The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
March 1, 2003

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of January 11-17

  1. Hospitals Try to Reduce Medical Errors
  2. Epilepsy Drug Succeeds Where Others Fail
  3. GERD Yourself Against Heartburn
  4. Winter Full of Risks for Seniors



FRIDAY, JANUARY 17, 2003 

Depressed Women Prone to Menopausal Symptoms 

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Friday, January 17, 2003

FRIDAY, Jan. 17 (HealthScoutNews) -- Depressed women begin perimenopause -- the period of hot flashes and mood swings that comes just before menopause -- earlier than non-depressed women, new research says.

Researchers followed 332 women aged 36 to 45 with a history of major depression, and 644 without depression. None of the women had gone through menopause yet.

Women with a history of depression had a 20 percent greater chance of having perimenopausal symptoms during the 36 months of the study than the non-depressed women.

Women who were depressed at the time of the study and women who had the most severe history of depression were twice as likely to begin perimenopause. And women who were depressed and taking antidepressants had nearly three times the risk of having symptoms of perimenopause during the study.

The researchers believe the added risk has little to do with the antidepressants. Instead, they believe women taking them may have particularly severe depression that isn't alleviated by medicine.

During perimenopause, a relatively new term, women often experience typical menopause symptoms: mood swings, hot flashes and sleep disruptions due to their wildly fluctuating hormones.

Previous research has shown women with a history of depression are at greater risk of relapsing during perimenopause, says Bernard Harlow, lead author of the study that appears in the current issue of Archives of General Psychiatry.

"What's happening is these women with a history of depression are sitting in a period of flux," says Harlow, an associate professor of obstetrics-gynecology at Harvard Medical School (news - web sites) and an associate professor of epidemiology at the Harvard School of Public Health. "It's a very vulnerable period of time for women susceptible to mood disorders. It is really horrible."

"It would be better for them to get into the menopause and be done with it," he says.

Perimenopause occurs when a woman's ovaries age and produce less estrogen. Perimenopause can last for a year or two, or for as long as 10, Harlow says.

In the study, women were considered to have symptoms of perimenopause if they had a change in menstrual flow amount or duration; if they missed a period for three months or more; or if they had a seven day or longer change in their menstrual cycle length. (For example, a woman who used to get her period every 28 days was now getting it every 35 days.)

A woman is considered to be in menopause when she's gone one year without a period.

Harlow and his colleagues also did blood tests on the women every six months to measure their hormone levels.

They found depressed women had lower levels of estrogen and higher levels of follicle stimulating hormone and lutenizing hormone than non-depressed women.

One indicator that the ovaries are withering is an increase in follicle stimulating hormone and lutenizing hormone, which are produced by the pituitary gland. The ovaries and the pituitary gland work in harmony: follicle stimulating and lutenizing hormone from the pituitary signals the ovaries to produce more estrogen.

If the ovaries don't produce enough estrogen, levels of follicle stimulating and lutenizing hormone increase, Harlow says.

However, Harlow notes, measuring hormone levels is a somewhat unreliable method of determining whether a woman is menopausal because during perimenopause, the levels fluctuate wildly -- a woman can have levels typical of a much younger woman one day and a much older woman the next, he says.

"It's a crap shoot as to whether you're going to catch the hormone level at the high end or the low end," Harlow says. "The menstrual cycle is a much better indicator of changes."

Susan Simonds, a psychologist in private practice in Moscow, Idaho, who specializes in women with depression, says the study is one of the first to look at the role depression plays in perimenopause.

"The study demonstrates the important link between reproductive hormones and depression, which is something that has only recently begun to be studied," Simonds says. "We just don't know enough about it yet and we need to know more."

Only about 60 percent of women who are depressed seek treatment, according to the study.

"This study shows the importance of getting early treatment for depression and for continuing to seek more effective treatments if antidepressants don't reduce symptoms," Simonds says.

Harlow and his colleagues set out to determine if depressed women began actual menopause sooner, but the study period wasn't long enough. They're conducting follow-ups to determine that now.

"I suspect they do begin menopause sooner, but we don't know that for sure yet," he says.

More information

The Mayo Clinic has more information about perimenopause and menopause. To order a copy of a perimenopause/menopause handbook, visit the North American Menopause Society. For information on the signs and treatments for depression, check the National Institute of Mental Health.

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Study: Women's Sex Problems Overestimated 

By Rick Callahan

Associated Press Writer

The Associated Press

Friday, January 17, 2003

INDIANAPOLIS - A new study suggests sex researchers have been overestimating the prevalence of sexual problems in women for years — perhaps because they have been looking at things from a man's point of view.

The Kinsey Institute study found that a quarter of American women are significantly distressed about their sex lives — far less than the 43 percent a 1999 study labeled as suffering from sexual dysfunction.

Research on the topic has tended to focus on physical aspects of sex, such as orgasms and arousal. But the new study found that the best predictors of a woman's sexual satisfaction are her general emotional well-being and her emotional relationship with her partner.

"This study emphasizes the importance of non-physiological components of sexuality as well as the general importance of mental health," said John Bancroft, director of the Indiana University-based Kinsey Institute. "It's not conclusive, but it counterbalances what I believe to be the rather extraordinary conclusion that 43 percent of women suffer from sexual dysfunction."

The Kinsey study, which will appear in the June issue of the Archives of Sexual Behavior, was a random telephone survey of 853 women, ages 20 to 65, who had been in a heterosexual relationship for at least six months.

Among other things, it found that 24.4 percent of those women reported "marked distress" about their sexual relationship, their own sexuality or both, within the previous month.

That contrasts with a University of Chicago study that questioned more than 1,700 women, ages 18 to 59. That 1999 study found 43 percent of women reported having one or more persistent symptoms of sexual dysfunction, such as a lack of desire for sex, during the previous year.

University of Chicago sociologist Edward Laumann, who led the 1999 research, said the new work cannot be directly compared to his study. While that study involved face-to-face, 90-minute interviews with women, he said the Kinsey study was an impersonal, random telephone survey.

He also said the Kinsey study excluded women who had not had a regular sexual partner within the preceding six months, potentially eliminating women with serious sexual problems.

Other researchers said science has for decades disregarded the fact that some women's sexual lives are encumbered not by physical problems, but relationship or emotional turmoil unrelated to sexual performance.

Beverly Whipple, president of the Society for the Scientific Study of Sexuality, based in Allentown, Pa., said researchers who have studied women in the past based their findings on what is important to men: desire, arousal and orgasm.

"I don't think we should try to lock women into a male model of what's important. Women are not men; there's so much we don't know," she said.

Patricia J. Aletky, a clinical psychologist with the Minneapolis Clinic of Neurology, noted that decades ago women were labeled "frigid" if they had little or no sexual desire. It was a diagnosis that often disregarded factors such as domestic violence or overwork from caring for children, she said.

"There has been a long history of over-pathologizing women, and in that regard I think it's very encouraging that we're starting to look at the bigger picture," Aletky said.

