Cold Tests Zinc's Mettle
DECEMBER 7, 2002
Up Against Winter's Chill
Disease Knows No Gender
DECEMBER 13, 2002
in the Dark About Hepatitis A
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
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.
To learn more about hepatitis A, go to the American
Evidence That Diet Plays Role in Parkinson's
By Alison McCook
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
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
"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
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
Source: Annals of Neurology 2002;52:793-801.
High Blood Pressure
(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
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.
of Death Higher in Infant Twins with Young Mom
By Alison McCook
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
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'
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.
All You Want to Know About Healthy
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
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.
Here's where you can find the National
Nutrition Summit site.
Group Supports Gay Adoption Rights
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
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.
New Lung Cancer Warning for Women
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
Adenocarcinoma accounts for about 40 percent of lung cancer
cases in women.
Here's where to go to find out more about lung
Drugs Linked to Breathing Problems—Study
LONDON (Reuters) - Drugs commonly used to treat glaucoma may
cause breathing problems in elderly patients, doctors said
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
"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
"We need to be pro-active about finding out about airway
obstruction, or shortness of breath, in patients," Kirwan
Lowdown on Lupus
By Randy Dotinga
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,"
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
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
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.
AM Blood Pressure May Help Diabetics
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
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.
Parents Urge Restrictions on Acne Drug
By Ori Twersky
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
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
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
"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."
DECEMBER 12, 2002
Pints of Plasma Quarantined
By Lauran Neergaard
AP Medical Writer
WASHINGTON - Blood banks are quarantining all plasma frozen
during the West Nile virus (news
sites) epidemic — an estimated 30,000 pints — to reduce
further the low risk of spreading the disease through blood
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
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
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
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
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.
Loss, Gum Disease May Up Man's Stroke Risk
By Keith Mulvihill
NEW YORK (Reuters Health) - Tooth loss and gum disease may
increase a person's risk for having a stroke, new study findings
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
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.
Zebrafish Helps in Heart Research
By Paul Recer
AP Science Writer
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
Most researchers are attempting to grow new heart cells by
manipulating stem cells to prompt them to transform into cardiac
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
"Is it possible that this could lead to human cardiac
regeneration?" he asked. "The answer is yes, it
Keating, a Howard Hughes Medical Institute researcher at Harvard
Medical School (news
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
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
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
"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,"
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
"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:
Inhaled Hormones Offer Breast Cancer
By Maggie Fox
WASHINGTON (Reuters) - An inhaled hormone treatment may offer
women at high risk of breast cancer (news
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
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
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
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
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.
"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
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
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.
Group Finds Brain Center for Liking
By Paul Recer
AP Science Writer
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
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
"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:
Eye Protein a Key Regulator of
Body Clock: Studies
By Amy Norton
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
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
"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
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.
Peptic Ulcer Linked to Anxiety
THURSDAY, Dec. 12 (HealthScoutNews) -- Peptic ulcer disease
and generalized anxiety disorder may have a common psychiatric/psychological
So says a study in the November/December issue of Psychosomatic
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.
The U.S. Centers for Disease Control and Prevention (news
sites) has more about peptic
Short Chemo Intervals Cut Breast
By Paula Moyer
NEW YORK (Reuters Health) - Shortening the interval between
chemotherapy treatments may help reduce the risk of breast
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
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
The researchers found that dose-dense treatment was associated
with a 26% reduction in the risk of recurrence and a 31% improvement
"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
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
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.
Study Confirms Benefits of Lower
By Adam Marcus
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
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
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
Poll Shows Most Americans Trust
By Charnicia Huggins
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
"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,"
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
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.
Periodontal Disease Linked to Stroke
By Ed Edelson
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
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
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
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,
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
"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.
Scientists ID Gene Key for Scary
By Merritt McKinney
NEW YORK (Reuters Health) - Scientists have identified a circuit
in the brain that may play an important role in how we experience
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
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
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
"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.
Work Out and Stay Alive
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
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
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.
The U.S. National Institutes of Health (news
sites) has more about the health benefits of exercise.
Many Jailed Adolescents Have Mental
By Charnicia E.
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
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
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
sites), the Center for Substance Abuse Prevention, The
Robert Wood Johnson Foundation and various other federal agencies
Source: Archives of General Psychiatry 2002;59:1133-1143.
Parkinson's Drug Tied to Heart
By Janice Billingsley
THURSDAY, Dec. 12 (HealthScoutNews) -- Pergolide, a drug used
to ease the tremors of Parkinson's disease (news
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
"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
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
"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,"
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
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.
Pediatricians, Family Docs Treat
By Alison McCook
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
"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
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
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
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
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
Warning Signs of Stroke
(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
- Sudden intense headache.
If you experience any of these symptoms, call 911 without delay.
Green Tea May Protect Against Heart
By Merritt McKinney
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.
Hyped for Hiking
(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.
US Reports Measles Among Adopted
Kids from China
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
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.
Stressful Events May Worsen MS
By Dana Frisch
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
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
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
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.
