The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
January 16, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 December 7-13

  1. Common Cold Tests Zinc's Mettle

    SATURDAY, DECEMBER 7, 2002
     

  2. Layer Up Against Winter's Chill
  3. Heart Disease Knows No Gender

 

FRIDAY, DECEMBER 13, 2002 

Many in the Dark About Hepatitis A 

HealthScoutNews

Friday, December 13, 2002

FRIDAY, Dec. 13 (HealthScoutNews) -- Most American parents don't know how hepatitis A is transmitted, how serious it can be, or how it affects the body.

So says a survey released recently by the American Liver Foundation.

About 200,000 cases of hepatitis A, an infectious liver disease, are reported each year in the United States, and 100 Americans die from the disease annually. Hepatitis A is the most common vaccine-preventable disease in the United States, and half the reported cases are children.

The foundation says the survey findings show that low awareness, misunderstanding and confusion about hepatitis A are among the factors that explain why this easily preventable disease is so common.

The survey of 865 American parents found that 43 percent aren't aware of the serious health problems that can be caused by hepatitis A, and 40 percent don't know the disease can be fatal.

Only 3 percent of the parents included hepatitis A when asked which diseases their children should be vaccinated against.

The survey also revealed the important role of doctors in educating parents. The survey found that 90 percent of parents rely on their pediatricians to inform them about necessary vaccinations for their children.

Hepatitis A can cause severe complications of the liver and, in rare cases, death. The disease is spread by consumption of contaminated food or water, close personal contact, or by fecal matter coming in contact with the mouth.

Fever, fatigue, appetite loss, nausea, abdominal discomfort, jaundice and dark urine are among the symptoms of hepatitis A. People who are infected can infect others up to two weeks before they have any symptoms.

More information

To learn more about hepatitis A, go to the American Liver Foundation.

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New Evidence That Diet Plays Role in Parkinson's 

By Alison McCook

Reuters Health

Friday, December 13, 2002

NEW YORK (Reuters Health) - Men--but not women--who eat a lot of dairy products appear to have a slightly higher risk of developing Parkinson's disease (news - web sites), but researchers cautioned that more study is needed to confirm the finding.

Dr. Honglei Chen from Harvard School of Public Health in Boston, Massachusetts said that even if diet played a role in the development of Parkinson's disease, it would likely be only one of many factors. Consequently, cutting back on dairy may not affect risk of Parkinson's disease in men, and may increase their risk of other conditions linked to low calcium and vitamin D.

"Like other chronic diseases, Parkinson's disease is multi-factorial. Many hypotheses have been proposed and nearly all of them need further evidence for their relevance in human Parkinson's disease. Diet, if it plays a role in Parkinson's disease, is going to be one of the factors that predispose a person to Parkinson's disease," Chen said.

Parkinson's disease causes tremor, muscle rigidity and movement problems. The underlying cause is the slow loss of neurons that produce dopamine, a brain chemical involved in movement. The exact cause of Parkinson's disease has eluded the research community since the condition first appeared, and many suspect a combination of environmental factors, genetics and aging are at work.

Many previous studies have sought to examine whether some aspect of diet brought on the condition, most of which have produced murky and contradictory results.

In the newest venture into an understanding of the role of food in Parkinson's, Chen and colleagues found that men who ate the most dairy products had a higher chance of developing Parkinson's than did men who ate the least dairy products. The biggest dairy lovers ate at least 3 servings a day, while the lowest consumers said they downed less than 1 serving per day.

The authors report their findings in the December issue of Annals of Neurology.

Although the association between dairy products and the risk of Parkinson's disease appeared strong, Chen told Reuters Health that researchers need to confirm this finding in other studies, and understand more about how these ingredients might raise risk before recommending that men scale back on dairy.

"Until further evidence comes out, I do not think there is need to cut dairy consumption as the incidence is still low," Chen said.

"On the other hand, if our finding is confirmed, we should reconsider it because dairy consumption is high in Western countries," the researcher added.

Chen and colleagues base the findings on a follow-up of 47,331 adult men and 88,563 adult women from the 1980s to 1998, tracking what they ate and noting if any developed Parkinson's disease. During the study period, 210 men and 184 women developed Parkinson's disease.

Source: Annals of Neurology 2002;52:793-801.

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High Blood Pressure

HealthScoutNews

Friday, December 13, 2002

(HealthScoutNews) -- Certain risk factors for high blood pressure are unavoidable. Gender, race, genes and age all play some role in determining your chances of developing high blood pressure.

But there are other factors that you can control. Abington Memorial Hospital in Pennsylvania offers this advice:

  • For every 10 pounds you lose, your blood pressure reading could drop as much as two or three points.
  • The more you work out, the more normal your blood pressure should be.
  • If you reduce your salt and saturated fat intake, you better your chances of avoiding or lowering high blood pressure.
  • Reducing daily stress can dramatically cut your risk.

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Risk of Death Higher in Infant Twins with Young Mom 

By Alison McCook

Reuters Health

Friday, December 13, 2002

NEW YORK (Reuters Health) - Babies born to women over the age 35 have a higher-than-average risk of dying after birth, but new research shows that, for twins, the picture is somewhat different.

US researchers demonstrated that twins born to mothers older than 25--including those in their late 40s--are more likely to survive the first year of life than twins born to mothers in their teens and early 20s. The risk seemed to occur when infants were slightly older and past the newborn stage.

Study author Dr. Dawn P. Misra of the University of Michigan in Ann Arbor told Reuters Health that the most common causes of death among infants between 2 and 12 months old are injury and sudden infant death syndrome (SIDS). These are both preventable, she noted--for example, SIDS deaths drop in babies who breast-feed and sleep on their backs, and injuries can be averted by "childproofing" the house. However, the current study findings suggest that the older a mother gets, the easier it becomes for her to adopt these prevention strategies.

The reasons for the disparity between ages remain unclear, she said, but may stem from causes such as different education, income, and social class in younger and older mothers of twins. Young mothers likely conceive twins spontaneously, while older mothers are more likely to conceive twins as a result of infertility treatments, Misra said, which may be less affordable to young parents with less income and savings. This suggests that older mothers of twins may, in general, be wealthier than younger moms with multiple births, and that difference in resources could affect how the babies are raised.

"Mothers who have more resources may have more support and be more able to engage in these prevention strategies," Misra said. "While this would also be important for (single babies) too, twins obviously pose a greater burden than a single newborn both in terms of financial resources but also time and energy for practices such as breast-feeding and 'childproofing' a home."

Misra and her co-author, Dr. Cande V. Ananth, obtained their findings from analyzes of deaths among twins born to mothers of different ages at intervals throughout the 1980s and 1990s.

Consistent with previous findings, the investigators found that death rates among single babies peaked for mothers younger than 25, fell for mothers in their mid-20s and 30s, and then rose again for mothers over the age of 40, forming what is known as a "U-shaped" curve.

However, for twins, the pattern was somewhat different: the risk of infant death indeed peaked for young mothers, fell for mothers in their mid-20s, then steadily dropped as the age of the mother increased, the authors report in the December issue of Pediatrics.

In an interview with Reuters Health, Misra said she hopes doctors treating new mothers carrying twins consider their ages, and counsel younger mothers and their families more intensively regarding SIDS and injury prevention.

"This includes helping (a mother) connect to resources to support her and her family," Misra suggested.

Source: Pediatrics 2002;110:1163-1168.

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All You Want to Know About Healthy Eating

HealthScoutNews

Friday, December 13, 2002

FRIDAY, Dec. 13 (HealthScoutNews) -- Here's your chance to tuck away a new source of nutrition information.

The U.S. National Institutes of Health (news - web sites) Office of Dietary Supplements recently launched the National Nutrition Summit Web site. It includes information, previously unavailable online, from the May 2000 National Nutrition Summit and the historic 1969 White House Conference on Food, Nutrition and Health.

The new Web site offers information about the recommendations made at the National Nutrition Summit, along with highlights of speeches and discussions at the summit. It includes journal articles and initiatives resulting from the summit.

There's also information from the 1969 White House conference, which is considered the starting point for refocusing on critical nutrition and public health issues.

The 2000 summit highlighted accomplishments in food, nutrition and public health since the 1969 White House conference. The 2000 summit also identified continuing challenges and emerging opportunities and focused on current nutrition and lifestyle issues, such as obesity.

More information

Here's where you can find the National Nutrition Summit site.

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Psychiatrist's Group Supports Gay Adoption Rights 

Reuters Health

Friday, December 13, 2002

NEW YORK (Reuters Health) - Joining a host of other psychological and medical organizations, the American Psychiatric Association (APA) on Friday issued a statement endorsing the right of gay and lesbian couples to adopt.

"The APA supports initiatives which allow same-sex couples to adopt and co-parent children and supports all the associated legal rights, benefits, and responsibilities which arise from such initiatives," the group said in a statement.

The new policy comes on the heels of a 2000 APA policy statement supporting the right of same-sex couples to have their unions legally recognized by the state.

According to the APA, which represents over 38,000 mental illness health professionals nationwide, "research over the past 30 years has consistently demonstrated that children raised by gay or lesbian parents exhibit the same level of emotional, cognitive, social and sexual functioning as children raised by heterosexual parents."

Studies have also demonstrated that parental caring and commitment--not sexual orientation--is the deciding factor in whether or not children grow into stable, healthy adults.

However, many US states still prohibit the adoption of children by both partners in a committed gay or lesbian relationship. The APA note that "while some states have approved legislation sanctioning second parent adoption, other court judgments and legislation have prohibited lesbian women and gay men from adopting or co-parenting," meaning that in many states only one partner has a legal tie to a child both partners care for.

This type of legislation can have practical and emotional implications when it comes to the welfare of the child concerned, the APA contends. They point out that, with full adoption by both partners, "children could avail themselves of both parents' health insurance, access to medical care, death benefits, inheritance rights, and child support from both parents in the event of separation."

Other major groups representing US health professionals have already issued statements supporting the adoption rights of same-sex couples. They include the American Academy of Pediatrics, the American Association of Child and Adolescent Psychiatrists, and the American Association of Family Physicians.

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New Lung Cancer Warning for Women Who Smoke

HealthScoutNews

Friday, December 13, 2002

FRIDAY, Dec. 13 (HealthScoutNews) -- There's new evidence that the most common form of lung cancer in women is more closely associated with cigarette smoking than previously recognized.

That's the disturbing finding of a Mayo Clinic study in the current issue of the American Journal of Epidemiology.

The study used a statistical model to compare incidence rates of three kinds of lung cancer in more than 41,000 postmenopausal women in Iowa. The three types of lung cancer the researchers looked at were adenocarcinoma, squamous cell carcinoma and small cell carcinoma.

The Mayo researchers concluded there was a strong association between adenocarcinoma and smoking.

They found that among 10,000 women who smoked a pack of cigarettes a day for 20 to 39 years, 30 of those women will develop lung cancer each year: 14 adenocarcinoma; eight squamous cell; and eight small cell lung cancer.

Among 10,000 women who do not smoke, three will develop lung cancer each year, with two of those being adenocarcinoma.

Lung cancer has been the leading cause of cancer death in women in the United States for more than a decade. About 68,000 American women died of lung cancer in 2000, compared to about 40,000 deaths caused by breast cancer (news - web sites).

Adenocarcinoma accounts for about 40 percent of lung cancer cases in women.

More information

Here's where to go to find out more about lung cancer.

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Glaucoma Drugs Linked to Breathing Problems—Study 

Reuters

Friday, December 13, 2002

LONDON (Reuters) - Drugs commonly used to treat glaucoma may cause breathing problems in elderly patients, doctors said on Friday.

Glaucoma is a group of eye diseases that can lead to nerve damage and loss of vision over time. It affects about three million people in the United States alone. Many do not realize they have it.

The risk of developing the disease, which gradually robs sufferers of their vision, increases with age.

Topical beta blockers, droplets that are applied to the eye, relieve the pressure caused by glaucoma and are similar to the drugs prescribed to lower blood pressure.

But researchers at the Institute of Ophthalmology in London said they may be linked with serious side effects in some elderly patients.

"It is associated with an increased risk of developing a new airway obstruction," said James Kirwan, a glaucoma specialist at the institute.

In a study of nearly 3,000 glaucoma patients reported in The British Medical Journal, Kirwan and his colleagues found that the risk of developing airway obstruction was 2.5 times higher in those exposed to the drugs than in the general population. The study could not prove the drugs actually caused the shortness of breath, but does indicate that more research is needed.

They said their findings raise an important public health issue because of the number of people taking them. About half a million patients in Britain with glaucoma take topical beta blockers.

"We need to be pro-active about finding out about airway obstruction, or shortness of breath, in patients," Kirwan added.

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The Lowdown on Lupus

 

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Friday, December 13, 2002

FRIDAY, Dec. 13 (HealthScoutNews) -- Many doctors have little understanding of the devastating effects of lupus.

And those physicians who are up to speed have few effective ways to combat the disease, in which the immune system turns on the body, a panel of experts said yesterday.

What's more, the most common treatments can kill patients, most of whom are women, many of them black.

However, the news isn't all bad.

Several drugs are in development that offer new approaches to fighting lupus. And the nation's leading lupus advocacy group is working with the federal government to raise awareness of the disease.

"Lupus is a significant women's health issue that deserves greater resources," Sandra Raymond, chief executive officer of the Lupus Foundation of America, said during a teleconference designed to attract media attention to the disease.

No one knows how many Americans suffer from lupus, but estimates range as high as 4 million, almost all of them women of child-bearing age. The disease killed an estimated 1,406 Americans in 1998, a number that is relatively small compared to other illnesses but includes a large number of younger patients.

Lupus spurs the immune system to attacking the joints, skin, kidneys, heart, lungs, blood vessels and brain. The disease remains a major challenge to diagnose and treat, partly because "it varies in (symptoms) and severity from person to person," said Dr. Robert Lahita, rheumatology chief at St. Vincent's Hospital and Medical Center in New York City.

According to the experts, the early signs of lupus are similar to those of flu and numerous other illnesses.

Once the disease is diagnosed, "there are many drugs that are available, but most of them are currently inadequate," Lahita said.

In milder cases, anti-inflammatory drugs and mediation used to treat malaria can be effective, but they have side effects, Lahita said. In more serious cases, doctors turn to steroids, which "turn the immune system down to prevent it from creating all of the toxic cells that attack the patient's own tissues and cells," he said.

But the steroids themselves can cause serious side effects that can lead to death, according to the Lupus Foundation of America.

Lahita said researchers are working to develop drugs that would dampen the immune system without creating havoc throughout the body. Several drugs are in the late stages of testing in humans, he said.

Meanwhile, federal researchers are compiling and examining statistics about lupus.

"We're trying to get a handle on how much lupus is really out there. This problem seems to be getting worse," said Dr. Chad Helmick, a co-investigator of a U.S. Centers for Disease Control and Prevention (news - web sites) study into lupus death rates.

Middle-aged black women seem to be especially susceptible to the disease. Their death rate from lupus has risen by 70 percent over the last two decades, twice the increase among the general population. However, federal researchers aren't sure why the numbers are going up among black women.

"There might be a lot more lupus than there was 20 years, there may be people getting a later diagnosis, there may be issues of access to medical care," Helmick said.

Asian women and Latinas also suffer from higher rates of lupus than white women.

Raymond said patients often must go through several doctors -- and several years -- to finally get a correct lupus diagnosis.

Part of the problem is that general practitioners often know little about the disease. So the foundation and the federal government plan to release a CD-ROM in 2003 that will educate doctors about lupus, she said.

What To Do

Get more information about lupus from the National Institute of Arthritis and Musculoskeletal and Skin Diseases or the Lupus Foundation of America.

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Controlling AM Blood Pressure May Help Diabetics 

Reuters Health

Friday, December 13, 2002

NEW YORK (Reuters Health) - People with type 2 diabetes who consistently have elevated blood pressure in the morning may be more likely to suffer complications such as kidney disease, eye disease, heart disease and stroke, new study findings suggest.

Dr. Kyuzi Kamoi of Nagaoka Red Cross Hospital in Niigata, Japan and colleagues published their current report in the December issue of the journal Diabetes Care

Type 2 diabetes occurs when the body loses its ability to respond to the effects of insulin, a hormone that helps the body to use sugar as fuel.

The condition is associated with obesity and increases the risk of heart disease, kidney failure, blindness and limb amputations. The longer people live with type 2 diabetes, the more likely they are to have devastating medical complications.

Previous research has shown that morning blood pressure can predict mortality risk in people who have hypertension, according to the Kamoi and colleagues.

In the current study, the investigators aimed to see how well regular home morning blood pressure readings for people with type 2 diabetes predicted complications related to their disease compared to blood pressure readings taken at a clinic. A total of 170 people participated. All were being treated with blood-pressure-lowering and anti-diabetic medications.

Both high blood pressure at home and in the clinic were defined as systolic blood pressure-the higher number in a blood pressure reading--equal to or above 130 millimeters of mercury (mmHg), and/or diastolic pressure, or the lower number, equal to or above 85 mmHg.

There were no significant differences in the prevalence of kidney disease, eye disease heart disease or cerebrovascular disease between people whose blood pressure measured high at the clinic and those whose did not. But the researchers did find that people whose morning readings revealed higher blood pressures were more likely to have diabetes-linked complications and heart disease than those whose blood pressure did not climb in the morning.

"In summary, in patients with type 2 diabetes, hypertension based on self-measurement of blood pressure in the morning after awakening is strongly related to...complications, especially (kidney disease)," the authors write.

"It is concluded that control of morning hypertension may prevent vascular complications in type 2 diabetic patients."

Source: Diabetes Care 2002;25:2218-2223.

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Advocates, Parents Urge Restrictions on Acne Drug 

By Ori Twersky

Reuters Health

Friday, December 13, 2002

WASHINGTON (Reuters Health) - A student well-liked by his teachers, Matthew Turney of Watertown, New York, took his own life at age 16 shortly after starting to take the acne drug Accutane (isotretinoin). His parents blame his death on the controversial drug.

James Bencz, a certified firefighter, rescue diver, athlete, licensed appraiser and homeowner, was found dead on March 4, 2002 at the bottom of a lake with a 44-pound barbell strapped to him shortly after beginning a course of the drug to treat pimples on his neck and back.

His parents too were convinced that Accutane was responsible.

According to US Food and Drug Administration (news - web sites) (FDA), 173 suicides have been reported and credited worldwide to the drug, made by Hoffmann-La Roche, since it was first approved in 1982 to treat severe acne that does not respond to conventional therapy, such as antibiotics.

As a result, some consumer activists and family members want the US regulatory agency to further restrict use of the drug in response to these deaths as well as its documented ability to cause birth defects.

In testimony before a congressional committee on Wednesday, these individuals argued that anything less would mean sanctioning such events, given the FDA's authority to take action to prevent future problems.

"You will hear from families and people who say this drug saved their complexion and gave them a better outlook on life," said Michael Bencz, father of James Bencz. "James could not have had a better outlook on life, and he killed himself without warning. How many more suicides and deaths have to occur before someone says enough is enough?"

Still, the drugmaker says that sufficient steps have been taken and further restrictions would just serve to prevent the drug from reaching desperate patients.

"Over 6 million US patients have benefited from Accutane since it was first approved," Hoffmann-La Roche CEO George Abercombie testified on behalf of the drug. "We believe such prescribing is generally appropriate and intended to alleviate the suffering of patients with severe recalcitrant nodular acne rather than less severe conditions."

The company and FDA officials further noted that a number of steps have been taken recently to ensure the drug's appropriate use and that these steps have led to a decline in the number of reported events.

"Overall, the steps we have taken to address the psychiatric events in the Accutane population are highly precautionary and unprecedented in scope," Abercombie said.

Among these steps was the development of a "Medication Guide" to emphasize key safety issues in lay language and a risk-management program to address concerns regarding the drug's potential to cause birth defects, said Dr. Janet Woodcock, director of the FDA's prescription drug division.

"FDA has worked diligently with the manufacturers and the medical and scientific communities to assure that patients have access to Accutane under conditions that make its use as safe as possible," she said.

But Dr. Nancy Green, medical director of the March of Dimes Birth Defects Foundation, said she believed further steps could still be taken if only to address the drug's ability to cause birth defects.

"No pregnant women should take isotretinoin, and no women taking isotretinoin should get pregnant," Green said, while noting that many pregnant women continue to take this drug and that the number is likely to grow now that the FDA is approving generic equivalents.

In November, the FDA approved the first generic version of the drug, which will be marketed by Bertek Pharmaceuticals of Research Triangle Park, North Carolina, the branded arm of generic drugmaker Mylan Laboratories.

Nonetheless, other healthcare professionals said they agreed with Roche that the risks were exaggerated and that the steps taken so far were adequate to protect patients.

"In the last 15 years I have prescribed Accutane to hundreds of patients without incident," said Dr. Diane S. Berson of Cornell Medical College in New York City. "I implore you to allow dermatologists to continue to prescribe Accutane to the patients for whom it is the only effective therapy. Please do not deny access to this 'life changing' medication."

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THURSDAY, DECEMBER 12, 2002 

30,000 Pints of Plasma Quarantined

 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Thursday, December 12, 2002

WASHINGTON - Blood banks are quarantining all plasma frozen during the West Nile virus (news - web sites) epidemic — an estimated 30,000 pints — to reduce further the low risk of spreading the disease through blood products.

West Nile virus is spread mostly by infected mosquitoes, but federal health officials discovered in September that it also occasionally is spread through donated blood or organs. Of the more than 3,800 West Nile cases this year, about 13 are believed to have been caused by a blood transfusion.

Most donated blood — the red blood cells and platelets — is used right away. The government had tried to limit West Nile risk by warning blood banks earlier this fall not to accept donations from people with West Nile-like symptoms.

But plasma, the liquid part of blood, is routinely frozen and thus can be used up to a year later. It's needed mostly by people with advanced liver disease and to treat serious trauma.

So large hospitals in states that were hard hit by the West Nile epidemic may face temporary tight supplies, as blood banks race to replace quarantined plasma with plasma donated in West Nile-free states or after the epidemic ended.

The American Association of Blood Banks and the nation's two major blood suppliers — the American Red Cross (news - web sites) and America's Blood Centers — announced the move Thursday. Included in the quarantine are frozen blood products that were collected anywhere from a week before each state's first case of West Nile virus, through a week after the last case.

That means that how much frozen plasma is quarantined will differ greatly from state to state, depending on how many West Nile cases each had.

Will there be serious shortages?

"Nobody really knows," said Dr. Steven Kleinman of the AABB, who said next week will be the crucial period.

But he said if hospitals have emergencies to treat and only quarantined plasma on the shelf, they should use it — but try to use bags dated near the beginning or end of their region's West Nile outbreak, when the risk of donations by sick people would have been lower.

During the holidays, blood banks always need more donations, particularly of red blood cells that make up most lifesaving transfusions.

But officials are hopeful of replacing the quarantined plasma fairly quickly. The quarantined amount makes up only about 15 percent of the Red Cross' frozen inventory, said medical officer Dr. Peter Page.

"The problem is worst today. It'll only get better in coming weeks," as shipments of pre-West Nile frozen bags go out and new blood donations come in, he said.

The quarantine was a voluntary decision by the blood industry. But the Food and Drug Administration (news - web sites), which regulates blood safety, called it a logical move considering hospital freezers still harbored plasma that might contain some West Nile virus.

Yet the quarantine couldn't have come earlier, because until winter ended the epidemic in the South, there was no way to replace the supply, noted FDA blood chief Dr. Jay Epstein.

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Tooth Loss, Gum Disease May Up Man's Stroke Risk 

By Keith Mulvihill

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - Tooth loss and gum disease may increase a person's risk for having a stroke, new study findings suggest.

Lead author Dr. Kaumudi J. Joshipura of Harvard School of Dental Medicine in Boston, Massachusetts and colleagues report their findings in the January 2003 issue of Stroke: Journal of the American Heart Association (news - web sites).

Periodontal disease, which includes gingivitis and periodontitis, involves a chronic bacterial infection that can lead to tooth loss. Scientists have speculated that over time, these oral bacteria may slip into the bloodstream and trigger inflammation in the blood vessels that feed the heart and brain. Some, but not all, studies on the topic have suggested a history of gum disease increases the risk of heart attack or stroke.

In the current study, Joshipura and her team followed the heart and dental health of 41,380 men between the ages of 40 and 75 who had no sign of heart disease or diabetes at the start of the study. After 12 years, a total of 349 men had an ischemic stroke. This is the most common type of stroke, and occurs when a clot or blocked artery cuts off blood flow to the brain.

Men who had 24 teeth or less at the start of the study had a 57% increase in their risk for having an ischemic stroke compared to men who had 25 teeth or more, Joshipura told Reuters Health in an interview. Tooth loss in most cases was due to gum disease or cavities, she added.

Typically, adults have a full set of 32 teeth.

Joshipura cautions that the findings do not imply that loss of teeth will definitely lead to a stroke.

The researchers tried to control for many factors related to increased risk of stroke, such as age, obesity, smoking, exercise and diet, explained Joshipura. But she added that it was impossible to control for every possible influence on stroke risk, such as genetic factors.

The authors also saw a modest association between having a history of periodontal disease at the start of the study and ischemic stroke risk.

"This is a preliminary study that will need to be confirmed by more research," Joshipura said.

Source: Stroke 2003;34.

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Zebrafish Helps in Heart Research

By Paul Recer

AP Science Writer

The Associated Press

Thursday, December 12, 2002

WASHINGTON - In a step toward finding ways to help ailing human hearts repair themselves, researchers have shown that the tiny zebrafish is able to totally regenerate cardiac muscle and fully recover after about 20 percent of its heart has been surgically removed.

Scientists said the work boosts efforts by many researchers to find ways to grow new, healthy cells to replace scarred heart tissue in cardiac patients, a goal still many years away.

Most researchers are attempting to grow new heart cells by manipulating stem cells to prompt them to transform into cardiac tissue.

But a team led by Dr. Mark T. Keating of Harvard University is taking a different approach: They are looking for the genetic secrets that allow some animals, such as the zebrafish, to grow new body parts.

Once the genes are found in zebrafish, said Keating, "it is likely that there are corresponding genes in the human genome (news - web sites)."

"Is it possible that this could lead to human cardiac regeneration?" he asked. "The answer is yes, it could."

Keating, a Howard Hughes Medical Institute researcher at Harvard Medical School (news - web sites), chose the zebrafish, a much-studied laboratory animal. It was known that the one-inch long, black-and-white striped fish could regenerate fins and eye parts, but nobody had ever tested to see if the little swimmer could grow new heart cells.

In the study, the researchers anesthetized the animals and then quickly cut into their abdomen to scissor away about 20 percent of their two-chambered heart. The incision was blotted, to stop bleeding, and the fish was returned to the water. Eight out of 10 of the test animals survived the radical procedure, said Keating.

"They're not happy for a while," he said. "They sort of hang out at the bottom of the tank."

But within 10 days, something remarkable happened: The test fish began swimming normally and soon were as active as their healthy schoolmates.

After two months, Keating said the test fish totally regenerated their hearts, replacing all the lost tissue with new cells that vigorously pumped blood. And, most notably, there was little or no scarring.