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Depression Stalking Younger Women

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Friday, January 17, 2003

FRIDAY, Jan. 17 (HealthScoutNews) -- Serious depression is on the rise -- but it's mostly younger women who are being affected.

That's one of several findings in a new report by the U.S. Agency for Healthcare Research and Quality (AHRQ) that looked at the care of women admitted to hospitals in the year 2000.

Among the study's conclusions: Depression was the second-leading cause of hospitalization for women aged 18 to 44, with some 205,000 admissions in 2000. The number one reason for hospitalization for women in this age group was obstetrical care and childbirth.

The researchers also found that depression was the seventh most frequent cause of hospitalization for women of all ages.

Interestingly, other statistics recently released by AHRQ show that depression does not even make the top 10 list of health concerns for men.

"The findings are simply an indication of where we need to look, where we need to concentrate our research to not only understand why women appear to be at such high risk [of depression], but in learning more about how we can reduce those risks," says study author Dr. Claudia Steiner.

Steiner is senior research physician with the AHRQ, which is part of the U.S. Department of Health and Human Services (news - web sites).

The new report cites the number of women hospitalized in the year 2000, and includes the reason for admission, discharges and any surgeries or procedures performed.

Overall, the top three reasons women of all ages were hospitalized in 2000 were physical trauma related to childbirth (785,000); pneumonia, (581,000); and congestive heart failure, (581,000).

In all age groups, a total of 361,000 women were hospitalized for depression.

For women aged 18 to 44, reasons for hospitalization other than depression and childbirth included fibroid tumors (139,000); gall bladder disease (117,000); back problems (85,000); and asthma (70,000).

The new report on women contrasts sharply with other AHRQ reports on male hospitalization statistics for the year 2000. The top three reasons for hospitalization for men were coronary artery disease, heart attack and stroke.

The AHRQ reports state that of the 646,416 hospital admissions for depression in the year 2000, 61.9 percent were women, and 39.1 percent were men, up from 38 percent in 1997.

The disparity between gender-based mental health statistics seems enormous. But if you look behind the numbers, men and women may be more alike than the research indicates, says reproductive psychiatrist Dr. Shari Lusskin.

"Generally speaking, women seek treatment for depression and men do not. But that doesn't mean men don't suffer with depression, because they do," says Lusskin, a clinical professor of psychiatry at New York University Medical Center.

The proof, she says, is in the bottle -- alcohol and medicine, that is.

"In men, you see far more treatment of alcoholism and drug abuse. But the underlying reason for these problems is still usually depression, even though the hospital admission forms may not have this on record," Lusskin says.

Previously released AHRQ statistics support her thinking. The agency found that while some 300,000 men were hospitalized for drug and alcohol abuse in 2000, just 138,000 women needed treatment for a similar problem.

Lusskin says it's important to pay attention to what the new report is saying about women and depression -- and use it to learn more about where to concentrate research and treatment efforts.

"Hopefully, researchers will use many of the statistical findings in this paper to recognize populations that are under-served, and identify women that need more medical attention, particularly new mothers, whose postpartum depression problems too often go unrecognized and untreated for a very long time," Lusskin says.

The new report, titled "Care of U.S. Women In Hospitals, 2000," is the third in a series published by AHRQ based on year 2000 health data collected on 7 million patients from 1,000 hospitals nationwide.

More information

You can find the new AHRQ report by clicking here. For more information on the newest treatments for depression, visit the National Institute of Mental Health.

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Skiers Can Get High-Altitude Lung Ailment: Study 

Reuters Health

Friday, January 17, 2003

NEW YORK (Reuters Health) - A serious type of altitude sickness typically associated with mountain climbing may occur more often among skiers than thought, French researchers report.

Although "very uncommon" at moderate altitudes, high-altitude pulmonary edema (HAPE) probably occurs more often at these heights than is generally suspected, according to the researchers.

Over nine years, they found, 52 skiers were treated at one hospital in the French Alps after developing HAPE at moderate elevations--between 1,400 and 2,400 meters, or about 4,600 to 8,000 feet.

HAPE refers to a build-up of fluid in the lungs caused by elevated lung pressure in low-oxygen conditions. The potentially fatal condition is often associated with climbing too high too fast, although susceptibility varies among people. Symptoms include labored breathing, cough and rapid heart rate.

In this study, HAPE patients were often "young, vacationing men, with no history of prior disease," according to Dr. Andre Louis Gabry and colleagues.

When HAPE has been known to occur at moderate elevations, the doctors note, the patients are often skiers or hikers who "start physical activity with no prior training."

Gabry, of Hopital de Moutiers, and his colleagues report the findings in the January issue of the journal Chest.

Although HAPE can prove fatal, all patients in the study recovered after a few days in the hospital.

In an editorial published with the report, Dr. Lawrence Raymond of the Carolinas HealthCare System points out that people with certain lung conditions, such as chronic bronchitis, may be more vulnerable to HAPE at moderate heights.

But, he adds, this study suggests that "anyone, regardless of health or fitness level," could develop HAPE at these heights if they start vigorous activity without first acclimating themselves to the elevation change.

Source: Chest 2003;123:49-53.

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Childhood Brain Tumor Survivors Prone To Later Problems

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Friday, January 17, 2003

FRIDAY, Jan. 17 (HealthScoutNews) -- Survivors of childhood brain tumors are at risk of developing other serious medical problems later in life, from hormonal imbalances to osteoporosis to stroke.

That's the conclusion of a new study that found that about 43 percent of teenagers and young adults who survived at least five years after being treated for a cancerous brain tumor experienced at least one "adverse endocrine event." And 18 percent experienced an "adverse cardiovascular event," the study says.

Endocrine events included hypothyroidism, growth hormone deficiency, delayed puberty and osteoporosis. Cardiovascular events included stroke, blood clots or angina (news - web sites)-like symptoms associated with cardiovascular disease.

"One of the points of this study is for us to get both childhood brain tumor survivors and primary-care physicians to be aware of the problems that can occur many years down the line," says Dr. James Gurney, lead author of the study.

"The survivors of brain tumors need to let their physicians know about the treatment they had and be vigilant about monitoring their health throughout their lifetime," adds Gurney, an epidemiologist and associate professor of pediatrics at the University of Minnesota in Minneapolis.

The study appears in the Feb. 1 issue of Cancer.

Gurney and his colleagues surveyed 1,607 young adults who were treated for a brain tumor between 1970-86 and had survived at least five years. They compared their medical histories to those of 3,418 siblings of childhood cancer survivors.

Information about how their cancer was treated -- chemotherapy, radiation, surgery or some combination of the three -- was obtained from their medical records.

The researchers found the survivors of brain tumors were 14 times more likely than the siblings to develop hypothyroidism, 278 times more likely to develop growth hormone deficiency, and 25 times more likely to develop osteoporosis.

Although the numbers sound terrifyingly high, Gurney says, the findings can be stated another way: 6.6 percent of young adult brain tumor survivors reported hypothyroidism first occurring five years after diagnosis; 21 percent developed growth hormone deficiency, and 1.8 percent developed osteoporosis.