Home Visits to Teen Moms Show Mixed
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
"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
Public to Get Data on Hospital
By Todd Zwillich
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
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
Under the voluntary plan, the US Department of Health and Human
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,
DECEMBER 11, 2002
Drug Claritin Hits Store Shelves
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
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
Vaccine Doesn't Ensure Protection
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
sites) in Atlanta, Georgia and colleagues report their
findings in the December 12th issue of The New England Journal
of Medicine (news
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
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
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,"
Source: The New England Journal of Medicine
Poll: Two of Three Want Smallpox
By Laura Meckler
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
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
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
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,"
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
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.
More Chemo Helps Herceptin Fight Cancer
By Deena Beasley
LOS ANGELES (Reuters) - The addition of a second chemotherapy
drug to a regimen of breast cancer (news
sites) drug Herceptin and chemotherapy nearly doubles
the time it takes for the disease to worsen, researchers said
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.
FDA Says It Will Stop Misleading
By Lauran Neergaard
AP Medical Writer
WASHINGTON (AP) - The new chief of the powerful Food and Drug
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
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
McClellan, a physician-economist and longtime adviser to President
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
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
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
Gene Variations May Have Heart Attack Link
By Alison McCook
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
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
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
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,"
Source: The New England Journal of Medicine 2002;347:1916-1923.
Leg Amputation, Reconstruction
By Janet McConnaughey
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
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
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:
Soothes Lung Patients, Promotes Exercise
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
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
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
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.
(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
- Second molars: 20-32 months
Women Waiting Longer to Become Moms
By Dana Frisch
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
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.
(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
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.
May Worsen in Some Women Taking Estrogen
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,"
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
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
"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.
Test Measures Toughness of Breast Cancer
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
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
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.
The National Cancer Institute (news
sites) has more about breast
Trick Helps Explain Failed Vaccine Attempts
By Amy Norton
NEW YORK (Reuters Health) - Scientists have discovered a new
way by which HIV (news
sites) skirts the body's immune response, helping to explain
why it's been so hard to develop a broadly effective AIDS
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
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
Source: Nature 2002;420:623-624, 678-681.
Walking Recommended for Those With
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
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
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.
The University of Michigan Health System has more about peripheral
Drugs Not Always a Bargain for Medicaid
By Karen Pallarito
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
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
Game-Triggered Seizures Can Be Reduced
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
"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."
May Erode Acid-Reflux Defense
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.
Simple Way to Help Patients Stick to Their Meds
By Charnicia E.
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
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
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
"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
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,
The study was led by Heather P. McDonald of McMaster University
School of Graduate Studies in Ontario.
Source: The Journal of the American Medical
Remains Misunderstood Among Older Adults
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
"When compared with other conditions, 7% said that they
feared seizures the most, even more than cancer or heart disease,"
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
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.
DECEMBER 10, 2002
Ads May Influence Teen Habits: Study
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
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
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.
Preventive Medicine 2002;35:511-518.
The Operation Women May Not Need
By Colette Bouchez
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
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
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
Complicating matters further: Some doctors aren't being truthful
about the consequences of a hysterectomy, critics of the procedure
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
"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
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
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.
Mental Illness Often Predates Ecstasy
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.
Flat Feet Facts
(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.
Experts Upset by Renewed Safety Doubts
By Maggie Fox
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
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
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
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
"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
The US Centers for Disease Control and Prevention (news
sites) and the Food and Drug Administration (news
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.
(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
- 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
After Retina Surgery May Damage Sight
By Suzanne Rostler
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,"
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
Source: American Journal of Ophthalmology 2002;134:761-763.
Genetic Link to Fat Absorption
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
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
Finding these genes in mice could help identify similar genes
in humans and lead to new cholesterol-lowering drugs to combat
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.
The U.S. National Heart, Lung, and Blood Institute has more
about the connection between cholesterol
and heart disease.
Obesity Ups Cataract Risk: Study
By Suzanne Rostler
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
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
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
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
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.
Prodding Doctors Can Boost Chlamydia
By Randy Dotinga
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
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
However, it's remarkably easy to cure chlamydia. Just a few
doses of an antibiotic will kill off the infection, Wibbelsman
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
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
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
for Disease Control and Prevention or the American
Social Health Association.
Brain Scans May Detect Early Signs
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
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
sites). Many more suffer from other psychotic disorders.
Source: The Lancet 2002 Online December 10, 2002.
Antidepressants May Cause Premature
By Jennifer Thomas
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
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,"
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
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
Colicky Baby? Endless Crying Fades
at 3 Months
By Jacqueline Stenson
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
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
"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
However, more research is needed to fully understand the nature
of infant crying, he said.
Source: Archives of Pediatrics and Adolescent Medicine
New Generation of Thalidomide Shows
Promise Against Cancer
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
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
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.
Here's where you can learn more about multiple
myeloma. And here's where to go to find out more about
Linked to Increased Risk of Stroke in Men
By Suzanne Rostler
NEW YORK (Reuters Health) - Men who are obese are twice as
likely as their leaner peers to suffer a stroke, researchers
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
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.
A Spark of Hope for Spinal Cord
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
The findings appear online this week and in the Dec. 24 print
issue of the National Proceedings of the National Academy
of Sciences (news
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.