"The whole 20 percent of the excised heart regrows and it actually overshoots a little bit," said Keating. "We have looked microscopically at the heart and it is beating and all aspects of it seem to be contracting."

This is in marked contrast to what happens in people. A heart attack patient may recover, but the heart is never quite the same.

"There is little or no heart muscle growth following a heart attack in humans," said Keating. Instead, injured cells are replaced by scar tissue which does not contract like muscle or conduct the electrical impulses needed for a normal heart beat.

Keating said the next step in his studies will be to start identifying the genes that the little zebrafish uses to grow new heart muscle cells.

"There's probably a whole family of genes involved," he said.

Dr. Joshua M. Hare, a researcher at the Johns Hopkins University School of Medicine who is attempting to regenerate human heart tissue using stem cells, said the work by Keating and his team "is definitely promising."

Finding the self-repair genes of the zebrafish, he said, "will provide very valuable clues into the reasons that human hearts don't fully regenerate or find ways to stimulate the human heart to regenerate."

John Fakunding, head of a heart research program at the National Heart Lung and Blood Institute, one of the National Institutes of Medicine, said Keating has now created a laboratory model that may be used to learn how to grow new heart tissue in humans.

"There is a lot of focus on repairing the heart using regenerative medicine, or growing new cells," said Fakunding. Most researchers are using stem cells, but Keating's approach addresses the problem on a more basic, genetic level and is looking at how to cause the heart to grow healthy muscle instead of scar tissue, he said.

"It may eventually be very applicable to humans and become a treatment for damaged hearts," said Fakunding.

On the Net:

Science: www.sciencemag.org

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Inhaled Hormones Offer Breast Cancer Alternative

By Maggie Fox

Reuters

Thursday, December 12, 2002

WASHINGTON (Reuters) - An inhaled hormone treatment may offer women at high risk of breast cancer (news - web sites) an alternative to losing their breasts or ovaries, researchers said on Thursday.

The nasal spray contains a drug that effectively shuts down the ovaries, and a small amount of hormones that keep the patient from going into premature menopause, the researchers told a breast cancer conference in San Antonio, Texas.

A very early trial involving just 13 women suggests the treatment may at least make it easier for doctors to watch for breast cancer in high-risk patients, and offers some hope that it could help to prevent cancer, the researcher said.

"This is a regimen that preserves a woman's options," Dr. Jeffrey Weitzel of the City of Hope Hospital in Duarte, California, who helped lead the study, said in a telephone interview.

Both breast and ovarian cancer are often related to the action on cells by the female hormone estrogen. It seems to accumulate over a woman's lifetime.

Breast cancer is the second-biggest cancer killer of women after lung cancer, killing 40,000 people in the United States every year.

Usually, its cause is unknown but a small percentage of women have mutations in genes known as BRCA1 and BRCA2 that put them at a very high risk of breast cancer. BRCA mutations account for somewhere between 4% and 10% of breast cancer cases.

Some of these women are opting to have their breasts or ovaries removed, which does seem to prevent the cancer. Women and doctors are eager to find a less drastic alternative.

Weitzel and colleagues at the University of Southern California and the University of Utah tested a treatment developed by privately held Balance Pharmaceuticals. Called Libra, it combines a drug called deslorelin with very small amounts of estrogen and testosterone.

The main purpose of the Phase I trial was to see if it made the women's breasts easier to look at in mammograms. Young women tend to have "dense" breasts that, when x-rayed, look opaque, making it harder to pick out tiny tumors.

Significant Results

"We have significant results already," Weitzel said in a telephone interview. "In BRCA1 and 2 carriers and women without the mutations we have seen a significant decrease in breast density while bone mineral density remained stable. Their quality of life remained good and unchanged throughout the studies."

After a year the women stopped using the daily nose spray and within a month or two their normal menstrual periods returned, suggesting they had regained normal fertility.

The drug, a gonadotrophin-releasing hormone agonist, "essentially shuts down the ovary," Weitzel said. The hormones in the spray replace the small amount of testosterone produced by the ovaries and are about equal to the smallest amount of estrogen that a woman produces during her menstrual cycle.

As with birth control pills, the women were given a small amount of progestin, in this case every three months, to protect the lining of the uterus. This caused period-like bleeding.

"Our focus now is on women at high risk--not the average woman," said Weitzel, who advises Balance Pharmaceuticals. "But it should ultimately act as a contraceptive."

Libra is in Phase III trials, the last phase of study before a drugmaker can seek US Food and Drug Administration (news - web sites) approval, for endometriosis.

The cancer-fighting drug tamoxifen reduces the risk of breast cancer in many women, but has not so far seemed to help women with BRCA mutations.

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Group Finds Brain Center for Liking Music

By Paul Recer

AP Science Writer

The Associated Press

Thursday, December 12, 2002

WASHINGTON (AP) - Sounds from the radio slip into a melody and suddenly your mind skips back to an evening of moonlight and romance and happy times. It happens to everybody, but until now science was unsure just why.

A new study by researchers at Dartmouth College in Hanover, N.H., suggests that recalling that melody is the job of a part of the brain known as the rostromedial prefrontal cortex. It is the part that remembers music and is even able to recognize a sour note in the midst of a familiar tune.

A team led by researcher Petr Janata of Dartmouth's Center for Cognitive Neuroscience explored the mind's memory for tunes by studying the brains of eight musicians as they listened to a bit of original music.

Using functional magnetic resonance imaging, which detects the part of the brain active in response to specific stimuli, they found that the ability to recognize music is contained in a centrally located area just behind the forehead.

Janata said that part of the brain also plays a key role in learning and in the response and control of emotions.

"Our results provide a stronger foundation for explaining the link between music, emotion and the brain," Janata said.

In the study, eight people who had studied music for at least 12 years listened to the music and were asked to pick out specific tones and to detect notes played by a flute-like instrument instead of a clarinet which had dominated the music. As they performed these tasks, the functional MRI tracked which parts of the brain were active.

The researchers reported that the brains of each of the subjects tracked the sounds in a slightly different way each time the music was played. This may be the reason the same music, in different times, may prompt different emotions.

Janata said the fact that the brain is naturally wired to appreciate and remember music suggests that the pleasant sounds were an important of part of the human mind from the earliest of times.

"It's not necessary for human survival, yet something inside us craves it," said Janata. "I think this research helps us understand that craving a little bit more."

On the Net:

Science: www.sciencemag.org

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Eye Protein a Key Regulator of Body Clock: Studies

By Amy Norton

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - New research in mice confirms that a light-sensitive protein in the retina called melanopsin is essential in setting the "body clock" in mammals. Scientists say the protein now stands as a potential target of therapy to normalize disturbed day/night schedules.

Previous research had suggested that melanopsin, found in a special network of cells in the retina, might be the main transmitter of light-and-dark messages to the central body clock in the brain. Melanopsin-containing cells appear to be separate from rods and cones, the retinal cells that allow people to see; instead, they provide a less-specialized perception of changes in light.

It's these daily shifts between day and night, perceived by the retina, that help set the body clock, or circadian rhythm. Besides governing the sleep-wake cycle, circadian rhythm plays an integral role in a range of body processes such as hormone production, blood pressure and body temperature.

Scientists have long sought to understand how the body "resets" this clock when the rhythm gets thrown off--by, for example, modern-day situations such as shift-work and travel across time zones.

Now two new studies, reported in the December 13th issue of Science, confirm that melanopsin plays a vital role in synchronizing circadian rhythm with the outside world--although, researchers add, other light-sensitive molecules must also be involved.

These findings are the first to "nail down a relationship between melanopsin and circadian rhythms," the lead author of one of the studies, Dr. Norman F. Ruby of Stanford University in California, told Reuters Health.

To do this, Ruby and his colleagues studied "knockout" mice that had been engineered to lack the gene for melanopsin, allowing the researchers to gauge the importance of the protein in adjusting to changes in the light/dark cycle. They found that, compared with normal mice, the melanopsin-deficient animals showed less of a response to changes in light--their body clocks did not "reset" to the same magnitude that those of normal mice did.

"The clock is not getting all of the light information because the retina lacks melanopsin, and the circadian clock 'sees' less light," Ruby explained.

Similarly, in the second study, an international team of researchers found diminished clock resetting in melanopsin-deficient mice. The study authors, led by Satchidananda Panda of Scripps Research Institute in San Diego, California, conclude that melanopsin is needed for normal body-clock function, but that "other mechanisms for light input to the clock also play a role."

Some scientists hope to use this growing understanding of how the body sets its clock to develop ways to restore these natural rhythms when they are disrupted by things like shift-work or insomnia. A growing body of research suggests that chronic body-clock disturbances can have health consequences, from stomach upset and ulcers to heart disease.

Ruby noted that for many blind people, circadian rhythm "cannot synchronize to the outside world," throwing off the normal sleep/wake cycle.

"Now that we know that melanopsin conveys light information to the clock," he said, "it is a new 'target' for developing...methods to keep people on a normal day/night schedule."

Some co-authors on his study are with Deltagen, Inc., a Redwood City, California-based biopharmaceutical company.

Source: Science 2002;298:2211-2213,2213-2216.

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Peptic Ulcer Linked to Anxiety Disorder

HealthScoutNews

Thursday, December 12, 2002

THURSDAY, Dec. 12 (HealthScoutNews) -- Peptic ulcer disease and generalized anxiety disorder may have a common psychiatric/psychological link.

So says a study in the November/December issue of Psychosomatic Medicine.

American researchers found that generalized anxiety disorder was associated with a greatly increased risk of self-reported peptic ulcer disease.

The study also found that people with generalized anxiety disorder who reported more anxiety symptoms were more likely to report they had peptic ulcer disease. The actual mechanism behind the link is unclear.

The researchers made the link after they analyzed data from the National Comorbidity Survey, which is a household survey of Americans aged 15 to 54.

Between 3 percent and 4 per cent of Americans have generalized anxiety disorder. Unremitting worry, lack of energy and a sense of dread are among the symptoms.

A peptic ulcer is a noncancerous sore on the wall of the stomach or the intestine.

Research in recent years indicates that infectious Helicobacter pylori bacteria causes peptic ulcers.

More information

The U.S. Centers for Disease Control and Prevention (news - web sites) has more about peptic ulcer disease.

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Short Chemo Intervals Cut Breast Cancer Recurrence

By Paula Moyer

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - Shortening the interval between chemotherapy treatments may help reduce the risk of breast cancer (news - web sites) recurrence, according to a New York researcher who is to report the findings Thursday at the annual San Antonio Breast Cancer Symposium.

What's more, when chemotherapy agents are given sequentially, patients experience less toxicity than when the drugs are given in combination. Adding a white blood cell stimulator to the mix helps prevent hospitalizations due to neutropenia, a condition characterized by a drop in infection-fighting white blood cells that can occur with frequent chemotherapy, said Dr. Marc Citron, a clinical professor of medicine at Albert Einstein College of Medicine in New York City.

"For patients with breast cancer, frequency of dosing is an important area of research now," Citron told Reuters Health. A new generation of breast cancer studies is looking at a more closely spaced regimen, known as the "dose-dense" approach, he said. If the results are confirmed, they may become more available to patients.

"More frequent dosing will be a treatment option for some patients. It is not yet the standard of care for patients with node-positive breast cancer, but it is an option that will be discussed with patients after these study results are released," Citron said.

In the study, Citron and colleagues followed 2,005 breast cancer patients who had undergone surgery, either lumpectomy or mastectomy, along with lymph node removal. All the women had cancer that had spread to the lymph nodes, a situation that often calls for chemotherapy.

The study had two aims: to see if shortening the interval between chemotherapy treatments helped reduce breast cancer recurrence, and to see if sequential chemotherapy was associated with less toxicity than combination chemotherapy.

Patients were randomly assigned to one of four treatment arms. Some patients were on a two-week cycle (the dose-dense group) while others received treatment on a three-week cycle. In addition, some patients took one drug during a cycle and then switched for the next cycle (the sequential group), while others took combinations of drugs.

In the dose-dense arms, patients also received treatment with a genetically engineered version of granulocyte colony-stimulating factor, called filgrastim, which stimulates white blood cell regeneration.

The researchers found that dose-dense treatment was associated with a 26% reduction in the risk of recurrence and a 31% improvement in survival.

"Disease-free survival was 82% in the dose-dense arms, and 75% in the conventional arms," Citron told Reuters Health. "There was no difference in the efficacy of concurrent treatment versus sequential treatment, but sequential treatment was less toxic." Dose-dense treatment was also associated with fewer hospitalizations for neutropenia, an outcome Citron attributed to treatment with the white blood cell-boosting drug.

In the combination dose-dense arm, 13% of patients received transfusions of red blood cells, compared to less than 4% in the other arms.

"This outcome surprised me, because there are medications to stimulate red blood cells," he said. "However, in my own practice we haven't had any transfusions." The transfusion rate may be related to insurance issues, he said, noting that some insurance companies do not cover red blood cell-boosting treatment unless hemoglobin--the oxygen-carrying component of blood--falls to a certain level.

The study was funded by the National Cancer Institute (news - web sites) (NCI) and Amgen, a company that makes the white blood cell-boosting drug. Some of the researchers were from Memorial Sloan-Kettering Cancer Center, which discovered and licenses the drug to Amgen.

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Study Confirms Benefits of Lower Blood Pressure

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Thursday, December 12, 2002

THURSDAY, Dec. 12 (HealthScoutNews) -- Lowering your blood pressure can pay off in significant reductions in your risk of strokes and heart attacks, regardless of your age and even if your readings are already in the normal range.

So say British researchers who analyzed the link between blood pressure and cardiovascular death in a million adults. They found that during middle age every drop in systolic pressure (the top number) of 20 millimeters of mercury, and every 10 point decline in diastolic pressure (the lower figure) reduced the risk of deadly strokes, coronary artery disease, and other vascular problems by more than 50 percent.

Somewhat surprisingly, lower blood pressure also helped the very elderly avoid cardiovascular deaths, though not by quite as much as in younger people. And the benefits weren't limited to people who brought their blood pressure down from unhealthy levels, according to the researchers, who report their findings in the Dec. 14 issue of The Lancet.

"If the general population could all reduce their blood pressure by just a few millimeters of mercury, you could prevent about 10 percent of [fatal] strokes and 7 percent" of deadly coronary artery disease, said Sarah Lewington, an Oxford University epidemiologist and a co-author of the study. The coronary arteries are the plumbing for the heart, and they are vulnerable to plaque buildup that can deprive the organ of blood and trigger a heart attack.

Drugs, exercise, and reduced salt intake, for certain people, can improve blood pressure, Lewington said.

An estimated one in four Americans has hypertension though a third don't know it, according to the American Heart Association (news - web sites). The condition, called the "silent killer," is the leading changeable cause of stroke in the United States, raising the risk sevenfold compared with people with normal blood pressure. High blood pressure is also a main source of kidney problems, which affect 8 million people in this country.

Lewington and her colleagues analyzed 61 previous studies of blood pressure and cardiovascular disease, which together included 1 million people. Of the 120,000 who died during the nearly 13 years of follow-up, 56,000 suffered fatal strokes, cases of deadly coronary artery disease, and other vascular mortality. Another 66,000 died of causes unrelated to the heart or vessels.

The researchers saw a protective effect of lower blood pressure until it hit about 115/75 mmHg, a low but fairly common reading.

"This study confirms what prior studies have been telling us for a long time, but in a much more powerful way," said Dr. Donald Lloyd-Jones, a researcher on the Framingham Heart Study and a cardiologist at Massachusetts General Hospital in Boston. "It is always better -- as long as it's not too low -- to have a lower blood pressure than a higher blood pressure in terms of your risk for cardiovascular disease."

What To Do

For more on high blood pressure, visit the National Institutes of Health or the American Heart Association.

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Poll Shows Most Americans Trust Their Doctors

By Charnicia Huggins

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - Nearly two thirds of Americans say they are confident that the medical information given to them by their doctor is accurate, according to the findings of a recent Gallup poll.

The remaining 34% of the 1,001 adults surveyed nationwide from November 11-14 said they opted for a second opinion on important issues or did independent research.

This percentage is "lower than I might have thought," Frank Newport, editor-in-chief of the Gallup poll, told Reuters Health.

"It clearly tells us that despite the proliferation of health news on the television and the Internet...(many people) don't have a great deal of trust in the accuracy of that information," he said.

In fact, when asked about their degree of trust and confidence in their doctor, one quarter of the respondents said they have more confidence now than they did last year and only 11% said their trust and confidence was lower than it was previously. Most (57%) respondents said their level of trust and confidence in their doctor had not changed over the past 12 months.

In other findings, results from a separate Gallup poll indicate that while the majority of Americans trust the health information they receive from their doctors, one in five people have a great deal of trust and confidence in the medical information they get from the Internet. Less than 15%, however, report the same level of trust and confidence in medical information from newspapers, magazines and television, respectively.

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Periodontal Disease Linked to Stroke

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, December 12, 2002

THURSDAY, Dec. 12 (HealthScoutNews) -- Why should people who have periodontal disease and lose a lot of teeth be more likely to have a stroke?

Kaumudi J. Joshipura, lead author of a new study finding the link, says she can't explain the relationship.

"It is still a mystery," says Joshipura, who is an associate professor of epidemiology at the Harvard School of Public Health and the Harvard School of Dental Medicine. "We need more studies."

It's true that the report, which used data on 41,380 men in the Health Professionals' Follow-Up Study, did find that participants with fewer teeth generally were older, drank more alcohol, were less physically active, and were more likely to smoke, all of which are risk factors for stroke.

But those common risk factors aren't enough to explain the relationship, Joshipura says.

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

Indeed, the analysis came up with one counterintuitive finding: The association between tooth loss and stroke was higher among nonsmokers than among smokers.

Other studies have tended to find a similar association, but they have been controversial, Joshipura says. One strength of her study, Joshipura says, is that its population consisted largely of professionals -- dentists, veterinarians, pharmacists, optometrists, and the like, most white, mostly male -- who generally "behave properly" as far as health habits are concerned.

All of them filled out health questionnaires that were mailed to them every two years. Over 12 years, there were 349 ischemic strokes, the kind that happen when a clot blocks an artery leading to the brain. Men who had fewer than 25 teeth when they entered the study were 57 percent more likely to have an ischemic stroke than those with more than 25 teeth.

Breaking it down by numbers, the risk was 50 percent higher for men with 17 to 24 teeth, 74 percent higher for men with 11 to 16 teeth, and 66 percent higher for men with 10 or fewer teeth.

The number of teeth lost during the 12-year study didn't have much of an effect on the risk of stroke -- perhaps because tooth loss tended to be minor, perhaps because it takes many years for the effect of tooth loss to impact stroke risk, Joshipura says.

One hypothesis that is gaining attention is that the infection related to periodontal disease and tooth loss causes inflammation that injures the arteries, says Dr. Ralph L. Sacco, professor of neurology and epidemiology at Columbia Presbyterian Medical Center in New York City and a spokesman for the American Stroke Association.

"We have our own studies showing that tooth loss is related to carotid artery disease," Sacco says. The carotid artery is the main artery to the brain.

"Could chronic infection, periodontal disease being one of its manifestations, possibly be related to hardening of the arteries?" Sacco asks. That concept has led to growing attention to C-reactive protein, a marker of inflammation that studies have associated with heart disease, he says.

At any rate, Sacco says, the relationship is "another good reason to brush your teeth."

What To Do

You can learn about periodontal disease and what to do about it from the American Academy of Periodontology. The American Heart Association has a page on dental and heart health.

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Scientists ID Gene Key for Scary Memory Storage

By Merritt McKinney

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - Scientists have identified a circuit in the brain that may play an important role in how we experience fear.

Though the research was performed in mice, researchers predict that the discovery could point the way to the development of new types of treatment for anxiety disorders.

"This paper represents an attempt to develop a molecular genetic approach to learned fear, a form of anxiety," lead author Dr. Eric R. Kandel of the Howard Hughes Medical Institute at Columbia University in New York told Reuters Health.

Kandel said that the strategy "should allow a deeper understanding of the molecular mechanisms of fear." The Columbia researcher, who shared the 2000 Nobel Prize for Medicine, added that this type of research eventually could lead to new therapeutic approaches for anxiety disorders.

A report on the findings is published in the December 13th issue of the journal Cell.

Most of us are not too fond of fear, except maybe at a scary movie or on a roller coaster, but animals and humans rely on fear to survive. One type of fear is known as "learned" fear, in which a person or an animal learns to associate something, say a sound or a sight, with fear. A part of the brain called the amygdala has been linked to fear, including learned fear, so Kandel and his colleagues zeroed in on this area to see what they could find out about learned fear.

The researchers designed an experiment in which mice learned to feel fear when they heard a sound that they associated with previous painful experiences. One group of mice was normal, but the other group had been engineered to lack a receptor called the gastrin-releasing peptide receptor (GRPR), which is plentiful in the amygdala.

Compared to normal mice, mice that lacked GRPR were more likely to respond to cues of past pain. These mice had "an enhanced memory of learned fear," according to the report. But the absence of GRPR did not affect normal memory that was not related to fear. Similarly, the altered mice were not different from normal mice in terms of innate fear, the type of fear that is hard-wired in the brain from birth and is not learned.

Kandel's team concludes that GRPR plays a role in keeping learned fear under control. "We identified a network that is specifically involved in amygdala-dependent long-term memories for fear," the authors state in the report.

The researchers suggest that the findings may have implications for the treatment of mental illness. Mice without GRPR had lower levels of the chemical GABA, levels of which are reduced in people with depression and anxiety and panic disorders. The lack of GRPR, by reducing the release of GABA in mice, may have "fine-tuned" the mice's system for storing long-term memories of learned fear, Kandel and his colleagues suggest.

"It is likely that molecular insights in the biology of fear will prove to be broadly informative regarding the genes important both for normal human fear and for anxiety states," the authors conclude.

Source: Cell 2002;111:905-918.

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Work Out and Stay Alive

HealthScoutNews

Thursday, December 12, 2002

THURSDAY, Dec. 12 (HealthScoutNews) -- Being a couch potato is more life-threatening than being overweight or obese.

That's the sobering conclusion of an American study in the current issue of the Annals of Epidemiology.

However, you don't have to become a marathon runner to lengthen your life. Even small amounts of physical exercise offer significant life-saving protection, while moderate and intense physical exercise provide only slightly more protection against dying, the study found.

Also, underweight people in this study were found to be at greater risk of dying from any cause than people of healthy weight.

The study is one of the first to examine body weight and physical activity at the same time, and compare their independent effects on the risk of dying.

The researchers examined data on physical activity and body measurements gathered between 1962 and 1965 from more than 9,000 men, aged 35 to 79. The men were ranked according to their activity levels and their body mass index (BMI), which reflects a weight-to-height ratio.

The study found the men in the lowest activity category had twice the risk of dying as men in the second-lowest activity category. The men in the lowest category had 38 percent more heart disease-related deaths than the men in the second-lowest activity category.

Men in the highest activity category lived the longest, regardless of their weight.

The study found that obese men (a BMI of 30 or more) had 33.6 percent more heart disease deaths than men with healthy weight. Overweight men (a BMI of 25 to 29.9) had 7 percent more heart disease deaths than those with healthy weight.

More information

The U.S. National Institutes of Health (news - web sites) has more about the health benefits of exercise.

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Many Jailed Adolescents Have Mental Disorders

By Charnicia E. Huggins

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - Psychiatric problems, such as substance use disorders and depression, appear to be common among youth serving time in juvenile detention centers, according to new study findings.

Mental health professionals have long speculated that many adolescents with mental health problems are being arrested instead of being treated, lead study author Dr. Linda A. Teplin of Northwestern University in Chicago, Illinois told Reuters Health. These findings do not prove that to be true, she said, but they do show the "tremendous burden that is placed on the juvenile justice system."

Teplin and her colleagues investigated the prevalence of psychiatric disorders in a study of 1,829 randomly selected African-American, white and Hispanic adolescents aged 10 to 18 who were being held in Illinois juvenile detention centers.

According to previous studies, nearly 60% of the more than 106,000 youth that are detained in juvenile facilities on an average day are African-American or Hispanic.

Almost two out of every three male detainees and three out of every four females met the criteria for a diagnosis of one or more psychiatric disorders, the investigators report in the December issue of Archives of General Psychiatry.

This prevalence of psychiatric disorders remained high even when conduct disorders, which are common among detained youth, were taken into consideration, the researchers note. Excluding those disorders, nearly 6 in 10 males and more than two out every three females still met the criteria for a diagnosis of one or more psychiatric disorders.

Half of the adolescent males and nearly as many of their female peers had a substance use disorder, characterized by substance abuse or dependence, and more than 4 in 10 youth had symptoms strongly suggestive of a disruptive behavior disorder, the report indicates. Many of the youth also had affective disorders, such as depression, which was identified among more than 20% of the females.

Despite these findings, it is not known whether the disorders caused the delinquency, made the youth more likely to be arrested and detained, or were just something common among the youth, the researchers note. Further, they add, the adolescents may have exhibited some of the symptoms in reaction to their detention.

Adolescents are served by a web of public health services including the educational system, childcare system and the primary care health system, Teplin said. "I'm concerned that when these systems fail, kids fall through the crack into the juvenile justice net."

But the juvenile justice system does not have the resources to provide adequate care for the many detained youth with mental health problems, the report indicates. And even if it did, most youth are detained for only about two weeks or so, Teplin said. Thus, the implications of the study findings stretch far beyond the justice system.

"We have to spend the money" to provide the resources that will enable community mental health centers to provide "continuity of care when these kids are released," she said. "If we don't, these kids could be on a lifetime cycle of dysfunction as they age."

The study was primarily supported by grants from the National Institute of Mental Health and the Office of Juvenile Justice and Delinquency. Additional funding was provided by the National Centers for Disease Control and Prevention (news - web sites), the Center for Substance Abuse Prevention, The Robert Wood Johnson Foundation and various other federal agencies and foundations.

Source: Archives of General Psychiatry 2002;59:1133-1143.

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Parkinson's Drug Tied to Heart Valve Problem

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Thursday, December 12, 2002

THURSDAY, Dec. 12 (HealthScoutNews) -- Pergolide, a drug used to ease the tremors of Parkinson's disease (news - web sites), may be responsible for serious heart damage, doctors at the Mayo Clinic report.

While the evidence in the report is based only on three cases treated at the clinic, the doctors say their evidence is enough to recommend that anyone with heart problems not take pergolide, which is sold as Permax and has been used since 1989 to treat the tremors and restless leg syndrome that Parkinson's disease patients suffer.

"Further study is needed to see if this condition is under-recognized or, conversely, so rare that it escapes attention," says Dr. Raul Espinosa, a cardiologist at the Mayo Clinic and one of the authors of the report. But, in the meantime, he and his colleagues write in the report that "pergolide should be discontinued if valvular disease is detected and no other cause identified."

The drug's makers say that it has had a safe record since coming on the market, but that they would consider adding the information when they update the labeling on the package.

In the cases that were treated at the clinic, three older women -- aged 61, 72, and 74 -- had been taking various doses of Permax daily for between three and seven years to treat their Parkinson's disease. At the clinic they were diagnosed with serious valve disease; two had to have valve replacement surgery. None of the three had a prior history of heart disease.