That means the absolute risk of getting osteoporosis, for example, is actually quite small, but the relative risk is much higher for survivors of brain tumors because the rates of osteoporosis among the young is typically very small, Gurney explains.

The study also found that childhood brain tumor survivors were nearly 43 times more likely to have a stroke, six times more likely to develop a blood clot, and twice as likely to develop angina-like symptoms, such as chest pain and shortness of breath, which may indicate heart disease.

Put another way, 2.4 percent had a stroke five years or more after their brain tumor was diagnosed, 1.9 percent had a blood clot, and 4.4 percent had symptoms of angina.

Researchers found the type of treatment had a big impact on how many medical problems survivors faced later on.

Children who received chemotherapy, surgery and radiation were at the highest risk of later complications.

Those who had surgery only were the least likely to have problems, while the risk of children who had only surgery and radiation fell somewhere in between.

The dangers of radiation to the young are well known, says Dr. Herman Kattlove, a medical oncologist for the American Cancer Society (news - web sites). Doctors try to avoid giving radiation to children under age 3, and ideally under age 5.

At that age, the brain is forming all sorts of connections, and radiation can cause a devastating disruption that can have lifelong implications, Kattlove says.

However, radiation is more effective at killing brain cancers than chemotherapy because of the blood-brain barrier, a membrane that deters drugs from entering the brain.

"The problem is you're dealing with a deadly disease and you have to do something," Kattlove says. "The good news is our treatments are becoming so good, more children are surviving. Now, we're taking a step back to really look at how we are treating people. This is occurring because the child is alive. It's better than a dead child."

About 54 percent of children with brain tumors in 1976 survived five years or more. The survival rate rose to 70 percent in 1998, according to the study.

Because so many more children are surviving, it's becoming more and more important to figure out what treatments put a child at risk of long-term difficulties, says Dr. Patricia Shearer, a pediatric oncologist at the Ochsner Clinic Foundation in New Orleans.

"This study is very important because it enables us to identify and predict the problems that are likely to happen in children later on," Shearer says.

More information

To learn more about children and brain tumors, visit the Children's Brain Tumor Foundation or the National Cancer Institute.

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Treat Deaf Children Early

 

HealthScoutNews

Friday, January 17, 2003

FRIDAY, Jan. 17 (HealthScoutNews) -- Early cochlear implants are critical for deaf children to develop neurological pathways needed for hearing response.

That's the conclusion of a study in a recent issue of Ear and Hearing.

The study, led by researchers at the University of Texas and Arizona State University, compared brain activity of children in response to sound. It included hearing children and deaf children who received cochlear implants at different ages.

The researchers found that hearing children have rapid development of neurological hearing pathways in response to sound at an early age. They found there can be similar development in deaf children with cochlear implants, but only if the children receive the implants before they're 42 months old.

In the deaf children who received cochlear implants between the ages of 42 months and 7 years, less than half of them showed a response similar to that found in hearing children. In deaf children who received a cochlear implant after age 7, virtually none developed a normal response.

The study says early exposure of the nervous system to sound stimulations seems critical to developing the neurological pathway necessary for hearing response. The researchers suggest parents of deaf children need to consider this information.

More information

Here's where you can learn more about cochlear implants.

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Living Well in the Golden Years

HealthScoutNews

Friday, January 17, 2003

FRIDAY, Jan. 17 (HealthScoutNews) -- Having friends you can confide in and being able to make choices about working or not working are two of the most important factors influencing quality of life in early old age, says a United Kingdom study.

Early old age is defined as the period between about 55 and 75 years old.

Researchers examined data on the childhood, adulthood and early old age of 282 people in different areas of Britain. They found the quality of life in early old age is less influenced by the past -- such as your father's job -- than by your present circumstances.

The study found that health and socioeconomic factors influence early old age quality of life. For example, affluent and healthy people have a better quality of life than those who are poor and sick. Affluent people in poor health and poor people in good health also have lower quality of life.

Having control over when to work has a major impact on quality of life in early old age. People who decide to retire early and then choose to work beyond the normal retirement age have better quality of life than people who aren't able to make those decisions for themselves.

That may include people who lose their job through layoffs or poor health or have to continue working past their expected retirement age due to financial problems.

The study also found the quality and density of a person's social network was more important than the number of people in that social network.

The neighborhood a person lives in can have a negative influence if a person can't escape from an area where he has to endure various nuisances or live in fear of crime.

The study was funded by the Economic and Social Research Council.

More information

Here's where you can learn more about the research into early old age quality of life.

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High Ephedra Doses Tied to Stroke Risk 

Reuters Health

Friday, January 17, 2003

NEW YORK (Reuters Health) - A new study backs up case reports tying the weight-loss herb ephedra to the risk of stroke, but the risk appears confined to higher doses, according to researchers.

Overall, the investigators found, ephedra-containing products were not associated with a higher risk of hemorrhagic stroke--strokes caused by a bleeding in the brain.

However, daily doses of more than 32 milligrams (mg) were linked to a three-fold increase in hemorrhagic stroke risk, according to findings published in the January issue of Neurology.

Ephedra, also known as ma huang, is used in some dietary supplements marketed as weight-loss aids (news - web sites) or energy-boosters. The herb has similar chemical properties to amphetamines and has been linked to side effects such as heart arrhythmia, psychotic reactions and seizures.

There have also been reports of heart attack and stroke. Ephedra affects the vascular and nervous systems, and one theory is that blood pressure spikes are one way the herb could promote hemorrhagic stroke--particularly when combined with caffeine, as is often the case in supplements.

The authors of the new study considered ephedra doses of more than 32 mg per day to be high because that is the maximum allowed dose under Canadian law.

Last year, Canadian health officials requested a voluntary recall of certain ephedra-containing products that exceeded that dosage mark. That came after authorities reported 60 cases of adverse cardiovascular or nervous-system effects tied to ephedra.

In the current study, researchers led by Dr. Lewis B. Morgenstern of the University of Michigan in Ann Arbor looked at data on more than 700 young to middle-aged hemorrhagic stroke patients. Patients were compared with nearly 1,400 "controls" who hadn't suffered a stroke.

The researchers found that the odds of hemorrhagic stroke more than tripled for people who reported taking ephedra doses above the 32-mg mark within three days of their stroke.

They point out, however, that their results are based on only a small number of people reporting ephedra use.

Ephedra has been in the news much of late. In the US, where the supplement industry is not tightly regulated and there is no maximum allowed ephedra dose, some medical and consumer groups have called for a ban on the herb.

The industry maintains that ephedra is safe when used as directed.

In 1997, the US Food and Drug Administration (news - web sites) proposed limiting the allowable doses of ephedra and taking other steps to restrict its use. It withdrew the proposals in 2000 after industry groups and a congressional audit said they were not supported by scientific evidence.

Last year, the government again said it would delay limiting the use of ephedra until results from ongoing studies of its safety were in.

Source: Neurology 2003;60:132-135.