The U.S. National Institute of Neurological Disorders and Stroke
has more information about spinal
Keeping in Touch Helps Elderly
By Ed Edelson
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
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,"
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
"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
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
Genes That Program Tumor Spreads
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
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
More studies are being done to validate the significance of
this group of genes.
The National Cancer Institute (news
sites) has more information about metastatic
DECEMBER 9, 2002
Tries to Plug Risky Drug Loophole
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
But the Food and Drug Administration (news
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
_Clozaril, for schizophrenia.
_Lotronex, for women with severe irritable bowel syndrome.
_Mifiprex, the abortion pill also called RU-486 (news
_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.
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."
Breast Cancer History Won't Up Uterine Risk
By Merritt McKinney
NEW YORK (Reuters Health) - Breast cancer (news
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
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
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
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
Source: Journal of Medical Genetics 2002;39:826-832.
Reeve's Brain, Paralysis Studied
By Paul Recer
AP Science Writer
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
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
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
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
"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
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
sites) is very interested in," said Kleitman. MRI
studies "hold tremendous promise" for determining
the severity of spinal cord injuries and helping doctors direct
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
"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
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
"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
Goes After Beer Ads Aimed at Underage Drinkers
By Peggy Peck
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
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
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
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
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."
Study Firms Evidence on Colic Relief
By Lindsey Tanner
AP Medical Writer
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:
Ties Chili Pepper to Gallbladder Cancer Risk
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
Source: International Journal of Cancer 2002;102:407-411.
Doctor Links Kids' Fears to Recovery
By Lauran Neergaard
AP Medical Writer
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
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
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
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
On the Net:
Parents' anesthesia brochure: http://www.asahq.org/patientEducation/childanes.htm
E, Bladder Cancer Risk Studied
By Suzanne Rostler
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
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,
"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
Source: American Journal of Epidemiology 2002;156:1002-1010.
(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
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.
Looks at Condoms, Wart Virus Transmission
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
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
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.
(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
- 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.
Safety Measures, Skate Parks Not Risk-Free
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
"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
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.
A Slave To Routine?
By Nancy Deutsch
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
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,"
What To Do
To learn more about the value of rituals to family life, visit
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
Healthcare Costs Jump 15 in 2002
By Karen Pallarito
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
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
Mercer also reported evidence that so-called consumer-directed
health plans are catching on and predicted significant growth
in 2003 enrollment levels.
An Unusual Treatment for Cocaine
MONDAY, Dec. 9 (HealthScoutNews) -- A drug used to treat cystic
fibrosis may reduce cocaine cravings, American researchers
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
The U.S. National Institute on Drug Abuse has more about cocaine
Predicts Whether Tumors Will Spread
By Alison McCook
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
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
"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,"
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.
Coffee's Jolt Tied to Genes
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
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.
Here's where you can find more information about the health
effects of coffee.
Women Unaware of Labor Pain Relief Options
By Martin F. Downs
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
Parkinson's Affects Driving Ability
MONDAY, Dec. 9 (HealthScoutNews) -- As their condition worsens,
people with Parkinson's disease (news
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
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
The study authors recommend larger, long-term driving simulator
studies in order to develop rigorous driving safety guidelines
for people with Parkinson's.
The U.S. National Institutes of Health (news
sites) has more about Parkinson's
Safe Way to Sedate Kids for Medical Scan
By Martin F. Downs
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
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
Statins Improve Heart Transplant
By Ed Edelson
MONDAY, Dec. 9 (HealthScoutNews) -- Giving heart transplant
recipients a cholesterol-lowering statin drug greatly improves
their chances of long-term survival, German cardiologists
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
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
"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
"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.
Fret as Plant-Derived Drugs at Crossroad
By Carey Gillam
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
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
"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
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
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
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
sites) to develop an HIV (news
"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."
Male Obesity More Risky Than Thought
By Ross Grant
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
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
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'
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
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
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
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
Still Opt for HMO Coverage Despite Upheaval
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
Anorexia, Bulimia May Be Autoimmune
By Amanda Gardner
MONDAY, Dec. 9 (HealthScoutNews) -- Scientists may have unraveled
another thread in the mystery of anorexia nervosa (news
sites) and bulimia nervosa, eating disorders that plague
three percent of women and girls and a lesser number of men
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
"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
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
"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.
End to Racial Care Gap Top Priority, AMA Urged
By Peggy Peck
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
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
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."
AMA's House of Delegates will consider the CSA recommendations
as well as the NMA resolution when it begins voting tomorrow.
DECEMBER 8, 2002
Man's Best Friends Warm and Cozy in Winter
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
Small dogs and cats shouldn't be kept outside, due to their
lower body mass. However, it's OK to take them outside for
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.
University of Minnesota has more cold weather pet tips.
Cold Tests Zinc's Mettle
By Ross Grant
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
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
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
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
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
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
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.
DECEMBER 7, 2002
Up Against Winter's Chill
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
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
- 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.
Here's where to go to find more cold
weather safety tips.
Disease Knows No Gender
By Jennifer Thomas
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.
Heart disease is the No. 1 killer of women in the United States,
according to the American Heart Association (news
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
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
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
- 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.