breast conditions.

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Can't Hack the Cough?

HealthScoutNews

Sunday, December 1, 2002

SUNDAY, Dec. 1 (HealthScoutNews) -- Do you have a nagging cough, but you're not sure if it's worth a visit to your doctor?

The November issue of the Mayo Clinic Health Letter says you should get that cough checked if:

·         You have a known risk of lung disease. This includes previous lung cancer, chronic obstructive pulmonary disease, or if you're a past or current smoker.

  • Your cough lasts 4 to 6 weeks. Possible causes of your cough could include undiagnosed asthma, stomach acid backing up into the esophagus, and medication side effects.
  • The cough is accompanied by fever or shortness of breath. In such cases, you should see your doctor immediately.
  • You notice a change in the color of your sputum. If your sputum is blood-tinged, you need to get immediate medical attention, especially if you're also experiencing chest pain. If your sputum is yellowish or greenish, you may have a bacterial infection.

More Information

Here's where to go to find out more about chronic cough.

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SATURDAY, NOVEMBER 30, 2002

The Lowdown on High Cholesterol Counts

 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Saturday, November 30, 2002

SATURDAY, Nov. 30 (HealthScoutNews) -- It's called "Cholesterol Low Down," and it's the American Heart Association (news - web sites)'s new offensive to defeat one of the top public health enemies -- high cholesterol counts.

The free national education program offers brochures; newsletters; a Health Risk Assessment, which helps you figure out your risk for heart disease; healthy living cookbooks; and a range of fitness tips to get you exercising.

All of these tools are available on the association's Web site, via e-mail or regular mail.

"It's more focused, targeted information that people can use," says program spokesman Dr. Roger Blumenthal, who is also director of preventive cardiology at Johns Hopkins University in Baltimore.

"We're trying to do things that are more practical. We can use this program and get people to realize that there are a lot of the things they can control," he adds.

High cholesterol is one of the leading risk factors for heart disease and stroke, which are the number one and number three killers in the United States. According to the American Heart Association (AHA), some 102 million U.S. adults have total blood cholesterol levels at or above the recommended level of 200 milligrams per deciliter.

Cholesterol is a soft, waxy substance that is present in all parts of the body including the nervous system, skin, muscle, liver, intestines and heart. There are two types of cholesterol: high density lipoprotein -- or HDL, the so-called "good cholesterol" -- and low density lipoprotein -- LDL, the "bad cholesterol."

A recent AHA survey found that most people over the age of 40 recognized the importance of healthy cholesterol levels in their blood, yet more than half did not know their own levels or even what the recommended levels are.

"The nation is not doing well in terms of cholesterol levels, even in high-risk individuals," Blumenthal says. "Study after study shows that a minority of individuals are being treated with medication who should be. We also know that of the people being treated, only a minority are at their target level for cholesterol and the same applies for blood pressure."

So what's the best strategy to conquer this insidious enemy?

First, by recognizing that combating cholesterol is a two-pronged issue, says Dr. Christopher J. White, chairman of the department of cardiology at the Ochsner Clinic Foundation in New Orleans. Cholesterol is a product not only of what you eat, but also of what your liver makes.

"A patient can be perfectly compliant in everything you tell them to do diet-wise and still churn out a ton of bad cholesterol," White says.

When that happens, a variety of medications -- such as statins -- can stem the flow. However, drugs should only enter the picture after patients have done everything they can to lower their cholesterol levels through diet and exercise, White emphasizes: "The drugs are toxic. There's no such thing as a non-toxic medicine."

Diet, medication and cholesterol are part of what Blumenthal calls the "ABC's" of cardiac care:

·         A, as in Aspirin. Discuss with your doctor whether the benefits outweigh the risks and whether you should take this medicine, which may prevent the occurrence of heart attacks and strokes.