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The Hazards of Hip Fractures 

HealthScoutNews

Friday, January 17, 2003

FRIDAY, Jan. 17 (HealthScoutNews) -- People recovering from hip fractures who are discharged from the hospital too soon are much more likely to die or to have to be readmitted to hospital.

The Mount Sinai School of Medicine study found that people recovering from hip fractures who had mental confusion, heart or lung problems, one or more abnormal vital signs, or couldn't eat when they were discharged had a 360 percent greater chance of dying and a 60 percent greater chance of being readmitted to hospital within 60 days. The report appears in the current issue of the Archives of Internal Medicine (news - web sites).

The researchers created a list of acute clinical issues (ACIs), which are potentially dangerous conditions that need to be remedied before a hip fracture patient is discharged from hospital.

These ACIs include abnormal vital signs such as fever above 101 degrees F, very high or low blood pressure, very high or low heart rate, high breathing rate, and poor blood oxygenation.

Other ACIs included on the list include: inability to eat; wound infection; acute chest pain or shortness of breath; and mental status that differs from pre-fracture status.

The study, funded by the U.S. Agency for Healthcare Research and Quality, also found the risk of discharging hip fracture patients too soon wasn't reduced by sending those people to a post-acute care facility such as a rehabilitation hospital or skilled nursing home.

That's because even one ACI puts these patients at increased risk.

The study looked at 559 people with hip fractures admitted and discharged from hospitals in the New York Metropolitan area in 1997 and 1998.

More information

Here's where you can learn more about hip injuries.

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Bell's Palsy

HealthScoutNews

Friday, January 17, 2003

(HealthScoutNews) -- Bell's palsy, a form of facial paralysis, affects about 40,000 Americans each year. Although it can strike almost anyone without warning, it seems to disproportionately attack pregnant women, people with diabetes, flu, a cold or some other upper respiratory ailment, says the U.S. National Institute of Neurological Disorders and Stroke.

In addition to one-sided facial paralysis, symptoms may include pain, tearing, drooling, hypersensitivity to sound, and taste impairment.

The good news is that with or without treatment, most people get significantly better within two weeks, and about 80 percent are completely recovered within 3 months. For some, the symptoms may linger a little longer, and in a few cases, they may never completely disappear.

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'Reading Circuit' in Brain by Age 7 

By Merritt McKinney

Reuters Health

Friday, January 17, 2003

NEW YORK (Reuters Health) - The networks the brain relies on to read may be in place earlier than expected in children, new study findings suggest.

Using a scan called functional magnetic resonance imaging (fMRI) to measure brain activity in children ages 5 to 7, researchers found that reading-related brain networks were in place by age 7.

In an interview with Reuters Health, the lead investigator, Dr. William D. Gaillard, explained that the left side of the brain is the dominant one for language skills in 95% of people. Gaillard and his colleagues expected that this predominance of the left brain for reading tasks would already be apparent in children ages 5 to 7.

The study, which included 16 healthy children, bore out those expectations. Even though the researchers thought that reading-related brain activity would be focused on the left side of the brain in these young readers, they expected that younger children would show more reading activity on both sides of the brain than a previously studied group of older kids.

That did not turn out to be the case, the researchers report in the January 14th issue of the journal Neurology. In most children, the same reading-related brain network found in adults was in place by age 7, according to the report. In some cases, these networks were comparable by age 5 to those seen in adults.

Despite the similarity between children and adults in the development of the reading parts of the brain, Gaillard said he expects that children may have more variability in how they read. Youngsters may have two or three strategies that they use to learn how to read, he suggested. As children age, they may lose some of this variability, according to Gaillard.

The next step, Gaillard said, is "to look more closely at larger populations of children who are learning how to read." The aim of these studies, he said, would be to trace what sort of development is needed for children to learn to read.

Source: Neurology 2003;60:94-100.

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Stepping on Something Sharp

HealthScoutNews

Friday, January 17, 2003

(HealthScoutNews) -- If you step on a piece of broken glass or on a nail, never try pull out the object if its embedded in your foot, says the St. John Ambulance corps in Ontario, Canada. This may cause more damage and increase bleeding.

Instead, follow these tips:

  • Place a clean, preferably sterile dressing around the object./li>
  • Build up paddings around the embedded material so it doesn't move.
  • Secure paddings with a narrow bandage.
  • Get medical help immediately.

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Less-Frequent Diabetic Eye Screen Said OK for Some 

By Amy Norton

Reuters Health

Friday, January 17, 2003

NEW YORK (Reuters Health) - Many people with type 2 diabetes could go longer between screens for the vision-threatening eye disease retinopathy, a UK study released Thursday suggests.

Based on the rates of severe retinopathy they found among study participants, researchers estimate that many type 2 diabetics (news - web sites) with no signs of retinopathy on one exam could go up to three years before having another one.

"I think that our evidence is sufficiently strong to allow screening intervals to be lengthened to two or three years in the 70% of diabetic people with no retinopathy," study author Dr. Simon P. Harding, of Royal Liverpool University Hospital, told Reuters Health.

However, others say it is too soon to revise guidelines that call for yearly tests for diabetic retinopathy--which include the recommendations of the American Diabetes Association.

Before moving to revamp such guidelines, researchers should show that less-frequent screening prevents vision loss in diabetics as well as yearly screening does, Dr. Ronald Klein of the University of Wisconsin-Madison told Reuters Health.

Klein wrote an editorial published with the new findings in the January 18th issue of The Lancet.

Worldwide, there's no consensus on how often people with diabetes should be screened for retinopathy, a condition that arises when diabetes damages the tiny blood vessels of the retina, the light-sensitive tissue at the back of the eye.

In the US, experts recommend yearly or more-frequent tests. The European Retinopathy Working Party recommends exams at least every two years, and at least yearly after the first signs of retinopathy.

But existing guidelines are based on expert opinion rather than "direct evidence," Harding and his colleagues note.

The argument for routine yearly screening is based largely on the fact that timely detection and treatment of retinopathy will prevent vision loss in many diabetics. If retinopathy enters an advanced stage, abnormal new blood vessels grow in the eye. Without timely treatment, these vessels can bleed, cloud vision and destroy the retina.

But according to Harding's team, the new study suggests that type 2 diabetics with no signs of retinopathy and no additional risk factors could safely be screened every three years.

However, patients on insulin and those who've had diabetes for more than 20 years appear to need yearly screening, according to the researchers. Over the study period, these patients had elevated rates of sight-threatening retinopathy even when their initial tests showed no signs of the disorder.

The risk of retinopathy is known to increase the longer a person has diabetes. And insulin use among type 2 diabetics is a sign that they may have poor control over their blood sugar, another risk factor for diabetic retinopathy.

Harding and his colleagues also advise that diabetics with mild pre-proliferative retinopathy--a stage preceding the growth of abnormal blood vessels--be screened every four months.

Source: The Lancet 2003;361:195-200.

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Watch Out for PI

HealthScoutNews

Friday, January 17, 2003

FRIDAY, Jan. 17 (HealthScoutNews) -- More than 100,000 American doctors have received a letter about a frequently overlooked, life-threatening disease that affects more children than leukemia and lymphoma combined.