The valve damage was quite exceptional, Espinosa says, the kind only explained by a very limited number of conditions, none of which the women had. So he and his colleagues looked for other causes and found that the women had all been taking pergolide for an extended amount of time.

The doctors knew that pergolide shares characteristics with a number of other drugs that have been associated with valvular heart disease. These drugs, including fen-phen, which is taken for weight loss, are all associated with a heightened stimulation of serotonin receptors, Espinosa says, which he speculates could somehow cause the valve damage.

Dr. Abraham Lieberman, the medical director of the National Parkinson Foundation in Miami, was one of the doctors who studied pergolide in the 1980s, when it was developed.

"There is evidence of pulmonary fibrosis that is associated with pergolide," he says, "but there's a 14-year history of people taking Permax, and why hasn't this showed up sooner?"

"I don't know the answer to that question," Espinosa responds, "except that you have to have a certain element of good fortune and coincidence to even begin to speculate on something like this."

He says that the first patient who was brought in for surgery for valve replacement sparked his and his colleagues' interest because she "had a combination of a particularly unusual appearance of valves combined with a coating of fibrous cartilage material that overlay the valves."

"This presentation is seen with a limited number of conditions, and the changes in the valves suggested only those conditions -- until we realized that the woman was on pergolide," he says.

That finding led them back to their surgical records to see if any other people who had had valve replacement in the previous year had also been taking pergolide. They found one out of 17 patients who had been on the drug. At the same time, a third woman came to the Mayo Clinic with the same diagnosis of valve disease and with a history of taking pergolide for her Parkinson's.

Espinosa says the fact that all the patients were women is not significant -- "with only three patients, it could easily be chance."

He says that further study is needed to find out how common valvular disease is among Parkinson's patients and the possible abnormalities that might occur with pergolide. "What is the risk of valve damage in relation to dosage and the duration of therapy?" he wonders.

"This drug has been on the market since 1989 and over a half million people have been treated. The Mayo Clinic findings are observations at this point, and what one wants to know is what other drugs the patients have been on during their lifetimes," says Mike Coffee, president and chief operating officer for Amarin Corp. in San Francisco, which now manufactures the drug. Pergolide was developed by Eli Lilly and Co.

"The bottom line, however, is that we encourage doctors to check the package inserts, which are updated annually or as needed to reflect new reports, and this new information may very well be added," Coffee says. "Doctors are experienced in this area, and if they believe that patients are at risk for developing side effects or potentially serious consequences, they should evaluate that when initiating treatment."

Parkinson's disease is a progressive neurological disorder resulting from the degeneration of neurons in a region of the brain that controls movement. The degeneration creates a shortage of the brain-signaling chemical known as dopamine, causing the movement impairments that characterize the disease. In the United States, at least 500,000 people are believed to suffer from Parkinson's disease, and about 50,000 new cases are reported annually, according to the National Institute of Neurological Disorders and Stroke.

What To Do

You can visit the Mayo Clinic for information about Parkinson's disease. Some information on the possible causes of Parkinson's can be found at the National Center for Biotechnology Information.

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Pediatricians, Family Docs Treat Kids Differently

By Alison McCook

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - Pediatricians and family physicians appear to adopt different approaches to treating children, according to new study findings based on doctors' responses to imaginary scenarios.

The scenarios were designed so that no one response is correct, study author Dr. Ann K. Boulis of the University of Pennsylvania in Philadelphia told Reuters Health. However, she noted, a pattern clearly emerges: in most cases, family physicians are more likely than pediatricians to use more resources when treating children, such as scheduling extra procedures or visits with a specialist.

Although the reasons behind these differences are not clear, Boulis suggested that they may stem from the fact that family physicians, due to the nature of their jobs, do not get as much experience treating children as do pediatricians. And if you are not up on the recent literature and are unsure how to handle a patient's problem, it's better to be safe than sorry and order more tests and doctors' visits, Boulis said.

"It's much easier, cognitively, to err on the side of action than inaction, if you're uncertain," she noted.

However, she stressed that these results do not suggest that pediatricians treat children better than family practitioners do or vice versa; only that the two types of doctors often have different approaches to treating the same patient.

The differences between the treatment choices of doctors will more likely have implications for cost, not the quality of treatment patients receive, Boulis explained. In that respect, parents have options, she said: ordering more specialists and tests will likely add to the cost of the treatment, but might save time by expediting the child's recovery. "This is really more about non-medical implications," Boulis noted.

Boulis and her co-author, Dr. Judith Long, base their findings on an analysis of responses of a nationally representative sample of 1,735 pediatricians and 1,267 family practitioners to six scenarios. In each story, the patient was a child with a problem that could be treated in multiple, equally correct ways.

Reporting in the December issue of the Archives of Pediatric & Adolescent Medicine, Boulis and Long discovered that family practitioners are more likely than pediatricians to call for a number of additional tests or doctors visits. For instance, family doctors were more likely to recommend drug treatment for a bed wetter, ask a child to come to the office after reports of fever and stuffy nose, and advise an x-ray for a child who had signs of the croup and symptoms such as coughing up phlegm and quick breathing.

In addition, family doctors also tended to refer children to specialists more often than pediatricians did, such as to an allergist for a patient with asthma or allergy, and to an ear, nose, and throat doctor for a patient with recurring ear infection.

However, the pattern was not consistent, for pediatricians were more likely than family physicians to order a test for a potentially deadly blood infection for children with a fever that exceeded 100 degrees Fahrenheit, or 38.3 degrees Celsius.

In an interview, Boulis said she believed these results would be no surprise to the medical community. Doctors who take on different specialties receive different training, she said, and people who choose one specialty over another often have certain qualities that draw them to that specialty, which could also distinguish them from other types of doctors, she added.

Boulis said that in non-urban areas, family physicians often are able to treat an entire family, which is the role they were intended to have. This can be an extremely useful way to provide medical care, she said, for it allows the doctor to get a more holistic picture of a patient's environment. "There should be some benefit of one provider taking care of the entire family," she said.

Source: Archives of Pediatric & Adolescent Medicine 2002;156:1210-1215.

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Warning Signs of Stroke

HealthScoutNews

Thursday, December 12, 2002

(HealthScoutNews) -- Strokes can begin with little warning and can be deadly without quick action. There are medications that can stop a stroke in its tracks, but they need to be taken within three hours of symptoms starting.

According to the University of California, Davis, warning signs of a stroke include:

  • Sudden blurred or decreased vision, possibly only in one eye.
  • Sudden weakness in any part of the body.
  • Difficulty speaking or understanding conversation.
  • Sudden intense headache.

If you experience any of these symptoms, call 911 without delay.

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Green Tea May Protect Against Heart Attack

By Merritt McKinney

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - New research from Japan suggests that drinking green tea every day may be good for the heart. Although people in the study who drank one or more cups of green tea were no less likely to have artery disease than people who did not drink tea, they were much less likely to have a heart attack.

"What we found was that was less prevalent in green tea drinkers, suggesting that regular green tea intake may be playing a protective role against the development of in Japanese," the study's lead author, Dr. Yukihiko Momiyama of the National Defense Medical College in Saitama, told Reuters Health.

Green tea is becoming more and more popular in the US and other Western countries, but the drink is the most common beverage in Japan, according to Momiyama. Heart disease is less common in Japan than in the West, and researchers have been trying to figure out why.

Although there are probably many factors that explain the difference in heart disease rates, some scientists suspect that green tea may boost heart health because it contains high levels of substances called flavonoids. These plant compounds, which are found in a variety of fruits and vegetables as well as in tea and red wine, are thought to boost health in part by combating oxidation, a process in which cell-damaging substances called free radicals accumulate. Oxidative damage can be caused by outside factors, such as cigarette smoking, or by factors on the cellular level. Oxidation is suspected of increasing the risk of heart disease, stroke and several other diseases.

Several studies have found that people who consume lots of flavonoids are less likely to die from coronary artery disease, and another study linked high flavonoid consumption to a reduced risk of heart attack.

In the new study, Momiyama's team did not detect a link between the number of cups of green tea a person drank each day and the risk of coronary artery disease or the severity of artery disease. However, people who drank green tea were less likely to have a heart attack, the authors report in the November 15th issue of the American Journal of Cardiology. In the study, people who drank at least one cup of green tea per day were 42% less likely to have a heart attack than people who did not drink green tea.

The people in the study did not represent a cross-section of the Japanese population. The 393 patients were undergoing a procedure called angiography to see whether they had coronary artery disease. Many of the participants had risk factors for heart and artery disease, including high blood pressure, high cholesterol and diabetes.

Source: American Journal of Cardiology 2002;90:1150-1153.

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Hyped for Hiking

HealthScoutNews

Thursday, December 12, 2002

(HealthScoutNews) -- If you're a hiker, preparing for your treks in advance will help keep you safe.

Aspen Valley Hospital offers these tips:

  • Before setting out, check the weather report.
  • Pack sun protection, regardless of the temperature, and include sunglasses, a hat, sun block, and lip balm.
  • Drink lots of water and eat something every two hours to fuel your muscles.
  • Tape hot spots on your feet before they become blisters.
  • Choose your location or trail according to your experience.
  • Never go alone and let someone at home know where you're headed.

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US Reports Measles Among Adopted Kids from China

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - A small measles outbreak among Chinese children recently adopted by US parents underscores the need to make sure internationally adopted children--and their adoptive families--get up-to-date on their vaccinations, according to US health officials.

Researchers at the Centers for Disease Control and Prevention (news - web sites) (CDC) identified 14 US measles cases in 2001 that were associated with recent adoptions of children from China. Ten were among adopted babies, while the other four were among adoptive mothers, a sibling and a caretaker.

In all but the case of the caretaker, measles infection apparently occurred in China, the CDC reports in the December 13th issue of its Morbidity and Mortality Weekly Report.

Measles is a respiratory disease caused by a virus, with symptoms including rash, fever, cough and a runny nose. In some cases, the infection causes serious complications such as pneumonia or brain inflammation, and is sometimes fatal. However, measles vaccination--given routinely in the US as part of the MMR vaccine--usually provides lifelong immunity against the disease.

This recent CDC investigation began after a baby adopted from a Chinese orphanage was taken to a Texas hospital with measles. Other US families who had recently adopted children from the same orphanage were alerted, as were adoptive families currently in China. Chinese officials also started a vaccination campaign at the implicated orphanage.

Because of the widespread measles immunity in the US, so-called "imported cases" of measles have limited potential to spread. Since 1997, according to the CDC, there have been only a few dozen imported measles cases in any given year--with the bulk occurring among foreign visitors and US residents returning from travel.

Health officials advise that US residents--including adoptive families--verify that they are up-to-date in their vaccinations before international travel, and that internationally adopted children get their needed immunizations soon after arrival in the US.

Source: Morbidity and Mortality Weekly Report 2002;51:1115-1116.

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Stressful Events May Worsen MS Symptoms-Study

By Dana Frisch

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - A new study suggests stressful incidents may trigger symptom flare-ups in multiple sclerosis (MS) patients, adding to the debate on whether mild to moderate levels of stress are protective or harmful to people with MS.

The study followed 23 women, 18 of whom had relapsing-remitting MS, the most common form of the disease, for a year. In this type of MS, symptoms wax and wane. The remaining 5 had secondary progressive MS, in which symptoms worsen over time. The women completed weekly surveys in which they reported any stressful incidents and their MS symptoms.

The study, in the December issue of the journal Psychosomatic Medicine, found that 85% of symptom exacerbations occurred after a stressful event had happened in the previous six weeks. On average, stressful events occurred two weeks before the symptoms worsened, and women were more than 13 times more likely to suffer symptom exacerbations after an increase in the number of potentially stressful life events. Women in the study had 2.6 exacerbations per year, lasting about a month, consistent with the profile of the disease. The study cannot prove that the stress caused the flare-ups, but does add to research in the field.

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, like lupus and rheumatoid arthritis, is believed to be an autoimmune disease, meaning that the immune system turns against the body's own cells.

Lead author Dr. Kurt Ackerman said that stress can influence the immune system and may cause changes that make it even more active, thus worsening damage to nerve cells and producing MS symptoms.

While this study included women only, Ackerman, an assistant professor of psychiatry at the University of Pittsburgh School of Medicine, said that the mechanism is similar in males as well. He noted that this stress-symptom link can be generalized to other autoimmune conditions, such as diabetes, lupus and rheumatoid arthritis.

Ackerman told Reuters Health that there has been controversy on whether mild to moderate levels of stress are protective, as in animals with MS, or harmful. "People have very strong opinions on this," he said. "Many people with MS believe that the disease is triggered by stress and neurologists are split, and so that is why these studies need to be done."

This research should not be construed as blaming MS patients for their disease, said Ackerman. Rather, people should view stress as something that can be controlled by a variety of mechanisms, including relaxation techniques, he said.

According to Ackerman, regardless of whether the association found in this study holds true over the long-term, people "need to handle stressful events as well as possible to keep them healthy." He added that this is important for people without MS as well.

Source: Psychosomatic Medicine 2002;64:916-920.

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Home Visits to Teen Moms Show Mixed Results

Reuters Health

Thursday, December 12, 2002

NEW YORK (Reuters Health) - Home-visit programs in which volunteers help new teen moms cope may have limited success, according to a study in one US city.

Researchers found that weekly home visits from trained volunteers appeared to improve some parenting skills among teen mothers in their study. But the program showed no effect on mothers' stress levels or mental health, according to findings published in the December issue of the Archives of Pediatric and Adolescent Medicine.

"Our findings regarding outcomes are mixed," conclude Dr. Beth Barnet of the University of Maryland School of Medicine in Baltimore and her colleagues.

According to the researchers, although volunteer-based home visitation can help low-income adolescent moms in some ways, such programs are "not a substitute" for other types of support services.

The study looked at a Baltimore home-visitation program in which trained female volunteers teach teenage mothers "nurturing parenting behavior." The researchers followed more than 200 12- to 18-year-old mothers of young infants, most of whom were African American and low-income. About half were randomly assigned to receive home visits.

In interviews conducted when participants entered the study and 15 months later, Barnet's team found that mothers in the program showed improved parenting skills--particularly when it came to their expectations of their children.

However, the program did not appear to ease high stress levels or poor mental health overall, according to the report.

The fact that home visits did not help mothers' distress is "a bit puzzling," the researchers note. They point out, though, that the program's volunteers were all laypeople not equipped to fully address mental health, and that volunteers "faced many challenges," such as the emotional stress of the work.

"Our findings," Barnet and her colleagues write, "highlight the need for programs that include specific methods for identifying depressed teens as well as procedures that to engage them in effective treatment."

Source: Archives of Pediatric and Adolescent Medicine 2002;156:1216-1222.

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Public to Get Data on Hospital Quality

By Todd Zwillich

Reuters Health

Thursday, December 12, 2002

WASHINGTON (Reuters Health) - The federal government will soon begin publishing limited information on the quality of medical care in US hospitals in an effort to help consumers screen the facilities, hospital groups and Bush Administration officials announced Thursday.

The data, expected to be published in early summer 2003, focuses on basic standards of care and will tell consumers little about patient outcomes such as how effectively a hospital treats strokes or how well it avoids prescribing errors.

But officials said that the move was important because it would lay the groundwork for a standardized, nationwide reporting system on hospital quality that is now nonexistent.

"This is only a first step and a lot more needs to be done," said Dick Davidson, president of the American Hospital Association.

Under the voluntary plan, the US Department of Health and Human Services (news - web sites) will collect and post data on how hospitals treat patients with heart attacks, heart failure and pneumonia.

The data will not focus on survival rates but on how well hospitals follow 10 basic points of care for patients with the three illnesses. For example, HHS will report on how often aspirin, a blood-thinning medication, is given to patients suffering from heart attacks.

It will also report on whether heart failure patients get an assessment of their heart functioning and whether pneumonia patients receive antibiotics in a timely fashion.

The information will be posted on the Web site of the Centers for Medicare and Medicaid Services (CMS), the HHS agency that regulates hospitals, officials said.

Most hospitals already collect such data and report it to the Joint Commission on Accreditation of Healthcare Organizations, a private group that certifies US hospitals. Under the new plan, hospitals will voluntarily allow the commission to report the data to CMS.

"We intend to make it known who is participating with this process and who is not," said Dr. Dennis O'Leary, the commission's president.

Hospitals have historically resisted efforts to make standardized quality information available to the public. A 1986 effort by CMS (then called the Health Care Financing Administration) to collect and distribute data on death rates from disease at different hospitals was met with opposition from many groups.

Federal health officials said Thursday that their initial program would lay groundwork so that they can build more quality measures into the reporting system.

"We have to develop an infrastructure. It's a lot easier to do with the hospitals going in the same direction," said CMS administrator Thomas Scully.

Two large groups representing consumers lent their support to the plan, saying it was an important first step but that it did not go far enough in guaranteeing consumers useful information about the performance of hospitals.

"Consumers want to know who is getting well and who's not at what institution," said John Rother, a lobbyist for the AARP. The 10 measures "are not responsive to what consumers usually ask," he said.

Gerry Shea, the chief policy advisor for AFL-CIO labor union, called the project a good beginning.

"Some of us would prefer a more complete and immediate thing," he said. "A year from now, how many measures are we going to have?"

The 10 performance measures were taken from 31 developed by the National Quality Forum, a group of hospitals, insurers and healthcare consumer groups. Eventually the program is intended to grow to include more of the remaining 21 measures, officials said.

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WEDNESDAY, DECEMBER 11, 2002 

Allergy Drug Claritin Hits Store Shelves

 

The Associated Press

Wednesday, December 11, 2002

KENILWORTH, N.J. (AP) - The allergy drug Claritin is now available in stores nationwide without a prescription, manufacturer Schering-Plough Corp. said Tuesday.

The popular nonsedating antihistamine, available in the same strengths as the prescription version, will cost less over the counter for people without insurance, but more for those with prescription drug coverage.

Ten-milligram tablets are selling for 90 cents to $1.35 each, based on an initial survey of retail outlets, Schering-Plough said. That equates to $27 to $40.50 for a 30-day supply — more expensive than the $5 to $10 copayment for many patients with a prescription plan.

Nonprescription Claritin, the first nonsedating antihistamine on the market without a doctor's prescription in this country, is being sold in three once-a-day formulations, a twice-a-day formulation and a syrup for children as young as two years old.

Schering-Plough initially fought the health insurance industry's push to switch the drug to non-prescription status; Claritin accounts for one-third of the Kenilworth company's roughly $9 billion in annual revenues. Faced with expiration of Claritin's main patent this month and the prospect of both generic and nonprescription competition, Schering-Plough backed down.

The switch could result in prescription plans refusing to cover other prescription-only antihistamines, such as Allegra, Zyrtec and Clarinex, Schering-Plough's successor drug to Claritin, or charging patients much higher copayments for those medicines.

On the Net: http://www.sgp.com

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Chickenpox Vaccine Doesn't Ensure Protection

 

Reuters Health

Wednesday, December 11, 2002

NEW YORK (Reuters Health) - An outbreak of chickenpox among a group of children in New Hampshire shows that the virus that causes chickenpox can be highly infectious even among those who have been vaccinated, according to a new report.

Dr. Karin Galil of the Centers for Disease Control and Prevention (news - web sites) in Atlanta, Georgia and colleagues report their findings in the December 12th issue of The New England Journal of Medicine (news - web sites).

The researchers evaluated an outbreak of chickenpox, which is caused by the varicella virus, at a daycare center in New Hampshire. A total of 88 parents returned a questionnaire that aimed to gauge prior chickenpox illness and vaccination among the children. In all, 25 children came down with chickenpox between December 2000 and January 2001. The researchers sourced the outbreak to a 4-year-old child who had been vaccinated for chickenpox 3 years prior to contracting the illness.

The child infected about half of his classmates who had no prior history of chickenpox infection. At the time of the outbreak, roughly 73% of kids old enough for chickenpox vaccine had received it, the report indicates.

"The effectiveness of the vaccine was 44% against disease of any severity and 86% against moderate or severe disease," write Galil and colleagues. Experts have estimated that the chickenpox vaccine is between 71% to 100% effective at preventing varicella infection.

Children who had been vaccinated 3 years or more before the outbreak were at greater risk of vaccination failure than those who had been vaccinated more recently, they add.

On the surface it appears that immunity against chickenpox weakened as time passed after vaccination. However, the authors note that "the reasons for the poor performance of the vaccine are not apparent.

"Although policy cannot be established on the basis of one outbreak, the findings in this investigation raise concern that the current vaccination strategy may not protect all children adequately," the authors write.

Nonetheless, the investigators point out that the illness is much less of a threat today than it was before the era of chickenpox vaccination, when there were roughly 11,000 hospitalizations and 100 deaths from the disease annually.

"Vaccination remains the most effective strategy for protecting children and adults against illness and death due to varicella," Galil and colleagues conclude.

Current guidelines call for one dose of chickenpox vaccine for children between the ages of 1 and 12 years and two doses of vaccine for people over 13.

"It has long been known...that 'breakthrough' varicella may nevertheless develop in 10 to 15 percent of vaccinated persons," Dr. Anne A. Gershon of Columbia University in New York City writes in an accompanying editorial.

Gershon suggests that a second dose of chickenpox vaccine "should decrease the number of children who have...vaccine failure and might also prevent waning immunity, if it does indeed currently occur."

What's more, Gershon points out that it eventually took the routine administration of two doses of measles vaccine to control measles in the US.

"The time for exploring the possibility of routinely administering two doses of varicella vaccine to children seems to have arrived," Gershon concludes.

Source: The New England Journal of Medicine 2002;347:1909-1915, 1962-1963.

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Poll: Two of Three Want Smallpox Vaccine

By Laura Meckler

Associated Press Writer

The Associated Press

Wednesday, December 11, 2002

WASHINGTON (AP) - Two of every three people in the United States are willing to be vaccinated against smallpox, a disease feared as a possible agent of bioterrorism, a poll released Wednesday finds.

The survey also found about six in 10 are worried that smallpox, wiped from the globe more than 20 years ago, will return in an act of bioterror.

People most trust their own doctors to give them correct information about how to protect themselves from disease caused by bioterrorism — although most regular doctors know little about smallpox and other rare diseases likely to result from an attack.

The question about getting the smallpox vaccine was asked after a series of questions about the threat of bioterrorism, so people being surveyed may have been thinking more about the threats than about the risks of the vaccine.

Also, people were not given details about the vaccine's risks: Fifteen of every million people being vaccinated for the first time will face life-threatening complications, and one or two will die.

People are significantly less likely to trust government agencies and officials for information, suggesting the government has a big job ahead of itself to educate doctors, who can then pass the information to their patients.

"Information about diagnosing and treating diseases used in bioterrorism needs to get to the front lines of the health system — doctors," said the report commissioned by the Robert Wood Johnson Foundation.

Among government officials, the most trusted is the head of the Centers for Disease Control and Prevention (news - web sites).

Overall, most of the public believes the nation is somewhat better prepared to handle a biological or chemical attack than it was last year, when anthrax was sent through the mail, though only a handful say the country is very well prepared.

Pollster Michael Perry noted that smallpox has received increased attention in the media as President Bush (news - web sites) nears a decision about offering the smallpox vaccine to the public for the first time in three decades.

"A growing number of people have moved from being uninformed about the disease and the vaccine to a state of heightened concern about the possibility of a smallpox attack," Perry said.

On smallpox, the poll found that 65 percent of people are willing to be vaccinated, although it "may produce serious side effects in a small number of cases." Twenty-two percent said they would not get the vaccine, and 14 percent said they didn't know.

The telephone poll of 1,002 adults was conducted Oct. 20-30. It has a margin of error of plus or minus 3 percentage points.

http://ww2.rwjf.org/index.jsp

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Study: More Chemo Helps Herceptin Fight Cancer

 

By Deena Beasley

Reuters

Wednesday, December 11, 2002

LOS ANGELES (Reuters) - The addition of a second chemotherapy drug to a regimen of breast cancer (news - web sites) drug Herceptin and chemotherapy nearly doubles the time it takes for the disease to worsen, researchers said on Wednesday.

Herceptin, made by Genentech Inc., is a bioengineered antibody designed to work by blocking a cell receptor active in about 25% of breast cancer tumors.

The Phase III study, the preliminary results of which were presented at the San Antonio Breast Cancer Symposium, included 194 advanced breast cancer patients found to "express" the protein targeted by the drug.

The study compared use of the standard combination of Herceptin and paclitaxel, the generic form of Bristol-Myers Squibb Co.'s Taxol, to treatment with the standard combination plus carboplatin--another Bristol-Myers chemotherapy commonly used to treat other forms of cancer, including lung and ovarian cancers.

Results show that the addition of carboplatin to Herceptin and paclitaxel resulted in a six-month improvement in the time it took for the disease to progress, compared to the standard Herceptin and paclitaxel regimen.

"This is important because patients with HER2-positive breast cancer have an aggressive form of the disease that is associated with more rapid cancer progression and shortened survival," Dr. Gwen Fyfe, Genentech's vice president of oncology, medical affairs, said in a statement.

The study found median survival in the Herceptin and paclitaxel arm was 33.5 months, while the group receiving the tripartite therapy had yet to reach that point after 36 months of follow-up.

Researchers reported that the patients receiving the three-drug regimen were more likely to see a drop in infection-fighting white blood cell counts and blood platelets than the group receiving Herceptin and paclitaxel.

There was one case of cardiac dysfunction in the Herceptin/paclitaxel arm, Genentech said.

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FDA Says It Will Stop Misleading Drug Ads

By Lauran Neergaard

AP Medical Writer

The Associated Press

Wednesday, December 11, 2002

WASHINGTON (AP) - The new chief of the powerful Food and Drug Administration (news - web sites) promised faster action Wednesday to stop drug advertisements that mislead patients into thinking a medication is better or safer than it really is.

Expect more aggressive action against makers of dietary supplements that make unproven health claims, too, said FDA Commissioner Mark McClellan.

But McClellan will have to make a big change, said a consumer advocate who tallied FDA's attempts to stop untruthful drug ads — and found warning letters to the offending manufacturers have dropped by almost two-thirds in the last year alone.

"The bottom line is they're not doing enforcement," said Dr. Sidney Wolfe of the advocacy group Public Citizen. Misleading advertising "can make the difference between someone getting the right drug and the wrong drug. ... It's a health and safety issue."

The FDA is responsible for ensuring that the $2.7 billion worth of drug ads aimed at patients each year are fair and accurate. But critics argue that ads too often make the pills seem a panacea while downplaying side effects. Just last week, congressional investigators said misleading ads often are off the air by the time FDA gets around to chastising their makers.

One reason: A Bush administration policy change this year that required FDA's chief counsel to review every warning letter before it's mailed to drug companies.

So far this year, the FDA has issued only 27 letters ordering drug companies to stop a misleading ad, down from 73 such warnings last year and a high of 157 in 1998, Wolfe said.

This year's policy change "had a chilling effect" on an already weakening regulatatory process, Wolfe said. "If you're one of these companies, you can't help but notice."

McClellan, a physician-economist and longtime adviser to President Bush (news - web sites) on health policy, said drug ads in general can be helpful if they make people aware of treatments for an ailment they've been suffering in silence.