  • B, for Blood Pressure. Again, talk to your doctor about ways to improve your lifestyle and possible medications to optimize your blood-pressure levels.
  • C, as in Cholesterol. Find out what your levels are and whether you need treatment. If your score is high, your doctor may prescribe medication.
  • C is also for Cigarettes, a known risk factor for heart disease. "If you smoke, you may want to have your head examined," Blumenthal says. And you should talk to your doctor about ways to quit.
  • D is for Diet and Weight, as well as for Diabetes and Blood Sugar Control. Weight and high blood sugar levels are also risk factors for cardiovascular disease. As White says, you don't have to be a saint when it comes to a healthful diet, but you should be reasonable.
  • E, as in Exercise. The Cholesterol Low Down Program has tons of information on how to improve exercise levels and get your heart rate up. "When it comes to cholesterol, it's not just eating, it's also exercise," White points out.

What Blumenthal didn't mention was the final letter: F as in Family.

This year, the AHA is emphasizing that heart disease is a family affair because it runs in families. So the association has brought in actress and comedienne Vicki Lawrence as a national spokeswoman. Lawrence recently found out she had elevated cholesterol.

"What we're trying to do with this year's campaign is emphasize that heart disease is a family affair and, if one person is at risk, the whole family should do their part," Blumenthal says.

What To Do

Visit the American Heart Association's Cholesterol Low Down Web site for all the program's details. The National Library of Medicine also has plenty of information on cholesterol.

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Unattainable Goals Can Be Unhealthy

 

HealthScoutNews

Saturday, November 30, 2002

SATURDAY, Nov. 30 (HealthScoutNews) -- Perfectionism and unhealthy eating habits can combine to put adolescent girls at risk for becoming anorexic later in life, says an American study in the International Journal of Eating Disorders.

The study also found that girls who reported symptoms of depression and had bulimic tendencies such as binge eating and occasional purging were more likely to develop full-blown bulimia.

Researchers interviewed 157 predominantly white, middle-to-upper class girls attending private school in New York City. The girls were interviewed when they were between the ages of 12 and 16 and interviewed twice more, when they were 14 to 18 and when they were 20 to 24 years old.

Girls who were perfectionists and had symptoms of anorexia nervosa (news - web sites) in their younger years were more likely to develop full-blown anorexia nervosa by the time they reached their early 20s, the study found.

These girls felt they were failures if they weren't able to meet unattainable goals they set for themselves, the study authors say. That includes goals in general, not just body image goals.

It may be that the girls feel their bodies are one thing they have more control over and they can meet their body goals, even if they're extremely unhealthy, suggests researcher Julia Graber, a University of Florida psychology professor, in a prepared statement.

About 20 per cent of adolescent girls and young women have signs of eating disorders. There can be serious consequences if they develop into full-blown eating disorders.

For example, anorexia can lead to the deterioration of heart muscles and development of severe heart problems. The constant vomiting associated with bulimia can cause damage to the gastrointestinal tract.

It's estimated that as many 3.7 per cent of women suffer from anorexia nervosa and as many as 4.2 per cent have bulimia in their lifetimes, says the U.S. National Institute of Mental Health.

More Information

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

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A Case for More Grocers

HealthScoutNews

Saturday, November 30, 2002

SATURDAY, Nov. 30 (HealthScoutNews) The availability of supermarkets in a neighborhood appears to influence the amount of fruits and vegetables that people eat.

New research, published in the November issue of the American Journal of Public Health, found that black Americans ate 32 per cent more fruits and vegetables and white Americans ate 11 percent more fruits and vegetables for each additional supermarket in the neighborhoods where they lived, says the study.

The researchers, from the University of North Carolina at Chapel Hill School of Public Health, say they don't know why the availability of supermarkets in a neighborhood had more influence on fruit and vegetable consumption by black people. They suspect it may be linked to a lack of private transportation in neighborhoods that are predominantly black.

The study examined data on 208 U.S. neighborhoods in Washington County, Md., Forsyth County, N.C., Jackson, Miss., and several Minneapolis suburbs. Researchers collected information on the types and amounts of food eaten by 10,623 people who filled out questionnaires.

Information was also collected about the availability of supermarkets, grocery stores, and fast-food and full-service restaurants in their neighborhoods.

The study found that white neighborhoods had five times more supermarkets than black neighborhoods. Only 8 per cent of the 2,392 black study participants lived in a neighborhood with at least one supermarket, compared to 31 per cent of the white study participants.

More Information

Experts recommend you eat five servings of fruit and vegetables a day. For more about the health benefits of fruits and vegetables, go to the U.S. Centers for Disease Control and Prevention.

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