The mail campaign about primary immunodeficiency (PI) is a joint effort of the U.S. National Institutes of Health (news - web sites) and the Jeffrey Modell Foundation.

Information about PI was sent to every pediatrician who is a member of the American Academy of Pediatrics and every family doctor affiliated with the American Academy of Family Practice Physicians.

PI is an umbrella term for more than 100 genetic defects. These range in severity from chronic sinusitis to Severe Combined Immune Deficiency (SCIDS), which is also known as Bubble Boy Disease.

PI can cause serious, recurrent and life-threatening infections.

PI symptoms often present as common, chronic childhood illnesses such as pneumonia, bronchitis, and ear and sinus infections. Because of that, many doctors misdiagnose PI.

The information mailed to doctors includes PI warning signs. These include:

·         Eight or more new ear infections within a year.

  • At least two serious sinus infections within a year.
  • At least two months on antibiotics with little effect.
  • At least two pneumonias within a year.
  • Failure of an infant to gain weight or grow normally.
  • Recurrent deep skin or organ abscesses.
  • Persistent thrush in mouth of elsewhere on the skin after the age of one.
  • The need for intravenous antibiotics to clear infections.
  • At least two deep-seated infections such as sepsis, meningitis, cellulitis, or osteomyelitis.
  • A family history of primary immunodeficiency.

More information

Here's where you can learn more about primary immunodeficiency.

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THURSDAY, JANUARY 16, 2003

Key Found to How Embryos Take Hold

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews
Thursday, January 16, 2003

 THURSDAY, Jan. 16 (HealthScoutNews) -- Scientists have figured out how a new embryo attaches to the mother's uterus, a crucial first step when it comes to making a baby.

Failure of the embryo to "implant," or attach to the uterus, is responsible for about three quarters of miscarriages, say the study authors. Until now, researchers didn't understand how the process worked and were therefore powerless to intervene.

The new findings, appearing in the Jan. 17 issue of Science, are expected to pave the way for new methods to diagnose and treat infertility and early pregnancy loss.

"You could envision a test for a couple who have otherwise unexplained infertility so that perhaps a cause of infertility would be elucidated," says Dr. Richard Grazi, director of Genesis Fertility and Reproductive Medicine, the in vitro fertilization program at Maimonides Medical Center in Brooklyn, N.Y. "In about 20 percent of couples who have infertility, it's unexplained. That doesn't mean there's no reason. It just means we don't know what the reason is yet."

Normally, a woman's egg is fertilized by the male sperm at the end of the uterine tube, explains Susan Fisher, senior author of the study and a developmental biologist at the University of California, San Francisco. The developing embryo then transits the tube and enters the uterine cavity. In order for the embryo to successfully grab hold in the uterus, both it and the uterine lining must be ready -- and the window of opportunity is extremely small. "It's all a matter of timing," Fisher says.

What, then, allows successful sticking to take place?

Fisher and her colleagues have uncovered a sort of intricate mating dance that seems to occur between the embryo and the uterine wall.

Human embryos, it turns out, are covered with proteins called selectins, which are attracted to carbohydrates. Every month after ovulation, the lining of the uterus expresses carbohydrates, which are drawn to a protein called L-selectin on the outer walls of the embryo.

This mutual attraction causes the L-selectin of the embryo to bind briefly with the carbohydrates of the uterine lining, separate and then bind again, slowing the embryo's rate of progress through the uterus. Eventually, the embryo comes to rest against the uterine wall and taps into the mother's bloodstream to form the placenta. Think of a plane landing on a runway: The wheels touch the ground several times before coming to a final stop.

"It's not surprising that there is communication between the implanting embryo and the endometrial surface, and we know that there's some type of signaling that's involved in the implantation process," Grazi says. "What's exciting about it is that they've been able to identify a specific molecular substance that is involved that can a) be tested for and, b) possibly in the future be controlled."

A similar principle is at work in the body's blood system: The sticking mechanism allows leukocytes (white blood cells, which fight infection) to slow down and stop before they exit the bloodstream destined for inflamed tissue.

In addition to shedding light on the mechanisms involved in miscarriage and infertility, this research may help us understand preeclampsia, a potentially fatal form of high blood pressure that occurs in about 10 percent of pregnancies. According to the study authors, in preeclampsia, the placenta does not attach fully to the uterine wall, depriving the fetus of oxygen and endangering the mother's life. This process may also involve the same interaction of carbohydrates and proteins.

"Certainly once you figure out what controls the secretion of these carbohydrates you can possibly control them, but obviously it's just one piece of information," Grazi says. "There are a lot of other putative implantation molecules that are involved, so this may be just one."

Any number of things might be affecting the embryo's ability to attach to the uterus. Women with sexually transmitted diseases, for instance, have a lower rate of being able to get pregnant, Fisher says. We know now that infection causes the L-selectin to shed, which means it lacks the ability to connect with the uterine lining. "You can imagine that if you have anything from chlamydia to gonorrhea that you might knock this part of implantation out," she says.

Fisher's next focus of research is on what happens "downstream" from the L-selectin or the proteins on the embryo. When L-selectin binds to the carbohydrates in the immune system, it triggers a set of signals that allow the leukocyte to stop and stick to a blood vessel, then leave the vessel for the inflamed tissue, where it's needed. Fisher wants to prove that the same thing is happening in the process of embryo attachment.

"That would mean if we could give an embryo or a placental cell those signals artificially, we might be able to get over a major hurdle to implantation and trigger downstream events," Fisher says.

In the nearer term, the University of California, San Francisco has filed for a patent to use L-selectin to help determine if a woman is infertile and to locate the exact cause.

More information

For more on infertility, visit the National Infertility Association or the InterNational Council on Infertility Information Dissemination.

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Prescription Drug Abuse on the Rise 

By Laura Meckler

Associated Press Writer

The Associated Press

Thursday, January 16, 2003

WASHINGTON - A growing number of teenagers and young adults are abusing prescription drugs, a government report says, with non-medical use of pain relievers and tranquilizers reaching record highs.

In 2001, nearly 3 million young people, age 12 to 17, reported that they had used prescription drugs for non-medical reasons at least once, the government said. The number of new users has been climbing since the mid-1980s.

Federal officials, who released the report Thursday, were promoting their education campaign highlighting the dangers of these drugs when used improperly.

"Abuse of prescription drugs can lead to addiction, misdiagnosis of serious illness, life-threatening circumstances and even death," said Charles Curie, administrator of the Substance Abuse and Mental Health Services Administration, a branch of the Department of Health and Human Services (news - web sites), which released the report Thursday.

He was being joined by officials from the Food and Drug Administration (news - web sites) in discouraging misuse of these drugs. The education effort includes posters, brochures and print advertisements.

A companion report, based on a survey of hospital emergency rooms, found a steady, significant rise in visits for opiate abuse since 1994.

In 2001, there were about 90,000 visits for abuse of these narcotics, a 117 percent rise over 1994, according to data from the Drug Abuse Warning Network. The largest increases were found in abuse of oxycodone, methadone and morphine.