The warning letter review was an attempt to strengthen FDA's legal hand, and while it initially caused delays, the chief counsel hasn't blocked any attempt to stop a misleading ad, McClellan said Wednesday during his first meeting with reporters since becoming commissioner last month.

"Let me be clear," he said. "We are not backing off on our policy of enforcing the law here. ... We will not be afraid to go to court if necessary."

Another problem is repeat offenders. Last week's congressional report cited as an example Pfizer's cholesterol-lowering drug Lipitor (news - web sites). Four times over the last four years, the FDA cited Lipitor ads for giving the wrong impression that it can reduce heart disease and falsely claiming it's safer than competing drugs.

For repeat offenders, "issuing warning letters is not enough," McClellan stressed. "We will not be afraid to go further in cases of recurrent patterns of abuse."

But he wouldn't detail what additional steps FDA might take. Wolfe called the options unclear, saying FDA can't even fine companies over ads.

Misleading ads are "exceptions to the rule" that FDA should target, said Jeff Trewhitt of the industry's Pharmaceutical Research and Manufacturers Association.

Truthful advertising is one piece of what McClellan called a top priority for his tenure at FDA: getting more information to consumers to help them understand the health consequences, good or bad, of the products they choose.

Aside from drug ads, makers of dietary supplements — which sell with little federal oversight to ensure they're safe or work — frequently make scientifically unproven claims about their products' benefits.

"We should take more aggressive action" to stop that, McClellan said. "You can expect to see more from FDA on this issue."

His other priorities: Improving patient safety, and anti-terrorism work that includes strengthening the security of the food supply and working to bring antidotes for biological, chemical or radiation attacks to market.

On the Net: http://www.fda.gov

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Three Gene Variations May Have Heart Attack Link 

By Alison McCook

Reuters Health

Wednesday, December 11, 2002

NEW YORK (Reuters Health) - By testing thousands of patients for minor genetic variations in a pool of more than 70 candidate genes, Japanese researchers have found three gene variations--one in men and two in women--that seem to increase the risk of heart attack.

However, because heart disease is a complex condition caused by numerous genes and environmental factors, the three gene variants are unlikely to be used to determine heart attack risk in patients any time soon, according to researchers not involved with the study.

In the study, Dr. Yoshiji Yamada of the Gifu International Institute of Biotechnology in Mitake, Japan, and colleagues discovered that male heart attack patients were more likely than other men to carry the C1019T form of the connexin 37 gene.

That genetic form was not linked to heart attack risk in women, but others were: namely, the 4G-668/5G form of a gene involved in the body's ability to dismantle blood clots, and the 5A-1171/6A form of the gene implicated in the breakdown of the network of material that surrounds cells.

Yamada and colleagues made the discovery after looking at 112 different variations in 71 candidate genes. After testing 2,819 heart attack patients and 2,242 people who had not suffered heart attacks, they selected 19 variations in men and 18 in women for further testing. These gene variants were then examined in an additional 4,152 patients, all of whom lived in Japan.

The authors present their findings in the December 12 issue of The New England Journal of Medicine (news - web sites).

Study author Dr. Mitsuhiro Yokota of Nagoya University in Japan told Reuters Health that, one day, patients who discover they have the genetic changes linked to high heart attack risk might be more strongly encouraged to take steps to try to reduce other risk factors. These include diabetes, smoking, high cholesterol and blood pressure, Yokota noted. The patient's "doctor will recommend for him to improve his daily life and give medications, if necessary," the researcher said.

Why the results suggest different genetic patterns predict heart attack risk in men and women is not clear, Yokota said.

More study is needed to confirm the findings, according to an editorial by Drs. Ron J.G. Peters and S. Matthijs Boekholdt of the Academic Medical Center in Amsterdam, the Netherlands.

"The findings are interesting and potentially important," they write. However, the study "also demonstrates the pitfalls" of such research.

They note that the study did not pick up other gene variants previously thought to be linked to heart attack risk. What's more, the patients used as a comparison group were selected from patients visiting a clinic and had at least one heart attack risk factor on their own.

"Advice to individual patients or recommendations for primary prevention cannot be based on these findings at present," they conclude.

Source: The New England Journal of Medicine 2002;347:1916-1923.

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Leg Amputation, Reconstruction Studied

By Janet McConnaughey

Associated Press Writer

The Associated Press

Wednesday, December 11, 2002 

People whose mangled legs were reassembled by doctors had about the same amount of disability and distress two years later as those who had amputations, a study found.

Dr. Michael J. Bosse, lead author of the study, said the results convinced him a rigorous series of operations is worthwhile for most patients.

"If we can, we should reconstruct," said Bosse, whose report is in Thursday's New England Journal of Medicine (news - web sites).

Other doctors said the results, though not a surprise, will help them convince patients that they may be as well off with a quick amputation as with years of reconstructive surgery.

Reconstruction often requires more operations and longer hospital stays, and risks more complications, then amputation.

Bosse, a surgeon at Carolinas Medical Center in Charlotte, N.C., expected the study to show amputees recover faster than surgical patients.

What he found was that both groups had equally severe disabilities, pain and emotional problems. Only about half of each group had been able to return to work.

Bosse and his colleagues tracked 545 patients whose foot or leg injuries put them at high risk for amputation. Of those, 149 had a foot or leg amputated during their first hospitalization, another 25 started reconstruction but later underwent amputation and the rest were reconstructed.

While they were in the hospital and periodically for two years afterward, the patients took a survey on the impact of their ailment. Most people score a 2 or 3; a score of 10 or above indicates severe disability and differences of two or three points are significant.

After two years, the 330 patients whose legs were rebuilt had an average score of 11.8; the 130 amputees averaged 12.6.

Drs. Randy Sherman of the University of Southern California and John Hunt of New Orleans' Charity Hospital said the results were about what they would have expected.

Doctors make many unsuccessful attempts to repair legs because people cannot believe that losing a limb might be better than keeping it, Sherman said.

He said doctors who read this study may get "more backing to be bolder in their recommendations to patients that amputation is a real possibility."

It is hard to tell which patients will do best with reconstruction, partly because will and attitude are so important, Hunt said.

Besides motivation, other factors unrelated to the injury and medical care — for instance, education, race, whether patients smoked and whether they had support from family and friends — also had a major effect on recovery.

Bosse said the patients in his study were followed for five to six years and the analysis of those results is just beginning, along with an economic analysis.

If the two-year results hold true at five and six years, he said, the higher cost of reconstructive surgery may turn out to be a savings over the cost of replacing $5,000 to $15,000 prostheses every two to five years.

On the Net:

Journal: http://content.nejm.org

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Music Soothes Lung Patients, Promotes Exercise

 

Reuters Health

Wednesday, December 11, 2002

NEW YORK (Reuters Health) - Getting an earful of music can motivate patients with severe lung disease to go the extra mile--make that four extra miles--while exercising to improve their health, according to a new report.

"Music could help distract people with serious lung disease from certain negative physical symptoms," lead author Dr. Gerene S. Bauldoff of the University of Pittsburgh School of Nursing in Pennsylvania said in a prepared statement.

In the current study, Bauldoff and colleagues evaluated 24 people with moderate to severe chronic obstructive pulmonary disease (COPD). The aim of the study, published in a recent issue of the journal Chest, was to see if listening to music while exercising had any positive effect on patients' exercise stamina.

COPD includes the lung disease emphysema and chronic bronchitis, and is marked by progressively worsening shortness of breath and coughing. The disease is currently the fourth leading cause of death in the world, after heart disease, cancer and stroke.

Previous research has found that regular exercise helps patients with COPD, the authors note. However, because exercising with COPD requires considerable effort, researchers are constantly looking for new ways to motivate patients and improve exercise levels.

According to the report, half of the patients were required to walk at their own pace for 20 to 45 minutes while they listened to music through headphones. The other group received the same instructions but did not listen to music.

The investigators monitored breathing ability during daily living and a 6-minute walk, as well as symptoms of depression, anxiety and quality of life.

After 8 weeks of therapy, there was a significant decrease in perceived breathing difficulties and an increase in the amount of distance covered during a 6-minute walking test among those who listened to music compared with those who heard no music.

Music listeners walked an average of 19.1 miles over the course of the study period, while those who didn't listen to music walked an average of 15.4 miles--or 24% less.

"The positive effects of increased exercise spilled over into other areas of the participants' lives--they were better able to handle routine daily activities and, in turn, retain a good degree of independence," said Bauldoff.

"A person with lung disease can develop symptoms so severe that she abandons daily routine activities...(and) becomes disabled," added Bauldoff. "But if that can be reversed first with a rehabilitation program, and followed up with an individual exercise program that includes music, she could very well retain her independence."

Source: Chest 2002;122:948-954.

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Teething Timetable

 

HealthScoutNews

Wednesday, December 11, 2002

(HealthScoutNews) -- When babies grow new teeth, the infants usually become overly cranky. So at what age can you expect this behavior? Well, there are 20 primary teeth -- 10 on top and 10 on the bottom -- and they come in at different ages for different kids. The St. Louis Children's Hospital has outlined a typical pattern of appearance:

  • Central incisors (upper and lower front teeth): 5-8 months
  • Lateral incisors (next to front teeth): 7-10 months
  • First molars: 12-16 months
  • Cuspids (eye teeth): 14-20 months
  • Second molars: 20-32 months

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US Women Waiting Longer to Become Moms

 

By Dana Frisch

Reuters Health

Wednesday, December 11, 2002

NEW YORK (Reuters Health) - US women, on average, are having their first child at about age 25, almost 3 years later than the 1970 average for first-time moms, according to a study released Wednesday by the Centers for Disease Control and Prevention (news - web sites) (CDC).

The trend reflects a decline in the number of births to teenage mothers and the growing number of women having their first child in their 30s and 40s. Education and career opportunities, as well as improved contraception, times of relative prosperity, social support and marriage patterns are other factors that may contribute to women choosing to delay the age at which they have their first child, according to the report.

Lead author T.J. Mathews, a demographer with the National Center for Health Statistics, told Reuters Health that this trend was "not unexpected." This study was the first to look at ethnic and geographic differences within the US, he noted, adding that there has been "huge public interest" in motherhood-age trends.

Data compiled from birth certificates confirmed that the trend persisted across the nation and across all ethnic groups, though there was variation. Massachusetts, for example, showed the oldest average age for first-time mothers in 2000, almost 28 years, compared with Mississippi, in which first-time motherhood occurred on average at 22.5 years.

Mathews said that the ethnic make-up of the state and overall number of teenage births might account for the discrepancies seen among states.

Different ethnic populations also showed variation in the age of first-time motherhood. For example, the average age of first birth for non-Hispanic black women was 22.3 years, whereas Japanese-American or Chinese-American women had their first child at age 30.

Mathews pointed out that this discrepancy again might reflect a higher teenage pregnancy rate among certain populations, as well as the overall numbers of women of childbearing age in the state.

Waiting until later in life to have children is a well-documented trend among women in developed countries. In Switzerland, for example, the average age at which woman had her first child was 29.

According to Mathews, older women--as well as very young women--are at higher risk of complications during pregnancy and birth, and an increase in such complications might be one implication of the trend for US women to give birth later in life.

For more information see www.cdc.gov/nchs.

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Swimmer's Ear

HealthScoutNews

Wednesday, December 11, 2002

(HealthScoutNews) -- Swimmer's Ear is caused when contaminated water gets into the ear. The resulting infection can be extremely itchy and painful, so knowing how to prevent it may save you a lot of misery.

The U.S. Centers for Disease Control and Prevention (news - web sites) offers these healthy swimming tips:

  • Dry your ears after swimming.
  • Ask the person who oversees the pool about the chlorine and pH-testing program. Pools and hot tubs with good chlorine and pH control are unlikely to spread Swimmer's Ear.
  • Don't swim in locations that have been closed because of pollution.
  • Avoid putting objects in you ear (fingers, cotton swabs) that may scratch the ear canal and provide a site for infection.

If you think you have Swimmer's Ear, speak to your doctor. You can treat the infection with antibiotic drops.

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Epilepsy May Worsen in Some Women Taking Estrogen

 

Reuters Health

Wednesday, December 11, 2002

SEATTLE (Reuters Health) - Some women with epilepsy report that estrogen-containing compounds, such as oral contraceptives and hormone replacement therapy, seem to make their seizures worse, according to the results of two studies reported here this week at the American Epilepsy Society's 56th Annual Meeting.

The results suggest that estrogen was implicated, although it is not conclusive, study author Pavel Klein of Georgetown University Hospital in Washington, DC, told Reuters Health.

"But if a doctor has a patient with epilepsy, it is worth inquiring whether the epilepsy has been sensitive to hormones. And if that is the case, then it may be worthwhile to be somewhat cautious about using estrogen-containing oral contraceptives," he said.

In the first study, the researchers evaluated 142 women with epilepsy between the ages of 14 to 55. Roughly half of the women had never used oral contraceptives. Among those who did, the duration of usage ranged from 2 months to 14 years.

"Approximately 20% of women had worsening of seizures when using estrogen-containing contraceptives," Klein said. "But the study couldn't pinpoint a specific type of estrogen because too many types were used to get any meaningful statistical analysis."

Of the women who had used the Pill in the past, 22% did not remember the type or brand of contraceptive they had used. But 21% of those who used birth control pills containing estrogen said that their seizures had worsened.

"Another interesting point of the study was that women who used long-term progesterone contraceptive methods, either injectable such as Depo-Provera or implantable like Norplant, did not have worsening of their seizures," explained Klein.

"It may be wise to exercise a little more caution, and to think about using the Depo-Provera," he added.

In the second study, Klein reported on two women with a history of seizures who experienced more seizures after they started using estrogen replacement therapy to treat menopausal symptoms.

Conclusions can't be drawn from these two isolated cases, he said, but as with oral contraceptives, it may be worthwhile to be more cautious about using hormone replacement therapy if a patient has seizures that are susceptible to hormones.

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Genetic Test Measures Toughness of Breast Cancer

 

HealthScoutNews

Wednesday, December 11, 2002

WEDNESDAY, Dec. 11 (HealthScoutNews) -- Duke Comprehensive Cancer Center researchers are leading a national clinical trial of a new genetic test that can identify drug resistance in breast cancer (news - web sites) tumors.

The technique, called gene expression profiling, subtypes each breast cancer tumor by its genetic defects, letting doctors tailor treatment to specific tumors. That could spare millions of women from receiving unnecessary chemotherapy.

Currently, there is no predictive model to help doctors determine which women with breast cancer will or will not respond to hormonal therapies. So, chemotherapy is prescribed as a backup measure against the cancer.

It's estimated that up to 50 percent of women with breast cancer needlessly receive chemotherapy.

The new gene expression profiling technique uses a commercially available gene chip to create a genetic "fingerprint" of a tumor. This information lets doctors categorize each tumor by its genetic defects, and to predict whether standard hormonal therapies alone will work against the tumor or whether chemotherapy will also be necessary.

The study design will be presented at the 25th annual San Antonio Breast Cancer Symposium this week. The national multi-center study will include 140 women.

Researchers will take samples of the women's breast cancer tumors. They will then receive the estrogen-depriving drug letrozole before they have surgery. Letrozole reduces production of estrogen, which fuels the growth of up to 80 percent of all breast cancers.

However, some tumors don't respond to hormonal therapies and some tumors that initially respond to hormonal therapies later become resistant.

To better understand that, the researchers will use gene expression profiling to measure changes in 16,000 genes as they respond or don't respond to letrozole.

More information

The National Cancer Institute (news - web sites) has more about breast cancer treatments.

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HIV Trick Helps Explain Failed Vaccine Attempts

 

By Amy Norton

Reuters Health

Wednesday, December 11, 2002

NEW YORK (Reuters Health) - Scientists have discovered a new way by which HIV (news - web sites) skirts the body's immune response, helping to explain why it's been so hard to develop a broadly effective AIDS (news - web sites) vaccine.

The finding adds the "final piece to the puzzle" of how HIV eludes the immune system's infection-fighting antibodies, even though they are churned out in large numbers when the virus invades, the study's lead author told Reuters Health.

"All these antibodies are generated, but virtually none neutralizes the virus," said Dr. Peter D. Kwong, a vaccine researcher at the US National Institute of Allergy and Infectious Diseases (news - web sites) in Bethesda, Maryland.

And while scientists have learned a great deal in recent years about HIV's ability to evade the body's defenses, a big question has been precisely how a key protein on the HIV surface, called gp120, escapes being neutralized by antibodies.

Gp120 plays a vital role in getting HIV into the cells it targets for infection. But the protein also offers "large," exposed binding sites for neutralizing antibodies to latch onto, Kwong explained. So the question has been why these antibodies--whether unleashed from the natural immune response, or elicited by a vaccine--largely fail to neutralize HIV.

In the new study, reported in the December 12th issue of Nature, Kwong and his colleagues looked at the interaction between the gp120 molecule and a number of antibodies. They found that, in the face of nearly all the antibodies, an "energetic barrier" was set up around the gp120 receptor sites.

"The barrier's set up in a very specific way to prevent neutralization," Kwong said.

He explained that antibodies, which basically "float around" in the body, only bind one at a time to the gp120 receptor sites on HIV. In contrast, the immune system cells that HIV infects have multiple sites that simultaneously bind to the gp120 receptors. So it appears that HIV is set up to have a barrier against interaction with antibodies, but not with its target cells.

Because of gp120's role in HIV infection, many experimental HIV vaccines have been based on the premise of generating neutralizing antibodies against the protein. This study should spark efforts already under way to refine gp120-based HIV vaccines, according to an accompanying commentary by Theodore Jardetzky of Northwestern University in Evanston, Illinois.

And, Kwong noted, researchers are also developing HIV vaccines that focus on immune system components other than the antibody arm.

Source: Nature 2002;420:623-624, 678-681.

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Walking Recommended for Those With PAD

WEDNESDAY, Dec. 11 (HealthScoutNews) -- "Walk off the pain" is a common expression in sports when someone receives a minor injury. It can also be applied to people with peripheral arterial disease (PAD).

Scientists at Johns Hopkins Medical Institutions say a supervised walking exercise program is an effective remedy for people with PAD who suffer cramping leg pain. Their report appears in tomorrow's issue of The New England Journal of Medicine (news - web sites).

Cramping leg pain is the most common symptom of PAD, which affects 8 million to 10 million American adults and 5 percent of people aged 50 and older. PAD is a form of atherosclerosis that affects blood vessels in the legs.

Cholesterol-laden plaque builds up in the blood vessels and reduces blood flow to the legs. That limited blood flow can't meet the demand from legs when a person with PAD is walking or exercising, and that shortfall results in pain, aching and fatigue in the legs.

The researchers reviewed more than 120 studies and concluded that people with PAD should walk until they reach a moderate level of pain and then continue walking for several minutes after that. They should rest and then resume walking. The cycle should be repeated until the person can walk for 50 minutes.

A supervised exercise program where the person with PAD walks on a treadmill several times a week may be the best way to lessen PAD-related leg pain.

More information

The University of Michigan Health System has more about peripheral arterial disease.

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Generic Drugs Not Always a Bargain for Medicaid

 

By Karen Pallarito

Reuters Health

Wednesday, December 11, 2002

NEW YORK (Reuters Health) - Contrary to popular belief, generic drugs aren't always the biggest bargain around. In some instances, the generic version of a prescription medication is costing state Medicaid programs more than various brand-name alternatives.

That's the odd result of Medicaid drug-discounting arrangements that are ratcheting down states' costs for prescription medications--sometimes below that of corresponding generics.

When a generic is priced at a premium to branded alternatives on a state's preferred drug list, filling with the generic can end up costing the state several million a year, according to Terry Taylor, president of Provider Synergies, a pharmacy benefits administrator that works with state Medicaid programs.

"There are some pretty glaring instances where the generic product could actually be more expensive than the branded product," he told Reuters Health.

The recent introduction of generic omeprazole, the active ingredient in AstraZeneca's heartburn treatment Prilosec, is one example.

At current pricing, generic omeprazole is more expensive for some Medicaid programs than brand-name heartburn-drug alternatives after rebates, Taylor said. Cheaper alternatives include TAP Pharmaceuticals' Prevacid (lansoprazole), Wyeth-Ayerst's Protonix (delayed release pantoprazole sodium), Eisai Co. Ltd.'s Aciphex (rabeprazole sodium), and AstraZeneca's own Nexium (esomeprazole).

The same quirky economics may be at play among the nonsteroidal anti-inflammatory drugs, he added.

"Coming from a managed care commercial environment and working there for several years, you just assume that generics are always going to be less expensive than the alternatives," said Taylor, whose company administers supplement rebate programs for Florida, Illinois, Louisiana and West Virginia.

On Friday, Taylor warned an association of state legislators that the once hard-and-fast rule of generics always being less pricey than brands may not hold true in the current environment. In states that enjoy a combination of federally mandated Medicaid rebates and state-negotiated supplemental rebates, the rule is being shattered in some cases.

"We have cases, I know, where the rebates drive the brand down to very close to the generic," said Jim Parker, Illinois Medicaid's deputy administrator of medical programs.

He said the issue arises for classes in which drugs are priced particularly high and then significantly rebated, reducing the net price for the brand to less than or close to the price of the generic.

In recent days, Illinois Medicaid officials have been discussing what to do about generic Prilosec. At a price of $57 for a 30-day supply, it is clearly less expensive than brand-name proton pump inhibitors, which can run from $80 to $120, Parker said. Yet Illinois Medicaid gets its two preferred drugs--Prevacid and Aciphex--"at a price that is far below the $57" after rebates, he noted.

Florida Medicaid officials are also reviewing omeprazole and may impose reimbursement restrictions to ensure that Medicaid's cost for generic Prilosec is no higher than the net cost for branded products.

The state took similar action about 3 years ago when the tranquilizer lorazepam came in at a higher net cost than the branded product Ativan, according to state pharmacy officials. Florida avoided more than $3 million in costs by placing a "maximum allowable charge" on the generic, they noted.

Provider Synergies is working with Medicaid officials in several states to identify costly generics and remedy pricing anomalies. Taylor declined to elaborate on potential fixes. "It would be premature to say, 'This is how to do it,"' he said.

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Video Game-Triggered Seizures Can Be Reduced

 

Reuters Health

Wednesday, December 11, 2002

SEATTLE (Reuters Health) - Seizures induced by electronic screen games and computer-related activities are less likely to recur if patients either avoid or limit their screen time, and take medication if necessary, new study results show.

Although it is rare, seizures can be triggered by certain frequencies of flashing or flickering lights, or the geometric patterns in the video display of computer games. This condition, known as photosensitive epilepsy, is more common in children and adolescents and becomes less frequent with age.

In the current study, which was presented on Tuesday at the American Epilepsy Society's 56th Annual Meeting, the researchers reviewed medical data on 324 patients with epilepsy. From this group, they identified 13 patients between the ages of 9 to 18, who had suffered from seizures related to electronic screen games.

"For most of them, their first seizure occurred with the video game," study author Shirley Simmons, of Children's Hospital of Alabama in Huntsville, told Reuters Health. "And they later went on to show clinical symptoms of a particular type of epilepsy."

Different people were sensitive to a variety of stimuli, and not just the video games, explained Simmons. One patient was set off by a flickering television, and some were set off by computer activities that weren't games. "We did not isolate a particular game," she said. "There were a wide variety of them."

Two of the children had a history of absence seizures, which is a type of seizure that causes very brief periods of unconsciousness but doesn't cause convulsions. However, after viewing an electronic screen game, they both experienced a more severe type of seizure called a generalized tonic clonic (GTC). Both are currently taking anti-seizure medication and have not had a recurrence.

Seven of the patients experienced a single seizure that was triggered by the games. Three have not needed medication, and have not experienced any further seizures as long as they avoid electronic screen games. The other four children take a single medication and their seizures are well controlled.

The researchers were unable to follow-up on one of the patients, but the remaining three continue to have generalized seizures, need to take multiple medications to keep them under control, and will have recurring electronic game induced seizures if exposed to the trigger.

"Our recommendations were to avoid the game or the initial trigger," said Simmons. "Or if they're going to be doing similar activities or games, to limit their time. We recommend that they limit their activity to less than 30 minutes at a time, just to avoid the issue of the flashing in combination with fatigue."

However, Simmons pointed out that the recommendation to limiting activity to less than 30 minutes is not a guarantee that they won't have a seizure. "It just helps to control it, she said. "And it also helps to avoid the fatigue issue."

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Smoking May Erode Acid-Reflux Defense

 

Reuters Health

Wednesday, December 11, 2002

NEW YORK (Reuters Health) - Smoking may dull a reflex in the throat thought to protect the airways from stomach-acid reflux, the results of a small study suggest.

Researchers found that smokers showed a slow-down in the pharyngoglottal closure reflex (PGCR), which momentarily closes off the vocal cords when fluid enters the throat. This and other upper-GI reflexes are thought to provide a defense against acids that back up from the stomach.

But in previous research, Dr. Kulwinder Dua and colleagues at the Medical College of Wisconsin in Milwaukee had found that smoking may impair some of these reflexes. According to the researchers, these new findings suggest the habit may weaken the upper airways' acid defenses even further.

Smoking is already thought to weaken the lower esophageal sphincter, the muscle connecting the esophagus and stomach. When this muscle does not work properly, stomach acids may chronically escape back into the esophagus--a condition known as gastroesophageal reflux disease, or GERD.

Because of the proximity of the digestive and respiratory tracts, Dua's team notes, acids that reach the throat may over time harm the airways. If smokers' airway defenses are indeed weakened, this could affect their risk of reflux-related respiratory problems, the researchers explain in their report in the December issue of the journal Gut.

For the study, Dua and colleagues looked at PGCR in response to infusions of water among 10 smokers and 10 nonsmokers. The investigators found that the throat reflex was much slower in smokers than nonsmokers.

Exactly why smoking might affect the pharyngoglottal closure reflex is unclear, the authors note. They speculate that damage to nerve endings in the throat or to tissue lining the throat or esophagus could be to blame.

Source: Gut 2002;51:771-775.

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No Simple Way to Help Patients Stick to Their Meds

 

By Charnicia E. Huggins

Reuters Health

Wednesday, December 11, 2002

NEW YORK (Reuters Health) - Giving patients simple, clear instructions about how to take their medications may make them more likely to comply with a short-term treatment regimen, but it does little to make them adhere to long-term treatments, study findings show.

Helping patients stick to their life-long prescription regimens for high blood pressure, asthma and other chronic conditions may require a more complex system involving combinations of oral and written instructions, counseling, family involvement and patient reminders, according to a team of Canadian researchers.

Previous study findings indicate that many patients do not completely adhere to their medication prescriptions. In some cases, patients may stop taking their medication prematurely, and in others they may simply forget to take all of the medication at the appropriate times, both of which can undermine the benefits of their therapy.

"For most treatments, we don't get as much goodness out of them as there are in them because people simply don't follow the treatment," study author Dr. R. Brian Haynes from the McMaster University Faculty of Health Sciences in Ontario told Reuters Health.

He and his colleagues reviewed 33 studies of 39 different simple and complex interventions designed to help patients adhere to their treatment regimens.

Overall, almost half of the interventions, used in studies of patients with high blood pressure, asthma, schizophrenia and various other conditions, helped patients do a better job of sticking to their medication regimens, the investigators report in the December 11th issue of The Journal of the American Medical Association (news - web sites).

Studies that measured patient adherence to short-term regimens, such as a 10-day antibiotic treatment, found that counseling and written instructions were enough to encourage patients' full compliance with their prescriptions.

For long-term regimens, multifaceted interventions were most effective, the report indicates, but even those were not associated with great improvements in patient compliance or with better treatment outcomes, such as more blood pressure control for patients with hypertension.

In fact, only 17 studies found that the interventions used were associated with improvements in treatment outcome, the researchers note.

"Sometimes the regimens people are prescribed are way too complicated," Haynes said. "Most people are on automatic pilot in the morning; if they don't lay out their medications in an organized fashion they are very prone to forgetting them."

Therefore, to maximize benefit from prescription medications, patients should use pill organizers, if needed, and should also agitate to have complicated regimens simplified in some way, he added.

For example, people who are instructed to take a particular medication at noon, which may often be an inconvenient time of day, should ask their doctors if they could take it at a different time. Also, patients who are on multiple medications should ask their doctors if the pills can be taken together, rather than assuming they must be spread out during the day, Haynes advised.

The study was led by Heather P. McDonald of McMaster University School of Graduate Studies in Ontario.

Source: The Journal of the American Medical Association 2002;288:2868-2879.

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Epilepsy Remains Misunderstood Among Older Adults

 

Reuters Health

Wednesday, December 11, 2002

SEATTLE (Reuters Health) - A sizeable percentage of older adults have misperceptions about both seizures and epilepsy, according to research presented here this week at the American Epilepsy Society's 56th Annual Meeting.

Even though the number of older adults with epilepsy is increasing, and they have the highest incidence and prevalence of seizures, researchers found that many of them are poorly informed about the disorder. This is despite the fact that a large number of the study participants were either acquainted with someone who had epilepsy, or had witnessed a seizure.

"There's still a lot of stigma attached to epilepsy, especially among an older population," study author Deborah L. Shulman of the Mayo Clinic in Scottsdale, Arizona, told Reuters Health. "One of the interesting statistics is that many people said they wouldn't tell their doctor if they had a seizure, because they felt they would be treated differently."

The researchers distributed surveys to 104 adults between the ages of 60 to 99, and found that most were familiar with seizures and epilepsy. However, 28% believed that epilepsy was a mental illness, or were unsure about it, and 8% thought that seizures were contagious. Only about half could identify the different symptoms associated with the various types of seizures.

"We found that 69% were not sure how to help someone with a seizure," explained Shulman. Some thought that a person having a seizure needed to be held down, or that an object needed to be placed in their mouth, both of which are incorrect actions.

"When compared with other conditions, 7% said that they feared seizures the most, even more than cancer or heart disease," said Shulman.

The researchers also found that roughly half of the respondents had other misperceptions about epilepsy, such as believing that people with the disorder should not have children, or that they were unable to live independently. Almost a third were uncertain if individuals who have seizures are prone to violence.

Only a quarter of women would tell a family member about a seizure, and even less would tell a friend or anyone at all for that matter. Men were a little more willing to reveal the information to a family member, with 37% saying that they would do so. However, they were far less willing than women to relate the information to anyone outside of their family. Only 2% said they would tell a friend, and 9% said they would tell anyone else.

"We need more educational programs that can reach older Americans out in the community," said Shulman, adding that while this was a small study, it may be indicative of how this age group views epilepsy.

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TUESDAY, DECEMBER 10, 2002 

Anti-Smoking Ads May Influence Teen Habits: Study

 

Reuters Health

Tuesday, December 10, 2002

NEW YORK (Reuters Health) - Young people who are exposed to multiple anti-tobacco advertisements on television and who can describe these ads accurately are less likely to take up smoking than their peers, study findings show.

What's more, their likelihood of remaining nonsmokers appears to increase with the number of television ads they view and are able to correctly describe.

The findings are based on telephone responses from 12- to 20-year-olds involved in a follow-up survey 22 months after the April 1998 start of the Florida "truth" anti-tobacco media campaign.

This campaign, targeted at 12- to 17-year-olds, included 11 television ads that aimed to prevent youth from starting smoking by informing them about strategies used by the tobacco industry to popularize smoking.

Overall, youth who were initially identified as nonsmokers were more likely to remain so at follow-up if they remembered the anti-tobacco ads and were able to give accurate descriptions of them, the investigators report in the November issue of Preventive Medicine.

For example, those who were able to describe, in detail, at least one of the 11 ads were 27% more likely to remain nonsmokers at follow-up. The almost 40% of youth who were able to accurately describe four or more ads were 68% more likely to remain nonsmokers, the report indicates.

The youth were also less likely to take up smoking if they said that the campaign's message--that tobacco companies specifically target and try to manipulate youth--greatly influenced their decision not to start smoking.

In contrast, young people who were unable to accurately describe any of the television ads were more likely to say that the campaign theme did not influence their smoking in any way.

Source: Preventive Medicine 2002;35:511-518.

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Hysterectomy: The Operation Women May Not Need

 

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 10, 2002

TUESDAY, Dec. 10 (HealthScoutNews) -- Imagine you're sick and you have two health-care options.

 The first involves a non-surgical treatment, requires a day or less in the hospital, has virtually no lasting side effects and offers a full recovery in 24 to 48 hours.

The second involves major surgery removing several organs, a lengthy hospital stay, weeks of recuperation and the possibility that you may suffer lifelong emotional and physical consequences.

Considering that either option would take care of your problem equally well, the choice seems obvious.

Not if you're a woman.

According to the U.S. Centers for Disease Control and Prevention (news - web sites), each year some 600,000 American women bypass relatively fast and simple medical procedures and choose instead a life-altering and -- in many instances, some say -- unnecessary operation known as a hysterectomy.

"It is hard to believe that in this day and age women are being pushed into surgeries they don't need. But this is exactly what is happening when it comes to hysterectomy -- an operation that is being needlessly performed time and again, even though we have so many other less drastic procedures available," says gynecologist Dr. Ernst Bartsich, an associate clinical professor of obstetrics and gynecology at New York Weill Cornell Medical Center in New York City.

A study published earlier this year in the journal Obstetrics and Gynecology found that while rates of hysterectomy are declining in most other developed countries, U.S. rates are on the rise. American women are four times more likely to have this surgery than women in other countries, including New Zealand, Australia and most European nations, according to the research.

A hysterectomy removes a woman's uterus, and sometimes her ovaries and fallopian tubes. Once considered the gold standard for virtually any uterine-related complaint, it was commonly used to treat everything from dysfunctional menstrual bleeding to pelvic pain, endometriosis and especially fibroid tumors -- which now account for 40 percent or more of the hysterectomies performed in the United States.

However, in the past two decades, and particularly the last 10 years, an array of new and less drastic treatment options have become available. They include some that help fibroid tumors shrivel and die on their own.

So why aren't women taking advantage of these new treatment options?

Bartsich puts the blame almost exclusively on his own profession.

"It's a sad but simple reason -- women are not being told the truth, and it's doctors who are deceiving them, particularly about what these options can accomplish," he says.

While some doctors stubbornly refuse to recommend treatments they don't personally perform, others remain painfully unaware -- or misinformed -- about what is available, Bartsich contends.

Dr. Robert Vogelzang, chief of radiology at Northwestern Memorial Hospital in Chicago, agrees. He is a radiologist who has extensively studied uterine fibroid embolization, a radiological treatment that destroys fibroids while leaving the uterus intact.

"In at least one study we conducted, only one in 10 women heard about our treatment from their gynecologist. And more than half of these women were told they needed a hysterectomy when, in fact, they did not," Vogelzang says.

Vogelzang adds that women in the study were told by their doctors that uterine fibroid embolization would result in severe pain, and that it was ineffective. Both statements, he says, are false.

Complicating matters further: Some doctors aren't being truthful about the consequences of a hysterectomy, critics of the procedure say.

In a survey of more than 600 hysterectomy patients conducted by the HERS Foundation (Hysterectomy Educational Resources and Services), nearly 78 percent of the women unexpectedly reported everything from a personality change to increased irritability and profound fatigue following surgery. Nearly 75 percent cited a loss of sexual desire they did not anticipate, while more than half experienced unexpected memory loss, and loss of sensuality and sexuality.

Scarier still: According to the American College of Obstetricians and Gynecologists, 12 out of every 10,000 women do not survive a hysterectomy.

"I really doubt that a woman would choose this option if she knew just how dramatic and life-altering the consequences can be," Bartsich says.

The only time this operation should be considered is if the diagnosis is cancer, which accounts for about 15 percent of current hysterectomies, Bartsich says.

Various states have enacted legislation requiring doctors to inform patients of all their treatment options before asking them to consent to a hysterectomy. In New York state, where this legislation went into effect in 1990, the rate of hysterectomy remains the lowest in the country.

Earlier this year, the U.S. Senate introduced the "Uterine Fibroids Research and Education Act of 2002." The proposal would authorize some $10 million in funding to the National Institutes of Health (news - web sites) for both research and public awareness campaigns about alternative treatments for fibroid tumors.

The bill has been endorsed by the Society for Interventional Radiology, the American College of Obstetricians and Gynecologists, the American College of Surgeons and the National Medical Association.

What To Do

If you want to learn more about treatment alternatives to a hysterectomy, visit The National Uterine Fibroids Foundation, The Endometriosis Association, and the U.S. Food and Drug Administration.

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Mental Illness Often Predates Ecstasy Use: Study

Reuters Health

Tuesday, December 10, 2002

BERLIN (Reuters Health) - Many studies have shown that the club drug Ecstasy can damage brain cells, but a large German study now shows that mental problems often predate Ecstasy use. Researchers suggest caution in interpreting the association.

The study, conducted by the Max Planck Institute for Psychiatry and the Technical University in Dresden, suggests that psychological problems are more likely to occur before taking the drug than to be a consequence of its use.

Professor Hans-Ulrich Wittchen and colleagues published their results in the journal Drug and Alcohol Dependence, based on information from nearly 2,500 people aged 14 to 24.

The participants were questioned twice, with a 3-1/2 year gap between the interviews. Overall, 9% had taken Ecstasy at least once by the end of the study and 69% of the Ecstasy takers had psychiatric disturbances as defined by DSM-IV, a text that specifies criteria for mental disorders.

This was significantly higher than for non-users, 44.5% of whom had psychiatric disturbances, and users of other illicit drugs (55.5%), the investigators found.

But 88% of the people who took Ecstasy and had psychiatric problems reported that those problems had presented themselves before they first took the party drug.

"The first use of Ecstasy was secondary to the onset of DSM-IV mental disorders in the majority of cases," the researchers note. "Subjects with mental disorders at baseline also showed a significantly increased risk for initiation of Ecstasy use during the 4-year follow-up period.

"Care should be taken in cross-sectional studies in interpreting mental disorder signs and symptoms merely as a consequence of Ecstasy use, as Ecstasy use might be associated with the use of multiple substances," they write. "Onset of mental disorder is more likely to precede rather than to follow use of Ecstasy and related substances."

Source: Drug and Alcohol Dependence 2002;68:195.

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Flat Feet Facts

HealthScoutNews

Tuesday, December 10, 2002

(HealthScoutNews) -- If your child has been diagnosed with flat feet, don't fret. According to the Shriners Hospitals for Children, flat feet -- or Pes Planus -- is a common and painless condition that usually does not need treatment.

Here are some other flat feet facts:

  • Corrective shoes or supports are an unnecessary expense and will not improve flat feet.
  • Shrewd sales people may tell you expensive shoes will help your child walk better, but this is not true.
  • Flat feet will not hamper your child's ability to learn to walk.

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Vaccine Experts Upset by Renewed Safety Doubts

By Maggie Fox

Reuters

Tuesday, December 10, 2002

WASHINGTON (Reuters) - Campaigners who doubt the safety of vaccines have launched a renewed effort to find a link between diseases such as autism and childhood shots, worrying experts in the field.

Indiana Republican Rep. Dan Burton reopened hearings into the alleged vaccine-autism link on Tuesday, and several groups railed against a decision in Congress earlier this month that made it harder to sue vaccine makers.

Doctors say vaccines may have been the biggest advance in health of the last century, saving millions of lives. But their success has opened the door to questions about safety.

The House Government Reform Committee (news - web sites) was scheduled to hold a hearing on vaccine safety on Tuesday. Burton, its chairman, has an autistic grandchild and blames vaccination.

"We are taking a closer look at the science," said Nick Mutton, a spokesman for the committee. "You can't argue with the numbers and the amount of cases. It is becoming an epidemic among our children and something has to be done about that."

Burton has held such hearings for years. Repeated reports have shown no link, including several university-based studies and a 2001 independent Institute of Medicine (news - web sites) report saying there was no evidence to show the measles, mumps and rubella, or MMR, vaccine causes autism.

Children are usually diagnosed with autism around age 2, just after they finish their series of vaccines.

Focus On Mercury

The latest focus is on thimerosol, a mercury-based preservative used in vaccines for decades.

It is no longer used in childhood vaccines--not because it was shown to be harmful but because US government officials were aware that people believed that mercury may be linked to autism.

"There's always been a minority opinion in the United States that vaccines aren't safe," Dr. Peter Hotez, chair of the department of microbiology at George Washington University and an adviser to the Sabin Vaccine Institute, said in a telephone interview. "There currently is no evidence that there is an association between vaccines and autism but somehow it still lingers."

Hotez said Burton and other vaccine critics are looking in the wrong place. "I have an autistic child and I wouldn't think twice about vaccinating her with the same vaccine series yet again," Hotez said.

"Autism has a strong genetic component. It is inconceivable that something like a vaccine could generate the complex set of neural pathways needed for autism."

He and other vaccine experts were angered by the tone of Burton's inquiries, which they said only raise questions among those who would otherwise have no doubts about vaccine safety.

"I think Dan Burton is not looking after the health of the citizens of his own state of Indiana," Hotez said.

A study published in November in The Lancet medical journal found that children given thimerosol-containing vaccines had safe levels of mercury in their blood as defined by the US Environmental Protection Agency (news - web sites).

The US Centers for Disease Control and Prevention (news - web sites) and the Food and Drug Administration (news - web sites), along with non-governmental groups such as the National Foundation for Infectious Diseases, have been pushing public education campaigns aimed at keeping up traditionally strong public support of immunization.

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Bad Egg

HealthScoutNews

Tuesday, December 10, 2002

(HealthScoutNews) -- Fresh eggs sometimes carry salmonella bacteria. This can make you severely ill, and in some cases, an infection can be fatal.

When buying eggs, the Medical College of Wisconsin recommends you:

  • Buy eggs only if they've been stored in a refrigerator.
  • Open the carton and make sure the eggs are clean and the shells aren't cracked.
  • Transfer them to your refrigerator as soon as possible and store them in their original carton.

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Anesthesia After Retina Surgery May Damage Sight 

By Suzanne Rostler

Reuters Health

Tuesday, December 10, 2002

NEW YORK (Reuters Health) - Patients may lose their sight if they receive nitrous oxide anesthesia within one month after having retinal surgery, new study findings suggest.

Researchers from New Zealand describe the cases of three patients who received intraocular gas, which is used to hold the retina in place during surgery to repair retinal detachment.

Within one month, the patients had other types of surgery unrelated to their eye operation. All three patients, who received nitrous oxide gas as anesthesia for their second surgery, suffered severe vision loss immediately after they received the anesthetic. Vision loss was permanent in two of the patients.

In an interview with Reuters Health, Dr. David R. Worsley, the study's lead author, explained that nitrous oxide can cause an intraocular gas bubble to expand, increasing the pressure within the eye and inhibiting circulation to the optic nerve and retina.

"Without a blood supply, these tissues are soon irretrievably damaged, resulting in vision loss that is frequently severe," Worsley said.

The reports highlight the need for surgeons to recognize patients who may have been given intraocular gas recently, the researchers conclude in the November issue of the American Journal of Ophthalmology. In all three cases, the anesthesiologist was not aware of the patient's recent retina surgery.

"It is imperative that the anesthesiologist be aware of the presence of an intraocular gas bubble before any anesthetic so that nitrous oxide can be avoided," said Worsley, from Waikato Hospital in Hamilton, New Zealand.

He suggests that patients wear identification bracelets following retina surgery. The gas is not visible during a regular exam and requires specialized equipment to detect. Also, patients are not likely to mention the gas to a doctor and may not be able to convey the information in an emergency room, Worsley noted.

Source: American Journal of Ophthalmology 2002;134:761-763.

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Genetic Link to Fat Absorption Found

HealthScoutNews

Tuesday, December 10, 2002

TUESDAY, Dec. 10 (HealthScoutNews) -- Rockefeller University scientists say they've moved closer to finding the genes that cause some people to absorb more cholesterol into their blood than others.

In recent genetic studies with lab mice, the scientists narrowed the search to two chromosome regions, says a study in today's issue of the Proceedings of the National Academy of Sciences (news - web sites).

Finding these genes in mice could help identify similar genes in humans and lead to new cholesterol-lowering drugs to combat heart disease.

The researchers used a technique called genetic linking mapping in their attempts to find the genes that regulate absorption of plant fatty molecules called plant sterols, which are markers of cholesterol absorption.

They were able to narrow the location of those genes to two distinct regions on chromosomes 2 and 14, and found an especially strong signal at chromosome 14. Even though they didn't pinpoint the exact location of the genes, the researchers did uncover the genes' general vicinity. They can now use a variety of techniques to identify the genes.

Some people absorb 25 percent of cholesterol from their diet, while other people absorb as much as 75 percent of the cholesterol from the foods they eat.

More information

The U.S. National Heart, Lung, and Blood Institute has more about the connection between cholesterol and heart disease.

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Obesity Ups Cataract Risk: Study

By Suzanne Rostler

Reuters Health

Tuesday, December 10, 2002

NEW YORK (Reuters Health) - On top of all the other problems related to being very overweight, researchers now report that obesity can increase the risk of developing cataracts, the world's leading cause of blindness.

Cataracts occur when proteins in the eye's lens begin to clump together, forming a milky cloud that obscures vision. Everyone will experience some clouding in the eye lens if they live long enough.

But according to new findings, the risk rises in tandem with body mass index (BMI), a measure of weight in relation to height. A BMI below 25 is considered healthy while obesity is marked by a BMI of at least 30. Those who fall in the middle are considered to be overweight or at risk for a host of chronic disorders.

In the study, middle-aged men and women with a BMI of at least 30 were 36% more likely than their leaner peers to develop cataracts. There was no relationship between obesity and nuclear cataracts, the most common type of cataract that strikes the center of the eye. The risk of developing a posterior subcapsular cataract, the most visually disabling type that forms in the back of the lens, rose by 68% among obese adults, the investigators found.

It is not clear from the current report how obesity may contribute to cataracts, but the researchers suggest that poor blood sugar control or elevated levels of inflammatory compounds in the body, both of which can occur in obese individuals, may play a role.

While more research is needed, the report published in the International Journal of Obesity indicates that maintaining a healthy body weight may prevent or delay the onset of cataracts and reduce the need for cataract surgery, which involves removing the cloudy lens and replacing it with an implant.

Although cataract surgery can restore vision, it is costly and not available in less developed countries, according to Dr. June M. Weintraub, currently with the San Francisco Department of Public Health (news - web sites) in California, and her colleagues from the Harvard School of Public Health in Boston, Massachusetts.

"Obesity is related to numerous chronic diseases, and the causal relationship between obesity and cataract extraction...adds further indication of the burden of obesity on our society," Weintraub explained in an interview with Reuters Health.

She suggested that understanding that obesity can increase the risk of developing cataracts might motivate some individuals to control their weight.

The study involved more than 130,000 US adults aged 45 years and older who did not have a cataract when the study began. Over the next 10 to 16 years, researchers tracked the development of cataracts and their relationship to BMI.

Source: International Journal of Obesity 2002;10.1038/sj.ijo.802158.

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Prodding Doctors Can Boost Chlamydia Screening

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 10, 2002

TUESDAY, Dec. 10 (HealthScoutNews) -- Researchers have discovered that simply encouraging doctors to screen teenage girls for chlamydia can significantly boost testing for the nation's most common sexually transmitted disease.

Kaiser Permanente health plan's Northern California region widened its chlamydia screening program and found that 8 percent of sexually active girls tested were infected with the disease.

"That's incredible. These kids would not have been picked up otherwise," said Dr. Charles Wibbelsman, director of Kaiser Permanente's Teen Clinic in San Francisco.

Chlamydia, which infects both men and women, is more common in the United States than HIV (news - web sites), herpes, syphilis, or gonorrhea. The disease is easily spread among teenagers because they often don't engage in safe sex practices, Wibbelsman said. "A lot of kids who are having vaginal intercourse are not using condoms, and while they may not be getting pregnant, they're taking the risks of getting chlamydia," he said.

The disease has a fairly low profile because it often has no symptoms. Even so, chlamydia can wreak havoc. "The severity is in the young women," Wibbelsman said. "It can cause pelvic inflammatory disease and sterility. It's a real serious problem."

However, it's remarkably easy to cure chlamydia. Just a few doses of an antibiotic will kill off the infection, Wibbelsman said.

Despite the ease of curing chlamydia, only 5 percent of sexually active teenage girls got screened for it during routine checkups or school physicals at Kaiser Permanente facilities in Northern California. As part of their study, officials tried to boost that number by encouraging doctors to screen for the disease and use a basic urine test instead of a complicated and unpleasant gynecological exam.

The result: The rate of chlamydia screening among sexually active girls aged 14 to 18 rose from 5 percent to 65 percent.

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

Part of the challenge has been teaching doctors how to talk to their young patients about sex, Wibbelsman said. "When a kid comes to see you for a (routine) visit, it has to be more than talking about smoking and acne. You need to sit down and talk to these kids alone and get the parents out of the room."

Kaiser Permanente also made the process a little easier by taking urine samples before the doctor-patient chats so they're available for testing if needed, he said.

Dr. M. Kim Oh, a pediatrician at the University of Alabama at Birmingham, agreed that doctors need prodding to realize that their young patients may indeed be sexually active. "A lot of doctors are in denial. How many times have I heard, 'I don't see that kind of patient in my practice?' "

Doctors also have to become comfortable when bringing up the topic of sex with young patients. "Doctors in general are reluctant to initiate the approach," she said. "They basically wait until the patient says, 'I want to be screened.' "

What To Do

To find out more about sexually transmitted diseases, check the Centers for Disease Control and Prevention or the American Social Health Association.

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Brain Scans May Detect Early Signs of Psychosis

Reuters

Tuesday, December 10, 2002 

LONDON (Reuters) - Brain imaging may help doctors determine if people who are at high risk of developing psychotic disorders such as schizophrenia will go on to experience a break with reality, researchers said Tuesday.

Sophisticated scanning techniques may be able to detect changes in areas of the brain that occur before or while a severe mental disorder is developing, their study showed.

This would allow doctors to treat the patient before symptoms begin and may help to prevent the illness.

"The fact that progressive changes were found during the development of the illness has important implications for the treatment of psychotic disorders," said Christos Pantelis of the University of Melbourne in Australia.

In the study, published in the online version of The Lancet medical journal, Pantelis and his colleagues used MRI (magnetic resonance imaging) scans to study the brains of 75 people with a high risk of developing psychosis. The patients were already experiencing some disturbing symptoms, such as paranoia or temporary psychotic-like ideas.

Although the patients' clinical symptoms were indistinguishable at the beginning of the study, the researchers did find differences between the brain scans of the 23 people who went on to develop severe psychotic symptoms in the next year and those who did not.

The researchers said it is still too early to say whether MRI scans could be used as a diagnostic tool. But they noticed that patients with a psychosis had less gray matter in regions of the brain associated with social behavior, emotion, memory and attention than the other individuals.

Pantelis and his team suspect the differences could be early signs of a psychotic disorder.

"Our data suggest that treating high-risk individuals before the onset of psychosis might minimize the brain changes we observed, and may even prevent the illness developing," Pantelis added in the research study.

Schizophrenia--any of several psychotic disorders characterized by distortions of reality, thought and language disturbances and social withdrawal--affects about 45 million people worldwide, according to the World Health Organization (news - web sites). Many more suffer from other psychotic disorders.

Source: The Lancet 2002 Online December 10, 2002. http://www.thelancet.com.

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Antidepressants May Cause Premature Delivery

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 10, 2002

TUESDAY, Dec. 10 (HealthScoutNews) -- Pregnant women who take antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be at higher risk of premature delivery, a new study says.

SSRIs include the popular antidepressants fluoxetine (brand name Prozac), paroxetine (Paxil) and sertraline (Zoloft).

However, the news is by no means all bad. On the plus side, researchers found no link between SSRIs and birth defects or developmental delays.

"Our results offer some reassurance and some cause for concern," says Dr. Greg Simon, lead author of the study and an associate investigator and psychiatrist at Group Health Cooperative's Center for Health Studies in Seattle. "The reassurance is SSRIs are not associated with any risk of birth defects or malformations. The concern is that SSRIs appear to be associated with an increased risk of premature delivery."

The study appears in the December issue of the American Journal of Psychiatry.

Researchers examined the medical records of 185 women and their babies who took antidepressants during pregnancy and 185 women and their babies who were treated for depression during pregnancy but did not take any drugs for the condition.

Women taking antidepressants were twice as likely to give birth prematurely. About 10 percent of women who took SSRIs at any time during their pregnancy gave birth before 36 weeks, the standard definition of premature labor, compared to only 5 percent of women who didn't take SSRIs.

The women on SSRIs gave birth, on average, a week earlier than those not exposed to these drugs.

"While this risk of premature delivery is low, the findings affect a large population of women," Simon says.

So what's a woman to do?

"Each woman has to consider her own situation and decide what to do," Simon says. "A woman who has severe depression while not using this drug would probably continue to take it. But a woman who has relatively mild depression might choose to stop using it during pregnancy."

Women are more than twice as likely to suffer depression as men, according to the American Psychological Association. And women are most likely to be depressed during their childbearing years, from about ages 20 to 50.

Dr. Milton Anderson, a psychiatrist at the Oschner Clinic Foundation in New Orleans, says the danger of depression to a mother and child should not be underestimated.

Depressed women often don't sleep well, eat well or get the medical care they need. Pregnant women who try to commit suicide can severely damage their baby, Anderson adds.

"Severe depression is toxic to mothers and babies," Anderson says.

While premature delivery is of concern, he believes the more crucial finding is that SSRIs are otherwise safe.

"The bigger importance of the study is the reassurance that there wasn't an increased rate of fetal abnormalities of birth defects," Anderson says. "We worry about that with any drug during pregnancy."

Given the new research, Anderson says he would recommend that women who have serious depression -- a lifelong history, recurrent suicide attempts -- remain on the medicine. Women who have milder depression -- perhaps a single bout and who've been in remission for six months or more -- should slowly come off antidepressants.

Either way, he'd make the decision with the woman and her obstetrician.