The average age of these ER patients was 37.

The first report is based on the National Household Survey of Drug Abuse, an annual survey that included 69,000 people in 2001. That includes more than 45,000 people age 12 to 25.

It found that in 2001, 36 million Americans — 16 percent of all people age 12 and up — had used prescription drugs non-medically at least once in their lives. That includes people who took a drug that had not been prescribed for them and those who took drugs only for the experience or feeling they caused.

Among young adults, age 18 to 25, 7 million had used these drugs non-medically at least once.

Among teens, girls were more likely than boys to have misused drugs; it was opposite among young adults. Abuse was more common among whites than Hispanics, blacks or Asians.

The number of new users has risen sharply since the mid-1980s. The number misusing pain relievers climbed from about 400,000 then to 2 million in 2000.

On the Net:

Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov

Food and Drug Administration: http://www.fda.gov

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Brain Booster 

HealthScoutNews
Thursday, January 16, 2003

(HealthScoutNews) -- Physical activity benefits your body as well as your mind, especially your memory skills.

 According to the Baycrest Center for Geriatric Care in Toronto, exercise increases the supply of blood and nutrients to the brain. Research shows that after a 20-minute walk, older adults perform better on memory tests.

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Scandinavia Leads in Maternity Benefits

The Associated Press

Thursday, January 16, 2003

LONDON - Maternity benefits vary widely around the world, but Sweden leads the way, giving moms up to 96 weeks off, according to a study released Thursday.

For more than half that period, Swedish mothers also receive the equivalent of 80 percent of their salary. Pay decreases sharply after 390 days, according to the poll of 33 countries. It was released by the New York-based firm Mercer Human Resource Consulting.

In the United States, there is no federal law requiring a minimum amount of maternity pay, although mothers may get short-term disability or sick leave benefits, the poll said.

Mothers in Norway, New Zealand and Australia got the second-best deal, with up to 52 weeks' leave, while women having babies in Singapore and Taiwan fared the worst, with only eight weeks off.

In Norway, a mother earning $25,000 a year would get $12,500 in state maternity pay during the first six months of her leave, according to the poll.

Brazil also did well, with mothers on a similar salary receiving $11,538 over the same period.

Danish mothers got maternity benefits of $10,556. Italian mothers received $10,096.

The lowest paying countries in the EU were Greece, Luxembourg and Britain, while the EU average was $6,738.

Australian mothers only get a one-time payment of $448.

On the Net:

Mercer Human Resource Consulting, www.mercerhr.com

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Strokes Can Strike at Balance 

HealthScoutNews
Thursday, January 16, 2003

THURSDAY, Jan. 16 (HealthScoutNews) -- Balance problems while getting dressed may be a major factor in the high number of falls suffered by stroke survivors.

Roughly 40 percent of these patients suffered a serious fall within a year after having a stroke, says a study in today's online issue of Stroke. Previous studies have found stroke survivors are four times more likely than other people to suffer a hip fracture as the result of a fall.

That can slow their stroke recovery and lead to new complications.

In this new study, researchers in the United Kingdom found women stroke survivors who reported often having difficulty with their balance while dressing were seven times more likely to fall than women stroke survivors who had no balance problems.

The study also found that stroke survivors with overall balance problems, dizziness or a spinning sensation had a fivefold increase in risk for falls.

The study included 124 women stroke survivors. Of those, 48 percent fell during the year after their stroke, and 26 percent of those women suffered repeated falls.

More information

Here's where you can learn more about stroke.

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Drinking Plus Pot Smoking May Equal More Injuries

 

Reuters Health

Thursday, January 16, 2003

NEW YORK (Reuters Health) - Problem drinkers who also use marijuana may be particularly injury-prone, according to a study of emergency room patients.

Rhode Island researchers found that among 433 injured patients considered problem drinkers, those who said they also smoked pot appeared more accident-prone than others.

Compared with patients who said they didn't use marijuana, users were more likely to have had another injury in the past year, particularly an alcohol- or driving-related one.

Overall, nearly half of the study participants said they had smoked pot in the past three months, according to findings published in the January issue of the journal Academic Emergency Medicine.

It is not known whether these ER patients had actually used an alcohol-pot combo before they were injured, the study authors point out. Nor could they tell whether marijuana use alone is an injury risk factor.

"Isolated use of marijuana may or may not contribute to injury," write the researchers, led by Dr. Robert Woolard of Brown University Medical School in Providence.

Still, they conclude, the findings do suggest that problem drinkers who also use pot may be especially vulnerable to injury.

According to the researchers, ER doctors need to be aware that many of their injured patients may need counseling for both alcohol and marijuana use--and not just alcohol alone.

However, they point out, few emergency departments routinely screen all injured patients for alcohol and other drugs. And when problem drinking is clearly the culprit, the researchers add, "screening for other drugs is unusual."

Problem drinkers in this study were identified either by breath testing in the ER, patients' own reports of drinking shortly before the injury, or by scores on a standard screen for "hazardous" drinking.

Those who also reported marijuana use tended to be young, white males with relatively less education--although many patients overall, the researchers note, were college students.

Source: Academic Emergency Medicine 2003;10:43-51.

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Cell Cultures May Get Too Much Oxygen In Labs 

HealthScoutNews
Thursday, January 16, 2003

THURSDAY, Jan. 16 (HealthScoutNews) -- Cell biologists may be exposing cell cultures used in laboratory research to too much oxygen.

The Ohio State University study making that claim appears online in the January issue of Circulation Research.

The study says cells act differently depending on levels of oxygen exposure, and that's especially true when there's too much oxygen. The study's finding could have a wide impact on cellular biology research.

The air humans breathe contains about 21 percent oxygen. Most cell research is done in open air with the same percentage of oxygen. However, the cells in our bodies are exposed to oxygen levels in the range of 0.5 percent to 10 percent.

This study says that means most cellular biology research is done in conditions that are unnaturally rich in oxygen. That triggers cell stress, the study says.

The Ohio State researchers exposed mouse heart cells to normal 21 percent oxygen levels. They found that cell growth slowed and the cells showed some major physiological changes, including producing arrays of free radicals and specific oxygen-sensitive genes.

However, mouse heart cells incubated at a 3 percent oxygen level remained mobile and continued to grow.

More information

Here's where you can get inside the cell.

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Antibiotics Could Up Intestinal Risk in Children

By Merritt McKinney

Reuters Health

Thursday, January 16, 2003

NEW YORK (Reuters Health) - Infants and young children who take antibiotics may have an increased risk of developing a rare type of intestinal blockage, according to a new study.

The results of the study do not prove that antibiotics cause the complication, known as intussusception. The researchers think that antibiotics may be just one of several factors that contribute to intestinal blockage in young children.

However, the findings may provide another reason to use antibiotics sparingly, the lead author of the study told Reuters Health.

"This is the first preliminary study to describe that antibiotic use may be a risk factor in the development of intussusception, the most common form of intestinal obstruction in young children ages 3 months to 6 years," Dr. David M. Spiro said.