"We would like to have pregnant women off any and all medicine during the pregnancy," he says. "But in those moms who have severe depression or who are at risk of severe depression, this looks like a relatively manageable risk of early delivery."

The study found the older generation of medicines called tricyclic antidepressants, which include imipramine and amitriptyline, had no effect on the risk of premature delivery.

Researchers did not look at some of the newest antidepressants on the market, including Wellbutrin, Effexor and Remeron.

What To Do

Find out more about depression, including symptoms and treatments, at the National Institutes of Health. Meanwhile, the University of Michigan Health System has information about depression during pregnancy.

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Colicky Baby? Endless Crying Fades at 3 Months

By Jacqueline Stenson

Reuters Health

Tuesday, December 10, 2002

NEW YORK (Reuters Health) - Canadian researchers have a double dose of good news for moms with colicky newborns: That seemingly endless crying usually stops by the time babies are 3 months old, and mothers do not appear to sustain lasting psychological impact from the noisy, often frustrating experience.

"This is information that mothers around the world should be thrilled with," said study author Dr. Tammy J. Clifford, director of epidemiology at Children's Hospital of Eastern Ontario Research Institute in Ottawa, Canada. "It is wonderful news."

It is estimated that 5% to 28% of infants develop colic, usually when they are 2 to 6 weeks old, note Clifford and colleagues, whose findings are published in the December issue of the Archives of Pediatrics and Adolescent Medicine. Colic has no known cause or cure, and some researchers suspect it may just be part of normal development in many infants.

In the new study of 547 mother-infant pairs, more than 85% of colic cases remitted by the time the babies were 3 months of age. There were 131 infants with colic at age 6 weeks, when crying tends to peak, yet just 18 of them still had colic at 3 months. The researchers defined colic as crying, irritability or fussing that lasts three or more hours a day and occurs three or more days a week.

The findings were based on mailed questionnaires that the mothers completed when their babies were aged 1 week, 6 weeks, 3 months and 6 months.

By age 3 months, the overall average duration of crying and fussing for infants in the study was about one hour a day--about half that observed at 6 weeks.

And having had a colicky newborn did not appear to affect a woman's depression or anxiety levels when the child was 6 months old, results show. By that time, with colic now a memory, the mother may be wrapped up in the joys of her infant crawling or exhibiting other positive aspects of development, Clifford suggested.

"Moms of colicky babies can take reassurance knowing that they're not the only ones going through this, and that it does end," Clifford told Reuters Health. "And if they feel that they are about to 'lose it'...they should feel no shame in getting help--asking a family member, friend or neighbor to help care for the baby."

Most of the women in the study were married, financially stable and had good access to healthcare, so it is not known whether women without such security would cope as well with a colicky baby, Clifford said.

Inconsolable crying has been identified as a trigger for child abuse, including shaken baby syndrome, she noted.

In an accompanying editorial, Dr. Ronald G. Barr of McGill University in Montreal, Quebec said the new findings offer reassuring news that the outcomes for colicky babies and their mothers is good, at least in the low-risk cases observed in the study.

However, more research is needed to fully understand the nature of infant crying, he said.

Source: Archives of Pediatrics and Adolescent Medicine 2002;156:1172-1174, 1183-1188.

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New Generation of Thalidomide Shows Promise Against Cancer

HealthScoutNews

Tuesday, December 10, 2002

TUESDAY, Dec. 10 (HealthScoutNews) -- A next-generation version of thalidomide shows early promise in treating people with recurrent multiple myeloma, an incurable form of bone marrow cancer.

Early data from an American study shows that the drug, dubbed CC-5013, causes myeloma cells to self-destruct and inhibits their ability to localize and grow in bone marrow. The new drug, known by the brand name Revimid, was designed to be more potent than thalidomide but with fewer side effects.

The drug also seems to stimulate the immune system to attack myeloma cells, say researchers from the Dana-Farber Cancer Institute.

The findings were presented yesterday at the American Society of Hematologists' annual meeting in Philadelphia.

Another study of CC-5013 by University of Arizona researchers found the drug produces red blood cells in people with myelodysplastic syndrome (MDS), a life-threatening blood disorder where people can't produce enough red blood cells.

The 16-week study found that six of nine people with MDS showed improved blood function, and four no longer needed blood transfusions. Some people in the study also had a complete or partial remission from the blood cell abnormality that causes MDS.

About 10,000 people are diagnosed with MDS each year in the United States. Blood transfusions are sometimes given to people with MDS to relieve anemia symptoms such as fatigue and weakness.

More information

Here's where you can learn more about multiple myeloma. And here's where to go to find out more about myelodysplastic syndrome.

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Obesity Linked to Increased Risk of Stroke in Men 

By Suzanne Rostler

Reuters Health

Tuesday, December 10, 2002

NEW YORK (Reuters Health) - Men who are obese are twice as likely as their leaner peers to suffer a stroke, researchers report.

The study finding adds more support to the view that excess body weight is hazardous to health. While it is well known that obesity raises the risk of heart disease, type 2 diabetes and some types of cancer, the current report shows that it is also a risk factor for stroke, the third leading cause of death in the US.

"Our findings underscore the fact that your risk of stroke is modifiable when it comes to how much you weigh," Dr. Tobias Kurth of Brigham and Women's Hospital in Boston, Massachusetts, said in a prepared statement.

The study included more than 21,000 middle-aged and elderly men in the Physicians' Health Study, a long-term, national investigation of a group of male doctors. The men were healthy; that is, they had no history of heart attack, stroke or cancer at the study's outset.

Over the next 13 years, obese men, meaning those with a body mass index (BMI) of at least 30, were found to be twice as likely to suffer any type of stroke, compared with leaner men with a BMI under 23. The risk of hemorrhagic stroke, which is caused by bleeding in the brain, was even higher, according to the report in the Archives of Internal Medicine (news - web sites) for December 9/23.

BMI is a measure of weight in relation to height and is considered a more reliable gauge of disease risk than weight alone. An adult with a BMI of 30 or more is categorized as obese and one with a BMI of 25 to 30 is considered overweight.

With each additional point increase in BMI over 25, the risk of stroke rose 6%. High blood pressure, diabetes and high cholesterol accounted for some of the higher risk but even those without these additional health problems were more likely to have a stroke, the investigators found.

It is not clear from the report how BMI affects stroke risk, but some data suggest that higher blood levels of compounds that are associated with clotting in overweight individuals may be to blame.

Alternatively, overweight and obese people are more prone to high blood pressure and diabetes, which can raise stroke risk, Kurth said in an interview with Reuters Health. He added that the mechanism by which excess body weight can affect a person's risk of stroke is worth investigating in future studies.

"These results suggest that individuals and their physicians should consider increased risk of stroke another hazard of obesity," the study authors conclude.

Source: Archives of Internal Medicine 2002;162:2557-2562.

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A Spark of Hope for Spinal Cord Injuries

HealthScoutNews

Tuesday, December 10, 2002

TUESDAY, Dec. 10 (HealthScoutNews) -- Brain areas that control movement and feeling can stay healthy and active in people paralyzed by severe spinal cord injuries, say researchers from the Washington University School of Medicine in St. Louis.

They studied a quadriplegic person who kept those brain capabilities five years after being completely paralyzed by a spinal cord injury.

The findings appear online this week and in the Dec. 24 print issue of the National Proceedings of the National Academy of Sciences (news - web sites).

The researchers used functional magnetic resonance imaging to compare brain patterns in the quadriplegic person and in a healthy control subject.

In this study, brain images were taken to measure the participants' brain response to touch and brain activity during movement. In the touch test, a massage vibrator was applied to the left hand or left foot.

During the activity test, the participants followed the image of a tennis ball with either their tongue or their left index finger. For example, if the ball moved up, they would move either their tongue or left index finger up.

The study found that brain activity was normal in both subjects, but the quadriplegic person had slightly stronger and more widespread brain activity.

More studies are needed to determine what this finding might mean for people recovering from spinal cord injuries.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more information about spinal cord injury.

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Keeping in Touch Helps Elderly Handle Depression

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Tuesday, December 10, 2002

TUESDAY, Dec. 10 (HealthScoutNews) -- A carefully organized program of constant checking can help older people better cope with depression, a study finds.

For many of those people, the program can be lifesaving, since badly treated depression worsens their ability to manage other chronic conditions, such as diabetes or heart disease, says Dr. Jurgen Unutzer, an associate professor of psychiatry at the University of California at Los Angeles. He is lead author of a paper on the study, which appears in tomorrow's Journal of the American Medical Association (news - web sites).

It's a program that builds on the progress made over the past decade, a period during which doctors have become increasingly aware of the problem of depression among older people; 10 percent or more of the elderly are believed to suffer from some degree of clinically diagnosed depression.

"Ten years ago, the odds that these people would have gotten treatment was close to zero," Unutzer says. "It often was not recognized because patients and physicians were not comfortable with the idea of depression. The advent of antidepressant medications has made depression more treatable, and the majority of older adults will be prescribed an antidepressant by their primary physician."

"But even so, a large number of older adults don't get effective treatment. They get the prescription, but not the support they need. Some take too small a dose, others don't stay on the medication long enough because of side effects or other reasons. The primary-care physician doesn't have enough time to follow up on this."

So Unutzer and others organized a program that enrolled 1,801 depressed older people (60 or older) at 18 primary-care clinics. Half got the usual treatment, while people in the other group were assigned someone to keep in touch with them -- most often a nurse, sometimes a psychologist. There were periodical phone calls asking about the effectiveness of the medication and any side effects that might be causing problems -- "subtle things that the usual care was not able to keep track of," Unutzer says.

After a year, 45 percent of people who had that kind of follow-up reported a reduction in the symptoms of depression of 50 percent or more, compared to 19 percent of those who did not get the follow-up, the researchers report.

"I call it a systematic, proactive follow-up of patients after they have been diagnosed," says Dr. Elizabeth H. B. Lin, a scientific investigator and family physician at the Group Health Care Cooperative of Puget Sound in Seattle and a participant in the study. "It is a collaborative model for managing depression that helps primary-care patients get better care overall."

Improving depression treatment "does make it possible to do more in the way of health care for chronic conditions," Lin says, noting that 80 percent of the people enrolled in the program at her facility had one or more other long-term conditions.

"Our hope is that these results will encourage other clinics to follow our model," Unutzer says. "It is somewhat encouraging to see that many of the clinics in our program have gone on to build it into their usual care. If you take your existing staff and train them to do this in an organized way, you can nearly double the effectiveness of this kind of treatment."

What To Do

You can learn more about depression among the elderly, its symptoms and treatment, from the National Institute of Mental Health or the National Institute on Aging.

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Genes That Program Tumor Spreads Identified

HealthScoutNews

Tuesday, December 10, 2002

TUESDAY, Dec. 10 (HealthScoutNews) -- The presence of specific genes in some kinds of primary tumors appears to predict that the tumors will spread to other parts of the body.

New research just published on the Nature Genetics Web site shows this genetic "signature" is present in the early stages of the tumor, long before there is any evidence that cancer has spread to other body areas.

The spreading of cancer -- called metastasis -- is common, but what triggers it hasn't been well understood. Cancer cells have to go through a series of gene-controlled changes to become metastatic.

That includes developing the ability to grow while unattached to any tissue, being able to bore through vessel walls to reach the bloodstream or lymphatic system, and being able to develop a new blood supply to grow.

The traditional view is that a tumor becomes metastatic more or less by chance. However, this new study indicates that a variety of tumor types are genetically encoded to metastasize.

Scientists at Dana-Farber Cancer Institute and the Whitehead Institute analyzed genetic profiles of primary tumors and cancers that metastasized from primary tumors. They identified a group of genes they believe program tumors -- including breast and prostate cancers -- to metastasize.

Using genetic tests to identify tumors likely to metastasize could help doctors provide better treatment for people with cancer.

More studies are being done to validate the significance of this group of genes.

More information

The National Cancer Institute (news - web sites) has more information about metastatic cancer.

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MONDAY, DECEMBER 9, 2002 

FDA Tries to Plug Risky Drug Loophole 

The Associated Press

Monday, December 9, 2002

WASHINGTON (AP) - The government is ordering 10 prescription drugs to be detained at the U.S. border if patients buy them abroad instead of through their doctors, calling the medications too risky for unsupervised use.

At issue are drugs ranging from the acne treatment Accutane to a version of the date-rape drug GHB that is used to treat narcolepsy. All can cause serious side effects and thus are allowed to sell in the United States only under severe restrictions, such as curbs on which doctors can prescribe them and what patients qualify.

But the Food and Drug Administration (news - web sites) noticed Internet advertisements for some of the drugs that entice patients to order the medications directly, ignoring the safety restrictions.

It is illegal to sell prescription drugs without a doctor's valid prescription, so the FDA is taking steps to shut those Web sites — and warned consumers Monday not to buy the drugs in question over the Internet. Because some of the Web sites are foreign, the FDA also asked U.S. Customs officials to seize shipments of the drugs from abroad.

"This is a loophole we're seeking to plug," said FDA drug chief Dr. Janet Woodcock.

Drugs cited in Monday's warning include:

_Accutane, or isotretinoin, for severe acne.

_Actiq, an oral version of the painkiller fentanyl for severe cancer pain.

_Clozaril, for schizophrenia.

_Lotronex, for women with severe irritable bowel syndrome.

_Mifiprex, the abortion pill also called RU-486 (news - web sites).

_Thalomid, a brand of the notorious birth defect-causing drug thalidomide that treats leprosy.

_Tikosyn, also called dofetilide, for certain irregular heartbeats.

_Tracleer, for severe pulmonary hypertension.

_Trovan, an antibiotic also called trovafloxacin or alatrofloxacin.

_Xyrem, a version of the date-rape drug GHB that prevents a complication of narcolepsy.

The FDA doesn't know of anyone harmed by buying the drugs underground, but notes that patients likely wouldn't volunteer that information to the government.

Woodcock, however, urged patients to remember these drugs have "special risks. Getting them outside of the health care system puts people at even higher risk for severe harm."

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Family Breast Cancer History Won't Up Uterine Risk 

By Merritt McKinney

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - Breast cancer (news - web sites) and endometrial cancer--cancer of the lining of the uterus--share several risk factors, but women with a family history of breast cancer do not have an increased risk of endometrial cancer, according to the results of a large new study.

However, breast cancer survivors do seem to be at higher risk of endometrial cancer, so they should be on the lookout for early signs of the disease, researchers say. Endometrial cancer is highly treatable if caught early enough.

In comments to Reuters Health, the study's lead author, Dr. Mark H. Greene of the National Cancer Institute (news - web sites) in Rockville, Maryland, said that "healthcare providers who treat patients with cancer have long been convinced that it is much preferable to prevent the development of this group of diseases than to wait for it to occur and then attempt eradication."

A basic prevention strategy, Greene said, is to find a way to identify people who are at increased risk of a particular type of cancer before cancer develops. Endometrial cancer and breast cancer share some risk factors related to hormones and a woman's reproductive history, so Greene and his colleagues reasoned that women with a family history of breast cancer might be more likely to develop endometrial cancer.

But the results of the new study "did not support this hypothesis," Greene said.

In the study, which included more than 37,000 women who were followed for an average of nearly 14 years, a family history of breast cancer--in a mother, sister, daughter, aunt or grandmother--was not linked to an increased risk of endometrial cancer. Women whose mother or sister had cancer in both breasts were more likely to develop endometrial cancer, but this increased risk was not statistically significant. The findings are published in the November issue of the Journal of Medical Genetics.

Although a family history of breast cancer does not seem to increase the risk of endometrial cancer, women who have breast cancer themselves may be more likely to develop endometrial cancer, the report indicates. The investigators found that breast cancer survivors were about 30% more likely than other women to develop endometrial cancer.

"Women who have had breast cancer and who have not had a prior hysterectomy should be alert to early signs suggesting the presence of endometrial cancer," Greene said. The most common symptom of endometrial cancer, he said, is post-menopausal vaginal bleeding or spotting. He advised women who experience this type of bleeding after breast cancer to let their healthcare provider know promptly. Greene noted that "early-stage endometrial cancer is easily cured in the vast majority of women."

Source: Journal of Medical Genetics 2002;39:826-832.

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Reeve's Brain, Paralysis Studied

By Paul Recer

AP Science Writer

The Associated Press

Monday, December 9, 2002

WASHINGTON (AP) - Seven years after actor Christopher Reeve was paralyzed from a spinal cord injury, tests show his brain has maintained a near-normal ability to detect feeling and direct movement. The finding suggests the "use it or lose it" rule may not apply to the brain after all, experts say.

Years of research has shown in animals that when the spinal cord is severed, cutting off signals to parts of the brain, then the brain will reorganize itself and eventually not respond to signals from the paralyzed part of the body.

But a study by researchers at Washington University School of Medicine in St. Louis using a MRI technique shows that may not be true for Reeve.

"We see evidence of some reorganization in this patient," said Dr. Maurizio Corbetta, a Washington University neurology researcher. "But we also see strong evidence for stability ... which goes against the principle of `use it or lose it.'"

"We are very encouraged with these results," said Corbetta, the first author of a study in the Proceedings of the National Academy of Sciences (news - web sites).

Other experts cautioned that the study deals with only one patient and that extensive studies would be needed to determine if the findings are true in other patients with spinal cord injuries.

Reeve, who played Superman and other roles in movies, was left paralyzed from the shoulders down after breaking his neck in a fall from a horse in 1995. The fall severed most of the nerves in the spinal neural bundle that carries signals between his brain and the rest of his body.

He started a concentrated program of exercise and electrical muscle stimulation in 1999 and doctors announced earlier this year that the actor has enjoyed a slow rebirth of limited sensation and movement. At the time, some doctors called it "an unprecedented amount of recovery" for a patient with such an injury.

Corbetta said the new studies show Reeve may be exceptional in another way — his brain has remained receptive to signals from the paralyzed portion of the body even though most of those signals were interrupted by the injury.

Some researchers, based on the animal studies, have suggested that repairing the spinal cord would do little good because the brain has effectively given up on the paralyzed portions of the body and has changed so it no longer could process those signals.

"The usual argument is that the brain has reorganized so what good is it going to do (to repair the spinal cord)," said Corbetta. "At least in this case, some of the responses are more normal than we would have expected. So there is new hope."

Naomi Kleitman, program director of spinal cord injury research at the National Institute of Neurological Disorders and Stroke, said the Reeve study is "an observation" that cannot be applied to spinal cord patients in general. But she said it does show the potential value of using MRI, or magnetic resonance imaging, to assess spinal injuries and to more precisely evaluate the prospects of recovery. The Reeve study should encourage more research in using the technique, she said.

"This is an area the National Institutes of Health (news - web sites) is very interested in," said Kleitman. MRI studies "hold tremendous promise" for determining the severity of spinal cord injuries and helping doctors direct rehabilitation.

In the study, Corbetta said he and others at Washington University used an MRI to map the patterns of brain activity in response to touch and movement. For the movement study, Reeve followed the video image of a tennis ball and indicated the direction with either his tongue or the movement of the left index finger.

As this occurred, the MRI detected the active parts of the brain.

"There is a picture of your body plotted on the brain," said Corbetta, "with different parts of the brain driving different parts of the body." MRI, in effect, maps the areas that respond to specific actions or sensations.

The researchers then compared Reeve's results with those of an identical test conducted on a healthy 23-year-old and found only slight differences.

"We were surprised with the results," said Dr. John W. McDonald, a Washington University researcher and co-author of the study. "This crosses a new threshhold."

Corbetta said Reeve's brain was "pretty much normal on the sensory maps. He had feeling in both his foot and his hand."

For motion, Corbetta said he found that areas of the brain that normally control the hand had been taken over, to some extent, by areas that control the face. The brain circuits linked to the foot, though, were normal.

Reeve said in a telephone interview that he was excited by the results.

"I find it very encouraging, not only for myself, but for other spinal cord injury patients as well," he said. "It means that there are no absolutes and patients should be encouraged to push as far as they can."

On the Net:

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

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AMA Goes After Beer Ads Aimed at Underage Drinkers 

By Peggy Peck

Reuters Health

Monday, December 9, 2002

NEW ORLEANS (Reuters Health) - The American Medical Association (AMA) wants to ban beer and wine ads from prime-time television and is asking both network and cable TV to veto all ads that feature "mascots, celebrities or sports figures promoting alcohol products."

Dr. J. Edward Hill, chairman of the AMA's board of trustees, said the AMA is asking both networks and cable outlets to sign onto a voluntary agreement to hold off beer and wine ads until after 10 PM or initiate a total ban during programs that are aimed at youth--defined as a viewing audience that is at least 15% adolescents. He announced the new initiative at a press conference held in conjunction with the AMA's office of alcohol and other drug abuse.

Hill said the AMA has a long-standing policy opposing alcohol advertising aimed at children but is acting now because of "recent evidence that alcohol damages the brains of young people and that damage may be irreversible." The AMA also released a new report titled "Harmful Consequences of Alcohol Use on the Brains of Children, Adolescents and College Students."

The report, authored by Drs. Donald W. Zeigler, Claire Wang and Richard Yoast, concludes that no "pattern of drinking is without special risks to the developing brain from its fetal stage until early adulthood."

Dr. Sandra Brown, an alcohol researcher from the University of California, San Diego, who joined the press conference by telephone, said researchers have long known that alcohol "has a detrimental effect on adult brains. The frightening new news is that it has the same effect on young brains."

Brown said published studies using functional MRI to compare adolescents who are regular alcohol users to abstinent teens demonstrate decreased function in brain areas that affect memory as well as spatial visual function. Additionally, she said that even after abstaining from drinking for 3 weeks, teens who are regular binge drinkers show deficits in retention of both verbal and non-verbal information, suggesting a defect in short-term memory.

Dr. David Jernigan, a researcher at Georgetown's Center on Alcohol Marketing to Youth, said his research suggests that both the beer and hard liquor industry specifically target underage drinkers. "Underage drinkers account for 12% of all alcohol sales," Jernigan said. He noted that two trade associations, the Beer Institute and the Distilled Spirits Council of the United States, have policies that prohibit ads targeting teens or ads that feature sexually suggestive behavior.

But Jernigan then illustrated several examples of television, print and Web-based advertising that appear to violate those standards. He said that his group will release another study on December 17 that will look at youth-targeted TV advertising. He said his center is petitioning the Federal Trade Commission to once again investigate advertising practices of the liquor industry.

Hill said the AMA is seeking voluntary cooperation from television outlets, but said that the organization will not back off this new campaign. Noting that in New Orleans it's less expensive to buy beer than milk or juice, he added, "we can't let our children drown in a river of cheap beer."

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Study Firms Evidence on Colic Relief

By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, December 9, 2002

Mothers of colicky babies, take heart: New research bolsters evidence that the incessant crying usually stops by about 3 months of age — and has no lasting effects on your sanity.

The good news "should provide some relief to parents who find themselves caring for a colicky infant," said Canadian researchers who studied 547 mothers and babies.

Based on the mothers' reports, 131 of the babies at age 6 weeks had colic, which was defined as inconsolable crying for three or more hours a day at least three days a week.

The maddening but generally harmless condition disappeared by 3 months in more than 85 percent of the babies. Babies at 3 months cried and fussed for an average of about one hour per day, or about half that seen when they were 6 weeks old, the researchers found.

The results suggest "that early crying patterns reflect a process of normal maturation," according to the study, led by researcher Tammy Clifford at the University of Western Ontario. Clifford is now at the Children's Hospital of Eastern Ontario Research Institute in Ottawa.

The study appears in December's Archives of Pediatrics & Adolescent Medicine, published Monday.

At least 10 percent of U.S. babies are thought to have colic. Their crying episodes have no obvious cause, may last several hours and can be terribly frustrating for new parents.

But the researchers found that, early on, mothers of colicky babies reported levels of anxiety and depression similar to those with less fussy babies, and that the symptoms in both groups of mothers generally subsided by the time the infants were 6 months old. Fathers were not studied.

Other researchers have suggested that colic may cause some parents to shake their babies to death.

Most of the mothers in the Canadian study were married, financially secure and had resources to help deal with their cranky babies. Clifford theorized that mothers facing extreme stress or financial hardship might be less able to cope with colic and could have elevated levels of anxiety or depression.

Nonetheless, colic expert Dr. Ronald Barr of McGill University called Clifford's study an important contribution to sparse research on colic.

The findings add to evidence that "the outcome for infants with colic is good, at least in low-risk populations," Barr said in an editorial.

On the Net:

Archives: http://www.archpediatrics.com

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Study Ties Chili Pepper to Gallbladder Cancer Risk 

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - Poverty and eating lots of red chili pepper may increase a person's risk of gallbladder cancer, new study findings from Chile suggest.

Since the 1970s, cancer experts have tracked a steady rise in the rate of gallbladder cancer among Chileans, who now have the world's highest rate of death from the disease. Gallbladder cancer incidence has grown from about 3 per 100,000 people to roughly 12 per 100,000, according to the report published in the International Journal of Cancer.

Public health officials can't explain the increase.

To investigate, lead author Dr. Ivan Serra of University of Chile in Santiago and colleagues evaluated 114 patients with gallbladder cancer. All were interviewed about various lifestyle habits and compared to a similar group of patients who had gallstones but not gallbladder cancer.

"Patients with gallbladder cancer differed from matched controls by exhibiting lower socioeconomic levels, having a much longer history of gallstone disease and presenting a dietary pattern characterized by high red chili pepper consumption and low fresh fruit intake," the authors write.

Specifically, poverty and high chili pepper consumption were associated with a sixfold and threefold increase in gallbladder cancer, respectively, the study indicates.

While the researchers found an increased risk for gallbladder cancer among people who consumed more than 20 grams of chili peppers per day, the authors note that this finding does not automatically implicate capsaicin--the substance that makes chili peppers hot--as a risk factor. "Other factors associated with high chili pepper consumption may be important," they note in their study.

In addition, the researchers say that consumption of fresh fruit may offer a protective effect against gallbladder cancer.

"Further examination of every potential risk factor (for gallbladder cancer) is warranted," Serra and colleagues conclude.

Source: International Journal of Cancer 2002;102:407-411.

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Doctor Links Kids' Fears to Recovery

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, December 9, 2002

WASHINGTON (AP) - The anesthesiologist lowers a drug-filled mask over the terrified child's face, holding it in place until the youngster goes limp and the screaming stops.

Often, that's how children are put to sleep for surgery, and it infuriates Dr. Zeev Kain. His research shows that children who cry as they're being put under anesthesia suffer nightmares and even heal more slowly than calm youngsters.

Yet too few hospitals routinely offer simple measures — like a cherry-flavored sedative before the scary anesthesia mask or a mom hugging her child in the operating room as he falls unconscious — that can ease tots' fears.

Armed with $3 million from the National Institutes of Health (news - web sites), Kain is out to get the final proof that easing children's anxiety helps their health, research that may change how hospitals prepare their smallest patients for surgery.

"We have a policy in this hospital in which the operating room is a no-crying zone," says Kain, anesthesiologist at Yale-New Haven Hospital and professor of child psychiatry at Yale University School of Medicine.

To minimize children's pain, doctors today induce anesthesia with gas instead of the needle parents may remember getting.

It should be simple: breathe through a mask for a few minutes and drift off.

But up to 65 percent of children experience high anxiety before an operation, especially those under 4 who can't understand what's happening. Much of the anxiety occurs when children are taken from their parents into a noisy operating room to undergo the anesthesia. The gas smells bad and the mask over their nose and mouth is frightening, and young children almost invariably cry and struggle to get away.

There are ways to ease the anxiety. A liquid sedative called Versed leaves youngsters drunkenly relaxed and causes temporary amnesia, so those who still cry don't remember it. It's very safe, but doctors must remember to give it 20 minutes before it's time for the anesthesia.

"It's just so nice not only for the kids ... but it makes the parents feel so much better," says Dr. Carolyn Bannister of Egleston Children's Hospital in Atlanta, which gives Versed to all toddlers and any older child who's anxious — and rubs the anesthesia mask with bubble gum-flavored lip balm to disguise the noxious odor.

Some hospitals let parents in the operating room to distract their child, perhaps by singing or playing with a balloon while they're being put under. But parents can't show nervousness or be critical — Kain recalls one dad making a 3-year-old wail even louder when he said only babies cry. For older children, get-acquainted hospital tours to learn what will happen may help.

No medical guidelines require such steps. Kain says 30 percent of hospitals ban parents from operating rooms. And, he says there is wide geographic disparity in how many routinely offer Versed — from a mere 5 percent of hospitals in some areas to 45 percent in others.

In fact, some anesthesiologists say crying under the mask is good because kids inhale the gas faster.

"Let them cry under a mask," retorts Kain, who laments that up to 15 percent of children must be physically restrained until the gas takes effect. "The anesthesiologist isn't at home with the parents to see the child with nightmares because of their experience."

Kain says about 40 percent of children undergoing outpatient surgery developed nightmares, separation anxiety or temper tantrums for weeks afterward. The more traumatic the anesthesia experience, the more behavior changes. About 75 percent of kids who screamed and had to be held down under the mask had nightmares.

Studies in Europe found similar results.

More significantly, Kain discovered that children who were calm before having their tonsils removed needed much less pain medication and returned to school sooner than upset kids.

"Physicians have to be aware of the fact that this preoperative anxiety does have an effect," says Dr. Lynne Haverkos of the NIH — which just awarded Kain $3 million to study 500 children in hopes of settling just how big a problem that anxiety is and whether Versed or other calming methods work best at easing it.

Many doctors aren't aware there is a problem, says Bannister, who heads an American Society of Anesthesiologists committee monitoring Kain's work. Still, even those who don't routinely offer Versed seldom refuse it, she says — "but the parent has to know to ask."

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

On the Net:

Parents' anesthesia brochure: http://www.asahq.org/patientEducation/childanes.htm

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Vitamin E, Bladder Cancer Risk Studied 

By Suzanne Rostler

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - People who take vitamin E regularly are less likely than those in the general population to die of bladder cancer, researchers report, but it's not clear if the vitamin itself is responsible for the reduced risk or some other lifestyle factor.

Researchers tracked nearly 1 million US adults for 16 years and interviewed them about their diet. Those who reported taking vitamin E supplements for at least 10 years were less likely to die from bladder cancer, compared with adults who did not use supplements for as long. There was no association between regular vitamin C use and bladder cancer, report researchers in the December issue of the American Journal of Epidemiology.

The results support those of two other reports that showed a link between bladder cancer and vitamin E intake. Such studies cannot prove that the vitamin E is responsible for the reduced risk, but do suggest an avenue for further study. Roughly 56,500 US adults are expected to be diagnosed with bladder cancer and some 12,600 individuals are expected to die of the disease in 2002, according to the report.

Cigarette smoking is known to raise the risk but there are few factors that are thought to prevent the disease. Vitamin E, an antioxidant, may squelch free radicals--compounds in the body that cause aging and chronic disease by damaging DNA. Alternatively, vitamin E may boost the immune system or prevent the formation of cancer-causing compounds called nitrosamines.

At this point, it is not clear why vitamin C, also an antioxidant, would not have the same effect. In an interview with Reuters Health, Dr. Eric J. Jacobs, the study's lead author, said that both nutrients have other functions in the body that might be responsible.

Additionally, the findings should be confirmed by other studies, he said.

"Regardless of the results of our study, the bottom line for preventing bladder cancer, as well as many other cancers and serious diseases," is quitting smoking and following a diet rich in fruits and vegetables," said Jacobs, a researcher with the American Cancer Society (news - web sites).

Source: American Journal of Epidemiology 2002;156:1002-1010.

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Frostbite

HealthScoutNews

Monday, December 9, 2002

(HealthScoutNews) -- Frigid air can cause exposed skin to become frostbitten. This is when the tissues in your skin freeze, creating a wood-like texture. The frozen area may turn whitish yellow.

If this happens to you, the Mayo Clinic recommends you first try treating it yourself: Immerse the entire foot, leg or other body part in warm bath water, about 104 degrees. Don't let the body part refreeze.

If the frostbite is hard and waxy or if the area doesn't return to its normal color after you've warmed it, or if it forms blisters, seek emergency care immediately.

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Study Looks at Condoms, Wart Virus Transmission 

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - Evidence remains inconsistent as to whether or not condoms will prevent transmission of the human papillomavirus (HPV), a sexually transmitted virus linked to cervical cancer, a new report suggests.

HPV can cause genital warts in men and women, and some types--usually the ones that do not cause warts--have been linked to an increased risk of cancers of the cervix, vulva, vagina, anus and penis. Up to 50% of the sexually active men and women between the ages of 15 and 49 are believed to be infected with HPV at some point in their life, although most people clear the infection on their own and never develop cancer.

While condoms can help prevent other sexually transmitted diseases, such as HIV (news - web sites), their effectiveness against HPV isn't entirely known, according to Lisa E. Manhart and Laura A. Koutsky of the University of Washington in Seattle.

Manhart and Koutsky analyzed 20 previously published studies of condoms, genital warts, and HPV, and report their findings in the November issue of the journal Sexually Transmitted Diseases.

They found that condom use did seem to protect against genital warts, though the effect was slightly stronger in men than women. They also seemed to protect against some other HPV-related problems, although the results varied. Six of eight studies showed that women whose partners used condoms had at least some protection from advanced precancerous changes in the cervix and 4 out of 5 showed at least some protection from invasive cervical cancer.

"Complete protection from genital HPV infection may be impossible because infections may occur at...sites not covered by the condom," they write.

However, their analysis was limited because the studies lacked information on how and when study participants used condoms--either before or after HPV infection. The researchers note that people using condoms for contraception--as opposed to disease prevention--may be more likely to have genital contact allowing transmission of the virus.

"The studies included here represent the best available data describing the relationship between condoms and HPV-related conditions," according to the report.

The findings suggest that condoms may help prevent warts and some other problems--possibly by cutting down on the amount of virus transmitted--but "perhaps not actual infection by HPV," the authors note.

Source: Sexually Transmitted Diseases 2002;29:725-735.

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Shin Splints

HealthScoutNews

Monday, December 9, 2002

(HealthScoutNews) -- Shin splints, aching on either side of the shinbone, are caused by weight-bearing exercises, such as jumping, running, and dancing. They usually occur over a period of time, with a gradual increase in pain.

To relieve pain and hasten recovery, the University of Illinois McKinley Health Center suggests you:

  • Lay off all high impact exercise.
  • Ice your leg two or three times a day.
  • To reduce inflammation, take an anti-inflammatory drug three times a day for one to two weeks.

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Despite Safety Measures, Skate Parks Not Risk-Free 

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - Commercial skate parks arose as safe havens for skateboarders and inline skaters, but a new study shows potentially serious fractures, dislocations and head injuries can still occur in these parks.

The results are based on data from 100 skaters and stunt bike riders who landed in a university emergency department after sustaining an injury in a skate park in southern California. Fractures, dislocations and soft tissue injuries accounted for 80% of all injuries, while head and facial injuries occurred in 17% of skaters. Some skaters lost consciousness after a head trauma, but no head injuries required operations.

The majority of injuries--55%--occurred in the ramps/bars region of the park, a finding that points to a way for skate park safety to be improved. This area of platform ramps and metal railings is one of the most popular attractions in the park, Dr. Worth W. Everett from the University of Pennsylvania in Philadelphia explains.

"The landing areas around the ramps/bars areas should be examined given the high-impact nature of the stunts and tricks performed in those areas," he writes.

In other findings, the use of safety equipment was high, possibly as a result of skate park rules requiring the use of helmets and other protective clothing. Nearly all--98%--of individuals in the study said they used a helmet, 94% said they used knee protection and 91% said they wore elbow guards.

However, just 18% said they used wrist protection, which has been shown to lower the risk of injury dramatically, according to the report in a recent issue of The Journal of Emergency Medicine.

The majority of injuries were considered mild or moderate, and just 9% of those injured were admitted to the hospital for further care.

Everett, the study author, acknowledges that skate parks provide a number of safety advantages over the street, including good lighting, regularly maintained skating surfaces and an enclosed space that eliminates the threat of motor vehicles.

However, "a substantial number of injuries occurred at the skatepark, despite controlled conditions and equipment requirements," he concludes.

Source: The Journal of Emergency Medicine 2002;23:269-274.

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A Slave To Routine?

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Monday, December 9, 2002

MONDAY, Dec. 9 (HealthScoutNews) -- Routines and rituals are alive and well in the United States -- and keeping people well in the process.

That's the contention of a review of 50 years of research that appears in the December issue of the Journal of Family Psychology.

Many Americans regularly engage in routines and rituals, and these practices help to improve their mental and physical health and sense of belonging, according to the researchers who did the analysis of 32 studies.

Routine events, such as evening dinners together as a family, provide comfort simply by being predictable events people can count on, says study author Barbara Fiese, a psychologist at Syracuse University in New York.

And many still favor rituals associated with important events, such as Christmas Mass, bar mitzvahs and funerals. These rituals, in turn, enhance emotional well-being, she says.

Fiese wasn't surprised by the findings, but she was buoyed by them. "I'm encouraged. It helps to dispel myths that families don't practice rituals and routines. They are alive and well," she says.

The information for her analysis was relatively sparse when one considers what is covered in a period of 50 years. However, people interviewed for the studies during that period reported participating in many routines and rituals, and the research shows each confers different benefits, Fiese says.

Routines are acts done regularly that need to be done, such as eating or preparing for bed, which take time but are seldom thought about afterward, she says.

"Having some predictability in life around routines is positive," Fiese says.

Children flourish when they can predict things in their life, such as family dinners or regular bedtimes, the study found. Regular family dinners, even if only for 20 minutes a day, are the most common routine.

"If you look at dinner time, for example, it's not happening seven days a week but usually four or five times," Fiese says. "Even that short period of time has a positive effect. It's related to physical health in infants and children and academic performance in elementary children."

Rituals, on the other hand, are symbolic practices people do or celebrate that help define who they are -- and about which they often reminisce, she notes.

The meaningful, symbolic parts of rituals seem to help emotional development and satisfaction with family relationships. When rituals are continued during times of stress, such as a divorce, they lessen the negative impact.

"They have the potential to protect kids from risks associated with one-parent families," Fiese says. "It seems that at points of transition, such as school or marriage, rituals can increase one's sense of security."

The studies reviewed were extremely diverse in the way they were conducted. That made it impossible to make comparisons between them to come to certain conclusions, such as how many routines or rituals are necessary to bring about improved health, Fiese says.

For example, although family dinner was found to be the most consistent routine, three to four times a week seemed average. "I don't know if that means five is better or two is bad," she says.

Irene Goldenberg is a family therapist at the University of California, Los Angeles.

In family therapy, Goldenberg says, therapists routinely advise people to create rituals they can follow because "they are so important. They represent an order and a sense of logic. They make the family more of a unit and tend to make it clear what the values are in the family."

Goldenberg says every ritual stands for something, such as marriage, which is an entrance into a family, or a funeral, which is recognition of the end of a life. They give people an opportunity to "talk about developing life forces."

As for routines, she adds, "I think everyone can understand why those are comfortable."

Fiese cautions that as people near the holidays, they shouldn't feel that because rituals and routines are beneficial, they must be strictly adhered to, even if they cause stress.

It may be beneficial to identify three things you dread about the holidays, and avoid them. Conversely, you can identify three things you look forward to, such as baking a particular type of cookie, and "make sure you preserve those things," she says.

What To Do

To learn more about the value of rituals to family life, visit ChildCareAware or read this paper offered by Kansas State University. To read it, you'll need the Adobe Acrobat Reader, which you can download by clicking here.

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US Healthcare Costs Jump 15 in 2002 

By Karen Pallarito

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - Healthcare costs per employee climbed nearly 15% this year, even though many of the nation's largest employers dropped health plans and scaled back benefits, according to survey results released on Monday by Mercer Human Resource Consulting.

The 2002 increase--the largest since 1990--punctuates a period of staggering growth in health benefits costs and underscores the difficulty employers are having in putting a lid on healthcare inflation. With healthcare costs ballooning at more than seven times the general rate of inflation, employees are being forced to pay for more of their own care out of pocket through higher co-payments and deductibles.

More than half of large employers (51%) now use three-tier co-payment plans for prescription drugs, for example, up from 40% in 2001. Individuals paid an average of $10 for generic drugs and $35 for non-formulary brand-name drugs this year, helping to keep the increase in large employers' prescription costs to 16.9% in 2002, compared with 17.8% in 2001.

The annual Mercer survey is based on a poll of nearly 2,900 public and private employers with 10 or more workers. The survey has a margin of error of plus or minus 3%.

Employers' average cost of providing health benefits for active workers jumped a total of 14.7% to $5,646 per employee in 2002, up from $4,924 last year, the survey found.

Small and medium-sized employers, however, experienced much sharper rates of increase. Companies with fewer than 500 workers saw costs surge 18.1% to $5,492 per employee. Large employers, on average, held cost increases to 11.5%, resulting in a $5,758 healthcare tab per employee.

"What the largest employers told us was that their threshold of pain had been met and exceeded, in fact," said Blaine Bos, a consultant in Mercer's Minneapolis office and one of the study's authors.

While holding the line on employee premium contributions for 2002, employers dropped the highest-cost HMOs, added hospital deductibles and boosted co-payments for physician office and emergency room visits, Bos told Reuters Health.

Despite those efforts, employers expect healthcare costs to rise an average of 14% for 2003, the survey found. The relentless rise means employers are "more likely to attack the premium" next year, Bos predicted.

One in four employers overall, and nearly one of every two large employers, say employees will pay a larger share of health plan costs as a percent of premium next year, the survey found.

Mercer also reported evidence that so-called consumer-directed health plans are catching on and predicted significant growth in 2003 enrollment levels.

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An Unusual Treatment for Cocaine Addiction

HealthScoutNews

Monday, December 9, 2002

MONDAY, Dec. 9 (HealthScoutNews) -- A drug used to treat cystic fibrosis may reduce cocaine cravings, American researchers say.

Studies by the scientists found that the drug, n-acetyl cysteine, reverses the changes in brain chemistry believed to cause cocaine craving. They've studied the effects of cocaine in a region of the brain called the nucleus accumbens, an area of the brain associated with motivation.

Their findings are being presented this week at the American College of Neuropsychopharmacology's annual meeting in San Juan, Puerto Rico.

Initial studies were done in rats, with promising results. The scientists are now designing experiments to determine if the drug will be as effective in controlling cocaine cravings in humans.

More information

The U.S. National Institute on Drug Abuse has more about cocaine addiction.

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Technique Predicts Whether Tumors Will Spread 

By Alison McCook

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - A technique that measures how genes are expressed in a newly formed tumor helps predict whether the cancer will spread to other parts of the body.

So far, the method has successfully distinguished between tumors from patients with the same form of cancer whose early tumors spread or stayed put, and has picked out tumors from patients who survived longer than other patients with the same type of cancer--another sign that the cancer had not spread to other regions.

However, the technique is many steps away from being able to predict an individual patient's chances of a tumor staying put or spreading, lead author Dr. Sridhar Ramaswamy of the Dana-Farber Cancer Institute in Boston told Reuters Health. Ramaswamy also holds a position at the Whitehead Institute at the Massachusetts Institute of Technology (news - web sites).

"We would hope that this information would be translated into some kind of diagnostic for cancer," Ramaswamy said. "But we still have a ways to go before that happens," he added.

That said, if this technique becomes available to individual patients, Ramaswamy predicted that knowing a patient's risk of developing distant tumors, known as metastases, would likely affect how a doctor treats that patient. Many cancer patients who appear to be free of metastases only return later showing signs their cancer has spread, he said. If this technique could predict a patient was likely to develop metastases, "then you might imagine being more aggressive with that patient in terms of treatment," Ramaswamy suggested.

Alternatively, the new tool might also spare other patients the experience of chemotherapy to wipe out cancer cells that might be wandering around their bodies, if a genetic profile of their tumor shows it will probably not spread. "Then you might imagine sparing those people the agony of going through that," Ramaswamy said.

He and his colleagues report their findings in the advance online edition of Nature Genetics, published December 9.

During the study, the investigators compared the expression of different genes in 12 samples of metastases and 64 samples from original tumors. The samples included cancers of the breast, lung, prostate, colon, uterus, and ovary.

Comparing the differences between the metastases and the primary tumors, Ramaswamy identified a certain pattern in 128 key genes, some consisting of genes that were over-expressed in metastases, and some suggesting that certain genes were under-expressed in a metastases. They then analyzed 279 primary tumors removed from patients and found that those with a certain gene expression profile were indeed more likely to have spread in the patient.

Although the test appears to distinguish between tumors that are more or less likely to spread, the researcher said in an interview that investigators would likely need to repeat the test on many more samples to refine how it differentiates between the two types of tumors.

If the technique holds up to further research, Ramaswamy added that it might also shed light on new methods to treat tumors. If certain genes become expressed differently in tumors that metastasize, "then maybe some of these things are actually driving the process," he said, and designing therapies that target these genes might help curb the cancer's aggressiveness.

Source: Nature Genetics 2002;10.1038/ng1060.

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Coffee's Jolt Tied to Genes

HealthScoutNews

Monday, December 9, 2002

MONDAY, Dec. 9 (HealthScoutNews) -- American and German researchers say they've found the genetic basis for the jitters that come with your java.

People with two linked genetic variations are far more likely to suffer caffeine-induced anxiety than other people, says the study, which was presented yesterday at the American College of Neuropsychopharmacology's annual meeting in San Juan, Puerto Rico.

It's the first study to identify why people have different behavioral reactions to the same drug. Not only does it provide new insight into why caffeine affects people in different ways, the study also validates a testing method that may help identify individual differences in how people respond to a number of major drugs, the researchers say.

The study was done by researchers from the University of Chicago and two German universities. They studied 94 healthy, infrequent caffeine users. The subjects were given either oral doses of caffeine or a placebo, and the researchers recorded the subjects' physiological reactions and their mood states.

Blood samples were also collected from the study participants and checked for the genes that code for two proteins, called adenosine receptors, that are known to interact with caffeine.

The researchers found four genetic variations of the adenosine receptors in the study group. After analyzing their results, they found that people with two specific variants in the A2a receptor gene had much higher levels of anxiety after consuming caffeine than other people in the study.

Previous studies found that people who suffer from panic disorder are likely to have one of the same variants. Caffeine is a common trigger of panic attacks in people with panic disorder.

The researchers plan to use the same testing method to study how people react differently to amphetamines.

More information

Here's where you can find more information about the health effects of coffee.

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Pregnant Women Unaware of Labor Pain Relief Options 

By Martin F. Downs

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - Many women may not know all their options for pain relief during childbirth, researchers report.

Doctors at the Texas Tech Medical Center in El Paso surveyed 200 pregnant women who visited the hospital, asking them what they knew about the various ways of coping with labor pain and what they thought of those methods.

Sixty-two percent of the women were not aware of all the options, even though 75% of all those surveyed had given birth before. Of the women who had given birth previously, less than half had ever received an epidural anesthetic--an injection that numbs the lower body--during labor. But of those who had, most said that getting the epidural was a good experience.

When asked about "natural" birthing techniques, 80% of the women said they knew about such things, and 83% said they would prefer to give birth naturally. Nevertheless, "the patients don't know what exactly natural birth is," lead author Dr. Phool Chandra told Reuters Health. "Even the doctors were not 100% clear what natural means."

But he said that natural birthing, in general, may be understood as any way of managing labor pain that doesn't involve drugs--such as breathing exercises and relaxation techniques.

Chandra said he thinks the women's age and ethnic background might explain why so few had used pain relief during labor, and why they expressed a preference for natural birthing techniques. Nearly three quarters of the women identified themselves as Hispanic, and about one half were aged 21 to 30.

He said there may be a cultural bias in favor of natural birthing, "in the sense of what has been told to the young mother by their older relatives who had the experience."

Giving a woman anesthetic during labor carries some risk. For example, if she takes a narcotic, the baby may have trouble breathing when it is born. "Any medication that you give to the mother is going to affect the baby, depending on how much and how long," Chandra said.

But he said, "The pain has to be somehow managed." Among all the options available, Chandra added, "we think that the local anesthetic epidurally is probably the better one, with a minimum effect on the baby, and giving the mother the best chance of enjoying the process."

Considering the survey results, Chandra and his colleagues intend to create a pamphlet to inform women about anesthetics in the hospital's prenatal clinic. But he said education about pain management should go beyond the hospital walls. "It should be at an earlier stage," he said. "It becomes kind of late when the patient is already in agony."

Chandra presented the study this weekend at the New York State Society of Anesthesiologists' 56th Postgraduate Assembly in Anesthesiology.

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Parkinson's Affects Driving Ability

HealthScoutNews

Monday, December 9, 2002

MONDAY, Dec. 9 (HealthScoutNews) -- As their condition worsens, people with Parkinson's disease (news - web sites) are more likely to have a traffic accident.

That finding comes from a University of South Florida study in tomorrow's issue of Neurology.

In the study, 39 people with Parkinson's and a control group of 25 people without neurological disease did driving simulator tests. They were all given 10 to 15 minutes to practice on the simulator before testing.

All the people with Parkinson's had more total collisions on the driving simulator than those in the control group. The collision rates for the people with Parkinson's corresponded directly to the severity of their disease progression, the study found.

Of the 39 people with Parkinson's, seven had stopped driving because of difficulties concentrating, 10 reported they had reduced their amount of driving, and 22 said their driving habits hadn't changed, even though most of them reported they had increased difficulty driving since being diagnosed with Parkinson's.

The study authors recommend larger, long-term driving simulator studies in order to develop rigorous driving safety guidelines for people with Parkinson's.

More information

The U.S. National Institutes of Health (news - web sites) has more about Parkinson's disease.

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Ketamine Safe Way to Sedate Kids for Medical Scan 

By Martin F. Downs

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - Ketamine is best known as an anesthetic vets use for surgery on cats, and as an illicit drug popular in the dance club scene. But some doctors say it is also good for sedating children during medical procedures.

At Brookdale University Hospital in Brooklyn, New York, doctors studied the effects of ketamine on 1,276 children, ranging in age from 2 months to 12 years. They injected the children with small doses of the drug before they underwent MRI or CT scans.

Children are routinely given some kind of anesthetic for these procedures; not because there's any pain involved, but because the experience can be frightening. "A 5-year-old kid isn't going to stand it if you put him in a scanner," lead author Dr. Thomas Crimi told Reuters Health.

Few of the children had side effects from the ketamine. The most common were nausea and vomiting, which occurred in 23 kids. Only seven experienced delirium or hallucinations, which were described as "mild," and which went away in a few hours.

"Ketamine was used extensively in the past," co-author Dr. Rafik Michael said in an interview. It fell out of favor with doctors because of the delirium and hallucinations, which are more common and more severe at higher doses. "Ketamine came back," he said, but many doctors are still afraid to use it because of these notorious effects.

Michael said the purpose of the study was to show that ketamine is not only safe to use on kids, but in some ways it's better than other anesthetics. "For short procedures it is a very good, effective drug," he said.

One reason is that the injection, given in the shoulder muscle, is "just a pinprick." Michael said parents tend to be more concerned about how their child is anesthetized, and less so about what drug is used. "Parents need to see the child not suffering," he said. "The child doesn't suffer from the injection, or even trying to find an intravenous line."

With ketamine there is also no need for a breathing tube, which may be necessary with some other drugs. "The patient can just breathe room air or a little oxygen," Michael said. "There are no tubes; there is no anesthesia machine."

What's more, the Brookdale doctors argue that ketamine can save time and money. "Our problem is cost-effectiveness," Michael said. Patients who have to stay and recover from a long-lasting anesthetic tie up hospital resources. "If every patient stays 3 to 5 hours, this would be a problem." With ketamine, he said, "after 20 minutes you go home."

At the dosage given to children in the study, the drug started working in about 2 minutes. Small children were held on their parents' laps when they got the injection, then taken to the scanner once the drug kicked in. The effects wore off in 20 minutes, on average. Some kids whose scans took longer than others got another shot of ketamine to keep them under. In these cases, the drug's effects lasted an average of 30 minutes.

"It's a very soothing, participatory process for the parents," Crimi said. "We found out when we did post-op callbacks that the parents were very satisfied, and we find no lingering effects for the child."

The study data were presented this weekend at the New York State Society of Anesthesiologists' 56th Postgraduate Assembly in Anesthesiology.

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Statins Improve Heart Transplant Survival

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, December 9, 2002

MONDAY, Dec. 9 (HealthScoutNews) -- Giving heart transplant recipients a cholesterol-lowering statin drug greatly improves their chances of long-term survival, German cardiologists report.

The eight-year survival rate for transplant patients who were given simvastatin, marketed in the United States as Zocor, was 88.6 percent, or 31 of 35 patients, compared to 59.5 percent, or 22 of 37 patients who got standard medical treatment, says a report by the heart transplant team at the Munich-Bogenhausen hospital.

The research appears in tomorrow's issue of Circulation.

The study was originally planned to run eight years, but the difference in survival, and in the condition of the patients' arteries, was so clear that they all were given simvastatin after four years, the report says.

In particular, the statin treatment prevented a condition called transplant vasculopathy, a thickening of the coronary artery that gradually chokes off blood flow. It also reduced the incidence of transplant rejection episodes that were severe enough to be life-threatening or fatal.

"The transplant arteriopathies [disorders] that a lot of people develop is recognized as a different disease than standard coronary artery disease," says Dr. Daniel J. Rader, director of preventive cardiology at the University of Pennsylvania School of Medicine. "We know that reducing blood cholesterol reduces the risk of heart disease, but we have not had the same reason to believe it reduces the risk of transplant arteriopathy. This is one of the first studies to suggest that it does."

The German study provides convincing evidence for a practice that has become common in most American heart transplant centers, says Dr. Sean Pinney, an attending cardiologist in the Columbia-Presbyterian Medical Center in New York City and a member of the center's heart transplant team.

"All the patients in our center and in other centers are treated with statins," Pinney says. "The interesting thing is that this study started eight years ago, before a consensus emerged on the use of statins. What it does is provide more supportive information about the use of statins in heart transplant patients, reinforcing their role in preventing artery disease."

"The consistent and effective lowering of cholesterol levels played a decisive role," the journal report says.