The results of the study "should reinforce the need for both parents and physicians of young children to wisely use antibiotics only when absolutely necessary," said Spiro, who is at Children's Hospital of Alabama in Birmingham.

Intussusception is the number one cause of intestinal blockage in young children, but what causes the condition is a bit of a mystery. Roughly 1 in 5,000 babies in the US develop intussusception, according to one study.

Since antibiotics can affect the workings of the gut, Spiro and his colleagues set out to see whether antibiotic use influences the risk of intussusception, something that had not been done before.

The researchers compared 93 children who developed intussusception with a "control" group of 353 children treated for injuries.

Children who took antibiotics were about four times more likely to develop the intestinal obstruction than children who did not take the medications, the researchers report in the January issue of the journal Archives of Pediatrics and Adolescent Medicine. The risk was greatest--more than 20 times higher--in children who had been prescribed a class of antibiotics called cephalosporins.

About one in four children had taken an antibiotic, most often for the ear infection otitis media, within 48 hours of developing the obstruction.

Spiro and his colleagues note that more research is needed to prove that antibiotics cause the condition, however.

Source: Archives of Pediatrics and Adolescent Medicine 2003;157:54-59.

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A Complication in Stem Cell Diabetes Research

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews
Thursday, January 16, 2003

THURSDAY, Jan. 16 (HealthScoutNews) -- Early reports that embryonic stem cells were transformed into insulin-producing beta cells -- a major goal in the search for a diabetes cure -- may have been too optimistic, scientists now report.

The insulin found in laboratory cultures may not have been produced by those cells, says a report in tomorrow's issue of Science. Instead, the cells may have been releasing insulin they absorbed from the medium on which they are grown.

Insulin is commonly used to promote the growth of cells in culture, says Dr. Jayaraj Rajagopal, a postdoctoral fellow at Harvard University and the Howard Hughes Medical Institute. "What we have shown is that when cells are cultured in the conditions previously reported, they have the ability to absorb insulin from the medium rather than making it themselves." They can then release the absorbed insulin for as long as two weeks, the scientists found.

When Rajagopal's group grew supposedly transformed stem cells in an insulin-free medium, no insulin was detected, he says.

The finding doesn't end the hope of using embryonic stem cells to make insulin-producing beta cells, which can then be implanted in diabetes patients, Rajagopal says. "What is needed is either modification of existing protocols [methods] or development of new protocols that will generate beta cells," he says. "What we are reporting is something scientists need to be aware of."

Dr. Linda B. Lester, an assistant professor of medicine at Oregon Health Sciences University and leader of a group working on the subject, is aware of the issue. Early reports of the Harvard work have been circulating among workers in the field, she says. Her group has reported successful transformation and "I still would stand behind the results," she says.

To Lester, a large part of the issue is that "we need other ways to identify a beta cell in culture" than the method used by Rajagopal and his colleagues.

They used a chemical that stains all cells that carry insulin. The results can be confusing because it is not clear whether the insulin is produced by the cells or was absorbed from the medium on which they were grown, Lester says.

Her group has been using a different chemical that stains C-peptide, a byproduct that is made only when a cell is producing insulin. That method shows that at least some of the insulin in the cell culture was produced by the cells, she says.

The Oregon group has been working with embryonic stem cells of rhesus macaque monkeys, which avoids the major controversy about use of human embryo stem cells in medical research. The federal government has placed severe restrictions on research with human embryo stem cells.

Dr. Joel F. Habener, a professor of medicine at Harvard Medical School (news - web sites), is working on a technique that would make such concerns unnecessary. He's using adult human stem cells from the Isles of Langerhans, the insulin-secreting bodies in the pancreas. Transplants of islet cells have worked well in humans, but the problem is a lack of donors, Habener says--"only enough for one in every 500 people who need it."

His idea is to take adult pancreatic stem cells -- in the best case from people who will need them -- then grow them in culture and implant them in diabetics (news - web sites). The technique has worked well in mice, Habener says.

And he stopped using the insulin-rich growth medium most laboratories use a while ago because its contaminating effects became clear, he adds.

More information

You can learn more about stem cell research from the Joslin Diabetes Center or from the National Institutes of Health.

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Drink, Be Merry, Blame the Beergut on Your Genes

 

By Claire Soares

Reuters

Thursday, January 16, 2003

NAPLES (Reuters) - Beer lovers around the world raise your glasses--it might not only be how much you drink that determines the size of your beer belly, it could be your genes.

A team of Italian scientists has linked a gene, known as DD and present in about 40% of the population, to abdominal weight gain in men. In a study published earlier this month in the medical journal Annals of Internal Medicine, researchers monitored some 300 male factory workers over a 20-year period and found that DD carriers put on 50% more weight--an average 9.9 pounds against 6.6 pounds for non-carriers.

"Some people, despite their sacrifice of looking at calories and trying to exercise as much as they can, tend to put on fat because they are genetically susceptible," research leader Pasquale Strazzullo, from the Federico ll University of Naples Medical School, told Reuters.

"And weight gain around the stomach is the way it goes, particularly for males," the trim doctor explained at his office in a Naples hospital.

The first set of figures collected in 1975 did not include waist measurements, so in the 1994 to 1995 data gathering Strazzullo took this measurement and widened his sample to about a thousand workers to calculate more accurately just how much bellies had ballooned.

He found the waist of a DD carrier grew by an average of nearly one inch over 10 years, compared to just under 0.3 inches for men without the gene.

The team also found that around 52% of the DD men were overweight compared to almost 44% of non-carriers.

"Obesity is a big jigsaw and this study is a small piece we have slotted into place," Strazzullo said.

"Two gene variants have already been linked to weight gain but they are actually rare. The interest with this study is that the DD gene occurs in about 40% of the population."

The World Health Organization (news - web sites) estimated that in 2000 there were some 300 million obese people worldwide, a leap from 200 million just five years earlier.

"The obesity epidemic is difficult to face because everything in our society tempts us to put on weight. What we eat and how much we exercise does matter, but there is a genetic tendency for some individuals," Strazzullo said.

Despite the new evidence linking DD to weight gain, Strazzullo says only half the mystery has been solved. Now scientists must try to unravel exactly how the process works.

"It is not excluded that in a few years we will know the mechanism of this association and we may find...a drug to counteract the effect, but at this time it is very premature."

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Stiff Fingers Are Windows Into Heart Disease

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews
Thursday, January 16, 2003

 THURSDAY, Jan. 16 (HealthScoutNews) -- Got arthritis in your finger? You've got trouble beyond just a stiff digit.

Finnish researchers have discovered an association between osteoarthritis in even a single finger joint in men and the likelihood they will die of cardiovascular disease.

Women with osteoarthritis in the fingers aren't home free by any means, the study found. They had a modestly higher risk of dying from heart disease if they had arthritis in one finger or in symmetrical joints, the Finns report in the February issue of Annals of the Rheumatic Diseases.