However, Dr. Edward M. Geltman, professor of medicine at Washington University in St. Louis and director of the heart failure program at Barnes Jewish Hospital there, says the reduction in severe rejection episodes could also be important.

By themselves, statins are not known to have any effect on the immune system. That might change in the presence of cyclosporine A, which is given to transplant patients to prevent the immune system from reacting against the transplanted tissue, Geltman says.

"Our assumption is that the way it works is not entirely by lowering cholesterol but by reducing the number of inflammatory episodes," he says. "It could be due to the way the liver detoxifies cyclosporine, a metabolic pathway in which there is an interaction with the statin. That has been shown for two different statins, simvastatin and pravastatin."

Whatever the reason, the high survival rate in the German study is "outstanding, way beyond the U.S. national average," Geltman says. And statin treatment "is remarkably safe, with no significant side effects," he adds.

What To Do

Get information about heart transplantation from the American Heart Association, which also has a page on statins and other cholesterol-lowering drugs.

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Scientists Fret as Plant-Derived Drugs at Crossroad 

By Carey Gillam

Reuters

Monday, December 9, 2002

KANSAS CITY (Reuters) - In Kentucky, tobacco plants are turning into cancer-fighting drug factories. In Virginia, corn is being harvested to treat cystic fibrosis, and in Nebraska, researchers are hoping that fertile farm fields will yield part of a cure for AIDS (news - web sites).

From fields of barley in Washington State to Hawaiian sugar cane groves, US scientists are cultivating agricultural advances that have nothing to do with food and everything to do with finding cheaper, faster and more effective ways to treat a range of human ailments.

The work, which involves using human or other donor DNA to modify plants to genetically produce human proteins, has been underway for more than a decade. But it has only recently reached the critical end stage of clinical trials and commercialization where real patients are receiving dosages of the plant-derived drugs.

"Things are coming to market now ... It's great that we're finally starting to affect patients' lives," said Barry Holtz, senior vice president of biopharmaceutical development at Large Scale Biology Corp. Through clinical trials, Large Scale is providing cancer patients with a lymphoma-fighting injectable drug processed in a tobacco leaf.

But as the science community celebrates its progress, it also is wrestling with opposing forces that fear unneeded medicines may accidentally wind up on a dinner table, making well people sick instead of sick people well. Those fears were underscored last month when it was revealed that one of the leaders of the high-tech pack, Texas-based Prodigene Inc., had violated federal guidelines, inadvertently contaminating grain in Iowa and Nebraska with corn genetically modified for use in medicines to treat diabetes and diarrhea.

The disclosure set off a firestorm of debate, highlighted by opponents hanging a banner on a Nebraska grain silo proclaiming: "This is your food on drugs."

Opponents have seized on Prodigene's failure to isolate its crops as proof that science cannot control its technology, and have called for the government to ban plantings of pharmaceutical crops, at least with food crops such as corn.

"We shouldn't be doing this with our food at all, period," said Friends of the Earth (news - web sites) spokesman Mark Helm. "These types of contaminations are going to occur and are potentially extremely dangerous. The practice of engineering drugs into our food crops... is bordering on insanity."

Not A Pipe Dream

The backlash sparked by Prodigene's problems has driven fear into the tightly knit group of research and biotech firms racing to perfect a range of drugs from plants.

Many are angry at Prodigene, which is facing a federal inquiry now into its "pharming" practices, fearing its missteps may spoil the playing field for the rest.

"It is extremely disappointing," said Biotechnology Industry Organization spokeswoman Lisa Dry. "Nobody wants to see the technology impugned because it is so important."

Amid the furor, powerful food industry players such as the National Corn Growers Association and the National Food Processors Association are demanding the government tighten regulations on pharmaceutical plant research.

The biotech industry had said it would move research out of the Midwest farm belt starting in 2003 to help allay concerns about contaminating food crops, but backed off that strategy on Dec. 3, saying it would leave such decisions up to federal regulators.

The US Department of Agriculture has said it is examining options to more tightly control the research.

What is at stake in the debate, both sides agree, is potentially the health of people throughout the world. Where opponents see problems introduced into the food supply, supporters of the technology see live-saving possibilities.

Among the products now in the pipeline: A hepatitis-B vaccine, a topical treatment for herpes, an injection that fights the spread of cancer cells, human insulin for diabetics (news - web sites), a vaccine that helps prevent cervical cancer and a treatment to help cystic fibrosis patients digest food.

One product expected to be brought to market soon is aprotinin, useful in controlling blood clotting in heart surgeries. The proteins currently used in the drug are derived from animals--beef lungs, to be specific--and are very expensive to cultivate, according to Prodigene, which is producing the proteins in corn in Nebraska.

The company is also working with the National Institutes of Health (news - web sites) to develop an HIV (news - web sites) vaccine.

"It's not a pipe dream," said Prodigene CEO Anthony Laos, who envisions an edible wafer containing the answer to AIDS, which could be easily distributed to distant countries ravaged by the disease. "We can save millions of lives in the future."

Making It Work

The technique for intermingling human and plant DNA is relatively simple, scientifically speaking. After identifying a specific human protein and its function, researchers insert that DNA into the cells of corn or some other crop. As the plants grow, they reproduce the desired protein, which is then extracted by the researchers after the crop is harvested.

Plant-grown drugs can be developed in greater quantities, faster and much more cheaply than traditional development in multi-million-dollar laboratories, the biotech companies say.

For Holtz and his colleagues at Vacaville, California-based Large Scale Biology, the challenge is no longer how to make the technology work, but how to make sure opposition to the technology doesn't kill its future.

Sixteen people have so far received the company's lymphoma treatment in the first phase of clinical trials, with successful outcomes for all, according to Holtz. A larger clinical trial is slated for 2003.

"We've worked so hard to do things right," he said. "Companies in this business are focused on doing good things for folks."

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Male Obesity More Risky Than Thought

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Monday, December 9, 2002

MONDAY, Dec. 9 (HealthScoutNews) -- Gentlemen, lay off the fatty foods -- they're worse for you than doctors had thought.

But, on the other hand, if you're worried about the risks of losing weight late in life, don't be.

Two studies released in today's issue of Archives of Internal Medicine (news - web sites) give insights into the dangers and myths of weight gain and weight loss for older men.

The first study adds stroke to the list of primary risks from obesity. The second concludes that middle-age and elderly men shouldn't fear the weight fluctuation that often results from healthy dieting.

"The problem is that in the United States, the number of people who are overweight is rapidly increasing. This should give another reason to stay lean," says the lead author of the first study, Dr. Tobias Kurth, with Brigham and Women's Hospital in Boston.

Kurth and a team of doctors associated with Harvard Medical School (news - web sites) examined 12.5 years of health records for 21,414 men, ages 40 to 84. The participants were all doctors who reported information from 1982 to 1995 as part of the Physicians' Health Study.

The researchers found that obesity was a major risk factor for stroke, independent of high blood pressure, diabetes, cholesterol and other common indicators.

Obesity has long been associated with heart disease, the leading cause of death in the United States. But obesity hasn't been clearly tied to stroke, the third-leading killer, because prior studies were too small, Kurth says.

"I think that we should view obesity as a primary risk factor and not a potential, secondary risk factor," Kurth says. "I think that this study's size and the methodology is strong enough for us to increase our focus on obesity."

In fact, the size of the study allowed Kurth to devise a simple formula showing how adding pounds increases the risk of stroke. For most men, an increase in weight of seven to eight pounds results in a 6 percent increase in the risk of stroke, he says.

To more accurately track how weight gain affects risk of stroke, men should calculate their body mass index, which shows the relationship between weight and height. According to the World Health Organization (news - web sites), a BMI less than 25 is normal, 25 to 30 is overweight, and over 30 is obese. According to Kurth, a point increase in BMI increases stroke risk by 6 percent.

"People should focus more on obesity," Kurth says. "Obesity is modifiable. You can reduce your risk of stroke if you can stay lean."

The other study should give older men more faith in the process of losing weight.

Doctors, supported by a few studies, had worried that losing weight and weight "cycling" -- gaining and losing weight through dieting -- was unhealthy for men. But a 12- to 14-year British study of 5,608 middle-age men concludes that "this belief is a barrier to the management" of obesity. The men came from 24 towns in England, and the study evaluated mortality rates for them from 1978 and 1980 to 1992.

Although the study found that men who experienced sustained weight loss or weight fluctuation were at greater risk of death than those who maintained a stable weight, the culprit wasn't weight cycling, says lead author S. Goya Wannamethee, of the Royal Free and University College Medical School in London. When the researchers adjusted the results for pre-existing diseases and smoking, those men who experienced weight fluctuation were at no greater risk of death, he says.

"Many of the earlier studies did not take pre-existing disease or smoking adequately into account," Wannamethee says. "Authorities should continue to encourage and facilitate healthy eating and regular activity towards the prevention and management of obesity."

What To Do

To calculate your body mass index, visit the U.S. Centers for Disease Control and Prevention. For assistance in losing weight, check the American Obesity Association.

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Seniors Still Opt for HMO Coverage Despite Upheaval 

Reuters Health

Monday, December 9, 2002

NEW YORK (Reuters Health) - Many seniors choose to receive their Medicare benefits through an HMO, even though Medicare HMOs have dropped more than 2.4 million seniors since 1998, Weiss Ratings Inc. said on Monday.

The independent financial ratings agency reports that enrollment in Medicare+Choice is off just 16.6% since the program's inception. Meanwhile, the number of health insurers offering a Medicare health plan has dropped 48.3%--from 346 companies in 1998 to 179 in 2003.

"Seniors want and need access to affordable and more comprehensive healthcare," noted Melissa Gannon, a vice president with the Palm Beach Gardens, Florida-based rating agency. "In exchange for the lower out-of-pocket costs and additional benefits that HMOs provide, consumers will accept a lack of provider choice, consistent decreases in covered services, and the risk of losing coverage altogether," she said.

Health plans say reimbursement rates have failed to keep pace with costs, causing a slew of insurers to drop out of the Medicare program entirely or scrap money-losing products in selected markets. The latest round of dropouts, effective January 1, 2003, will affect 215,000 seniors.

Medicare beneficiaries who are losing coverage by the end of the year need to act quickly to avoid any gaps in coverage. Weiss Ratings advises seniors to avoid HMOs if they can afford to, noting that Medicare+Choice enrollees risk losing coverage in the future if HMOs continue to exit the program. It suggests switching back to traditional Medicare and shopping around for the lowest cost "Medigap" policy that meets their needs.

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Anorexia, Bulimia May Be Autoimmune Disorders

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Monday, December 9, 2002

MONDAY, Dec. 9 (HealthScoutNews) -- Scientists may have unraveled another thread in the mystery of anorexia nervosa (news - web sites) and bulimia nervosa, eating disorders that plague three percent of women and girls and a lesser number of men and boys.

Researchers in Sweden have preliminary evidence that the brains of people suffering from anorexia and/or bulimia might be under attack from autoantibodies.

This would put the disorders in the category of autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, which occur when the body's immune system turns on itself and starts to destroy different parts of the body.

The finding, if true, would also radically alter the perception and treatment of these two prevalent eating disorders, which have traditionally been described in behavioral and developmental terms.

"We've seen hints of these abnormalities for a couple of years but this is a very, very strong paper that demonstrates quite convincingly that there's more to eating disorders than meets the eye," says Dr. Henry Anhalt.

"What is becoming clear is that energy metabolism is much more involved," adds Anhalt, director of the division of pediatric endocrinology at Infants and Children's Hospital of Brooklyn at Maimonides Medical Center in New York City

The results of the new study are detailed in this week's edition of the Proceedings of the National Academy of Sciences (news - web sites).

Bulimia and anorexia usually manifest themselves as obsessions with weight and body appearance. People with anorexia try to starve themselves to lose weight, often when no weight loss is needed. Those suffering from bulimia have uncontrolled eating binges followed by purging or vomiting. Often, individuals suffer from both disorders at the same time.

No one knows what causes anorexia and bulimia, but there is at least some suggestion of involvement from neuropeptides, which are chemicals that regulate metabolism and are secreted by the hypothalamus and the pituitary gland.

The Swedish researchers hypothesized that the hypothalamic system in the brain, which is responsible for the regulation of food intake, might be targeted by autoantibodies in women with anorexia and/or bulimia.

To test the theory, the investigators withdrew blood serum from 57 women between the ages of 17 and 42 who had anorexia, bulimia or both. Most of the women (74 percent) produced antibodies that, when applied to sections of rat brains and rat pituitary glands, selectively attached to cells that produce three specific neuropeptides: alpha-MSH, ACTH and LHRH.

Although that's all the researchers know right now, it is possible that the antibodies are destroying or interfering with the brain signals that regulate food intake and body weight.

"This is a possible scenario which we suggested, but it should be ultimately proven," says Dr. Serguei O. Fetissov, lead author of the study and a member of the department of neuroscience at Karolinska Institutet in Stockholm, Sweden.

The fact that a small number of healthy control subjects carried similar antibodies may help unravel the mystery further.

"It may be that the presence of autoantibodies... is related to activation of the stress axis," Fetissov says. "The presence of these autoantibodies could be a stress-related risk factor for the development of anorexia/bulimia, but other factors may trigger this disorder, including those which make women more vulnerable for anorexia."

More research is needed before these and other questions are answered.

"We are going to screen a larger group of patients with stress-related disorders for the presence of autoantibodies against neuropeptides of the stress axis," Fetissov says of his lab's next project. "We are also planning to work with experimental models of disorders potentially linked to autoantibodies against neuropeptides."

Even if the results are verified, it's likely that they would apply to a subset of people with anorexia and bulimia. But they may also apply to people who struggle with obesity. Obesity, of course, is one of the most pressing public health concerns facing Americans, Anhalt says.

"The study really expands our horizons and gives us food for thought," Anhalt says. Right now, physicians feel like "carpenters in a microchip factory," he adds.

Studies such as the Swedish one open the way for new, more finely tuned therapeutics that could target more specifically and more effectively the mechanisms that are responsible for other disorders, such as leukemia, Anhalt says.

What To Do

For more on anorexia and bulimia, visit the National Eating Disorders Association or KidsHealth.org.

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Make End to Racial Care Gap Top Priority, AMA Urged 

By Peggy Peck

Reuters Health

Monday, December 9, 2002

NEW ORLEANS (Reuters Health) - The American Medical Association (AMA) is considering a plan aimed at identifying and eliminating all racial and ethnic disparities in healthcare.

Earlier this year the Institute of Medicine (news - web sites) (IOM) issued a report that concluded racial and ethnic disparities were present in virtually every area of medicine. The AMA's Council on Scientific Affairs (CSA) agreed with the IOM conclusion and in its new report it states that the AMA now recognizes racial and ethnic disparities as "a major public health problem in the United States and as a barrier to effective medical diagnosis and treatment."

Dr. Carolyn Robinowitz, a CSA member from Bethesda, Maryland, urged delegates who might still need convincing on the existence of racial disparities to consider that the CSA produced "a report that contains six pages of text and 11 pages of references."

The CSA report calls on the AMA to work with other organizations and agencies, including the US Department of Health and Human Services (news - web sites), to develop strategies aimed at eliminating the disparities. It also asks the AMA to develop "evidence-based performance measures that adequately identify socioeconomic and racial/ethnic disparities in quality."

In addition to the CSA report, delegates are considering a resolution sponsored by the National Medical Association (NMA) that asks the AMA to direct every one of its councils and committees to identify ways in which each can work to eliminate racial and ethnic disparities. Dr. Rodney G. Hood, the NMA delegate to the AMA, said that directing this type of specific response will guarantee that racial disparities are considered a top priority.

American College of Physicians-American Society of Internal Medicine delegate Dr. Sandra Fryhofer of Atlanta, Georgia, said she was a member of the IOM committee that produced the racial disparities study. "It was quite a shock, because we found these disparities in every area of medicine, across every disease," she said. Fryhofer urged the AMA to take action because "we think the causes are multi-factorial and change will require a system-wide approach."

The AMA's House of Delegates will consider the CSA recommendations as well as the NMA resolution when it begins voting tomorrow.

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SUNDAY, DECEMBER 8, 2002 

Keep Man's Best Friends Warm and Cozy in Winter

 

HealthScoutNews

Sunday, December 8, 2002

SUNDAY, Dec. 8 (HealthScoutNews) -- Don't give your best friend the cold shoulder.

Dogs, cats, birds and other pets are just as affected by cold weather as their human companions and need appropriate protection, says information from Mississippi State University.

Old, sick, newborn and pregnant pets are especially vulnerable to cold, so it's essential they stay indoors during cold weather and get plenty to eat.

Dogs and cats need to stay dry during the winter. If they get wet, their fur coats can't provide the necessary insulation. So, if you have dogs or cats that have to stay outside in the winter, you have to provide them with shelter from wind and rain.

Small dogs and cats shouldn't be kept outside, due to their lower body mass. However, it's OK to take them outside for short periods.

Some people have sweaters to keep their dogs warm. It's a good idea, but dogs with sweaters need to be supervised. If the sweater's threads get caught on something, the dog may get stuck and unable to get back inside to warmth.

Hypothermia is a major risk for hunting dogs, especially those that go into water to retrieve ducks and other waterfowl. If you're a hunter, bring towels so you can dry off your dog after it goes into the water to retrieve a bird.

If you're going to be out for a long time, give your dog regular snacks so it has enough energy to maintain body temperature.

Pet birds need to be kept indoors during winter and should be in a room with a constant temperature. Birds are sensitive to inhalation agents, so you need to keep them away from fireplaces, wood stoves and conventional stoves.

Your pet snake can also be affected by winter chill. Make sure snakes and other reptiles keep their body temperature above 75 degrees Fahrenheit, or their immune system weakens. An external heat source, such as a heat lamp or heating pad, will help provide the necessary warmth for your pet snake or other reptile.

However, remember to keep heating pads on a low setting and cover them with a towel, or your reptile may get burned. Here's a good rule of thumb -- if you can't keep your hand under a heat source for an extended length of time because it's too hot, then it's too hot for your reptile pet.

More information

The University of Minnesota has more cold weather pet tips.

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Common Cold Tests Zinc's Mettle 

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews

Sunday, December 8, 2002

SUNDAY, Dec. 8 (HealthScoutNews) -- Sniffling again?

Perhaps you should try zinc supplements, which have been shown in certain trials to cut the duration of a cold in half. Some researchers have even heralded the element as the long-sought "silver bullet" for treating the common cold.

However, does it actually work?

"It depends on who you ask," says Dr. Sherif Mossad of the Cleveland Clinic in Ohio. "The weight of the data is equal in both directions."

Over the past decade, about 14 studies have been done on the mineral's cold-curing power. According to Mossad, half have shown that it works and half that it doesn't.

"I don't think the pendulum is going one way or the other at this time," he says. "Every year, one or two studies come out because the cold is such a common problem."

An estimated 62 million people develop colds in the United States annually, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

Children have about six to eight colds a year. In families with children in school, the number of colds per child can be as high as 12 a year.

Adults average two to four colds a year. And women, especially those 20 to 30 years of age, have more colds than men, possibly because of their closer contact with children, the National Institute of Allergy and Infectious Diseases (news - web sites) says.

While health authorities know a lot about who gets colds and how frequently, it's much more difficult to nail down the strain of cold and its symptoms.

Colds are caused by viruses, and researchers estimate that about 200 of them circulate during the cold season, which runs from November to April. So determining the type of cold a person has and what it will do is nearly impossible, Mossad says.

Another limiting factor to studying the common cold is the wide variety of symptoms associated with it, and the subjective evaluation of them. When scientists analyze the effectiveness of a cold treatment, they depend on patients' reports about how they feel, which can alter results from study to study.

"With this illness, you have mainly subjective responses to the medicine. It's not like you give a person a blood test and you can see a change," Mossad says.

All that said, however, zinc appears to be one of the most effective cold treatments available. The element is usually taken as a lozenge or nasal spray. Scientists believe it works by either preventing virus cells from reproducing or coating them so they can't take effect in the body.

Six years ago, Mossad conducted a randomized, double-blind, placebo-controlled study of zinc's ability to cure the cold in 100 adults. The patients who received zinc lozenges six or eight times a day felt relief nearly twice as fast as those using a placebo lozenge. They saw their symptoms disappear after an average of 4.4 days, compared to 7.6 days for the placebo group. The difference was most apparent with coughing and sore throat.

Mossad's best evidence, though, may be the element's work on his own stuffy head.

"Personally, I use it when I have a cold and I seem to get better quicker," he says.

Other studies, however, cast doubts.

Four years ago, a prominent trial of school children showed that zinc did little to assuage their symptoms. Researchers reported in the Journal of the American Medical Association (news - web sites) that they tested 250 children outside Cleveland, and found that both those taking zinc lozenges and those taking a placebo suffered symptoms for an average of nine days.

Moreover a "meta-study" in the Journal of Nutrition two years ago, which evaluated 11 studies, found that zinc's effectiveness in curing the cold still hasn't been proven. Many of the positive studies suffered methodological failings, such as using an ineffective placebo lozenge, researchers say.

However, the studies concluding zinc doesn't work also suffer from problems, says Dr. Ananda Prasad, a professor of medicine at Wayne State University in Detroit. They failed, he argues, because scientists used lozenges that included elements besides zinc, because they used doses that were too small, or because they started treatment more than 24 hours after the cold began.

"It is really very disturbing. This is not fair for the public," he says. "Most of the confusion is that people have been using the wrong preparations of zinc. Many don't work."

Prasad recommends that people use simple zinc lozenges without added ingredients or flavorings. Even though such lozenges have a poor taste and can cause nausea on an empty stomach, they work much better, he says. His study in 2000 also showed that zinc cut the duration of a cold in half.

"I have no question in my mind that zinc works. We have used it a lot here at the medical center. But we always use the right kind, so it works," he says.

For the lozenges to work, they should be taken every two or three hours, in 12 milligram to 13 milligram doses, he says.

Since too much zinc can reduce the copper level in the body, hurting immune response, people shouldn't take high doses of the element for longer than four days, Prasad says.

What To Do

For more information about the cold virus, visit the Common Cold Centre, run by Cardiff University in South East Wales, Britain. Or read more about the cold at the National Library of Medicine.

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SATURDAY, DECEMBER 7, 2002 

Layer Up Against Winter's Chill 

HealthScoutNews

Saturday, December 7, 2002

SATURDAY, Dec. 7 (HealthScoutNews) -- You don't need to come in from the cold as long as you know how to warm up to it.

Winter can be a beautiful, enjoyable season if you know how to dress for it. Here's some advice from the Medical College of Wisconsin:

·     When you go outside, dress in multiple thin layers of clothing that let moisture escape but trap warm air close to your skin. This approach keeps you warmer than using a single thick layer of clothing.

  • Proper layering includes a moisture-wicking fabric next to your skin that moves sweat and other moisture away from your body. That should be followed by a warmth-trapping layer. The final step is an outer layer that repels rain/snow and blocks wind.
  • Protect exposed skin against wind chill by wearing a hat, gloves and scarf.
  • A hat also prevents heat loss from your head.

More information

Here's where to go to find more cold weather safety tips.

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Heart Disease Knows No Gender 

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Saturday, December 7, 2002

SATURDAY, Dec. 7 (HealthScoutNews) -- Few women would dare to skip regular mammograms after the age of 50. But far too many fail to heed an even bigger health threat.

They shouldn't.

Heart disease is the No. 1 killer of women in the United States, according to the American Heart Association (news - web sites). In sheer numbers, more women than men will die of heart disease this year.

But many women don't think of themselves at risk of heart disease, doctors say. A recent heart association survey found that only 8 percent of women identified heart disease and stroke as their biggest health threat.

"The key thing women don't understand is that half of them will die of cardiovascular disease or stroke, and many of them will die prematurely," says Dr. Rose Marie Robertson, past president of the American Heart Association. "They worry about cancer, but many more will die of cardiovascular disease."

The lack of knowledge could be one reason why so many women aren't taking measures to protect themselves. An American Heart Association survey of 521 women found that 75 percent aren't following recommended guidelines for diet and exercise.

The survey revealed that only 28 percent of women eat a diet low in fat and cholesterol. And only 31 percent exercise at least three times a week for 30 minutes or more.

Before menopause, a woman's hormones provide some protection from heart disease, says Dr. Naveed Malik, a cardiologist at the Ochsner Clinic Foundation in New Orleans. After menopause, "the incidence of cardiovascular disease rises very rapidly and catches up with men," Malik says.

"Even we as physicians need to be more vigilant about the presence of cardiovascular disease in women," he says.

Still, women are by no means immune from heart disease before they hit menopause. Research has shown artery-clogging plaque buildups can begin in the teens and 20s, setting the stage for heart attacks in middle age.

"There are women in their 40s and 50s having heart attacks in this country every day," Robertson says.

Major risk factors for heart disease include smoking, hypertension, diabetes, high cholesterol and obesity, Malik says.

And obesity rates are soaring. About 60 percent of Americans are overweight. Of those, about 30 percent are obese, according to recent statistics.

Because a sedentary lifestyle puts you at risk for obesity and other ailments, a key component of warding off heart disease is exercise, Robertson says.

Earlier this year, the federal government issued new exercise guidelines that recommend adults and children spend at least an hour a day in moderately intense physical activity to maintain maximum cardiovascular health.

However, any exercise is better than not exercising at all, Robertson says: "We worry that if people see it as an overwhelming job, they might not start."

To increase awareness about the risk of heart disease in women, the American Heart Association has launched a campaign called "Simple Solutions." The aim is to teach women small steps they can incorporate into their lives to decrease their risk of heart disease.

"Women are very busy," Robertson says. "They're taking care of everyone else, and they often forget to take care of themselves. We wanted to come up with simple, practical steps they could do every day to lower their risk."

Here are 10 suggested steps:

·     1. Buy the deepest color of ground beef you can find. The darker the red, the less fat it contains.

  • 2. Do your own yard work. Mow your lawn. Rake the leaves or grass. It's great exercise for your arms.
  • 3. When eating at a restaurant, split an entree. Portions at restaurants tend to be large. Before eating a pizza, blot up the oil with a napkin.
  • 4. Take the stairs whenever you can. Each flight burns 10 calories.
  • 5. Don't use creamy dressings or croutons on your salad. If you must have something crunchy on it, walnuts can be a good alternative because they are high in omega-3 fatty acids.
  • 6. When talking on the cordless phone, stretch your arms and legs or do arm curls with a can of food in your hand.
  • 7. Keep high-calorie, high-fat foods out of sight in your pantry. Put raw vegetables and fruits in the front of the refrigerator so you see them first.
  • 8. Play with your children or pet. Play chase with the dog or take him for a walk. Take the kids to a park for a game of tag or push them on the swings. Badminton, volleyball and swimming are fun things you can do together.
  • 9. Eat crunchy, healthy snacks such as carrots, celery or rice cakes instead of chips, cookies and soda.
  • 10. Walk as much as you can. Park you car at the far end of the lot, and walk to the grocery store or the drycleaners. When you take your kids to soccer practice, spend the time walking around the field while your kids play.

What To Do

For more information on "Simple Solutions" and maintaining a healthy heart, visit the American Heart Association or WomenHeart.

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