A team led by Dr. Mikko Haara, a researcher at the University of Kuopio in Kuopio, Finland, looked at a population sample of 8,000 Finns, aged 30 and above, and took hand X-rays of 3,595 subjects. The subjects were gathered from 1977 to 1989; by the end of 1994, 897 had died. Then Haara's team looked at causes of death and whether the subjects had arthritis.

Men with symmetrical arthritis of the fingers weren't at increased risk of dying from heart disease, but those with arthritis in a single finger joint were 42 percent likelier to die.

Women were at increased risk whether they had a single digit involved or symmetrical joints, with a 25 percent higher risk for symmetrical joints with arthritis and 26 percent for a single joint.

The biggest surprise, says Haara, was that "osteoarthritis in any finger joint significantly predicted cardiovascular deaths in men."

Exactly why this occurs isn't known, Haara says. But "even if the mechanism remains unclear, it is well known that body mass index" is tied to both osteoarthritis and cardiovascular disease. Of the 3,595 participants, 2,139 had body mass indexes above 25, which is considered overweight.

Dr. James Cerhan, an epidemiologist at the Mayo Clinic who has reported the same association previously in women, says the study is interesting. However, he adds, the finding for men requires further research and replication with a bigger sample.

"It's interesting because this is such an understudied area," he says. "It's very consistent with most of what is in the medical literature for some of the larger epidemiological studies."

Haara says that even though the association between hand osteoarthritis and increased risk of death from heart problems isn't thoroughly understood, "this study shows clearly how important are the healthy ways of living. Try to avoid getting overweight by exercising enough and eating low-fat food, and you have a lower risk both of osteoarthritis and cardiovascular disease and you will live a longer life."

If you already have arthritis, he says, ask your doctor about anti-inflammatory medicines to delay the progress of the disease and about a moderate exercise program.

"The strongest take-home message in this paper is the importance of controlling obesity," Cerhan says. While the public may be aware of the connection between obesity and arthritis of the knee, he says, they are perhaps less aware that excess weight can also be to blame for stiff fingers.

More information

For more on osteoarthritis, visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases or the Arthritis Foundation.

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Repeal of Helmet Law Brings Higher Medical Costs

Reuters Health

Thursday, January 16, 2003

NEW YORK (Reuters Health) - Mandatory adult helmet laws may not only reduce a motorcycle rider's risk of serious injury or death, they may also save hospitals and taxpayers lots of money, a team of Arkansas researchers reports.

They investigated the impact of Arkansas' repeal of its adult helmet law and found that it was associated with both an increase in deaths among non-helmeted riders and nearly $1 million in potential lost revenue due to unreimbursed hospital charges.

In light of these findings, "other states that are debating whether to repeal their motorcycle helmet law...should carefully consider the additional financial resources that will likely be needed to cover increased health care costs," write lead study author Dr. Gregory H. Bledsoe of the University of Arkansas for Medical Sciences in Little Rock and his colleagues.

The July 1997 repeal made Arkansas the first state in 14 years to abolish its mandatory helmet law, with Texas, Kentucky and Louisiana following soon afterwards.

The repeal was due to strong lobbying by various motorcycle rider organizations that dispute the idea that mandatory helmet laws can improve safety and cut costs, and to the congressional repeal of financial incentives intended to promote universal helmet laws.

In the three years before the repeal, deaths of non-helmeted riders accounted for 40% of all crash fatalities, and rose to about 76% of all deaths during the three years after the law's repeal, the researchers report in a recent issue of The Journal of Trauma: Injury, Infection, and Critical Care.

Further, whereas one quarter of motorcycle riders admitted to the hospital after a nonfatal crash were not wearing helmets in the years before the repeal, just over half of hospitalized riders were unhelmeted in the years following the repeal. And patients not wearing helmets had more severe head and neck injuries and longer stays in intensive care units than helmeted riders.

Finally, motorcycle riders who were not wearing helmets--many of whom had public insurance or were uninsured--had much higher unreimbursed medical charges than did helmeted riders, the investigators report.

In one case, a non-helmeted uninsured patient had charges that totaled more than $60,000, and reimbursements that covered less than $35,000.

Altogether, for each non-helmeted patient, there was an additional $14,240 in unreimbursed charges, bringing the total amount of potentially lost revenue--hospitalization and medical costs as well as the costs borne by society due to a loss in productivity--to about $983,000 over the course of the study.

"Helmet laws do have a clinically and financially significant impact on the sequel of motorcycle riders hospitalized after nonfatal motorcycle crashes," the authors conclude.

Prior to Arkansas' repeal of its mandatory helmet law, 97% of motorcyclists wore helmets, according to previous research. That proportion dropped to 52% just nine months after the law was repealed and then to 30% nine months after that, Bledsoe and his team note.

Source: The Journal of Trauma: Injury, Infection, and Critical Care 2002;53:1078-1087.

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Diabetics Need to Watch Their Eyes

HealthScoutNews
Thursday, January 16, 2003

THURSDAY, Jan. 16 (HealthScoutNews) -- A United Kingdom study proposes recommendations on how often to screen for diabetes-related eye disease.

The study, in this week's issue of The Lancet, included more than 7,500 people with diabetes. It provides information about the incidence of diabetic eye disease and also offers recommendations for how often people with diabetes should have their eyes checked.

Diabetic retinopathy -- diabetes-caused damage to retinal cells in the eye -- is a leading cause of vision loss in developed countries.

The researchers say their screening recommendations would be 95 percent effective in detecting sight-threatening retinopathy.

The study proposes that people with diabetes who have no retinopathy have their eyes checked every three years; those with no retinopathy who use insulin or have had diabetes for more than 20 years should be screened every year; people with background retinopathy should be screened every year; and people with mild preproliferative retinopathy should be screened every four months.

More information

Here's where you can learn more about diabetic retinopathy.

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Heart, Stroke Risk Starts Early in Type I Diabetics

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews
Thursday, January 16, 2003

THURSDAY, Jan. 16 (HealthScoutNews) -- The risk that young people with Type I diabetes -- the kind in which the body stops making insulin -- will die of stroke or other cardiovascular disease is much higher than had been thought, a British study finds.

In the 20-to-39 age group, the risk of cardiovascular death for persons with Type I diabetes was more than fivefold higher in men and sevenfold higher in women than in the general population, says a report in the February issue of Stroke.

The finding is "not entirely surprising," says Susan P. Laing, an epidemiologist at the Institute of Cancer Research (news - web sites) in England, who led the study. But while previous studies have documented the increased risk among people with Type II diabetes, in which the body produces some insulin, this is the first study to produce hard numbers about the risk of cardiovascular death in young people with Type I diabetes, she says.

"Physicians need to be much more aware that young diabetics (news - web sites) will be having more cardiovascular risk than the general population," Laing says.

The subject already is of concern to the American Diabetes Association, says Dr. Francine R. Kaufman, an endocrinologist at Children's Hospital in Los Angeles who is president of the association.

"Just last week at a postgraduate course I said that it is important to start to look at cardiovascular risk factors at adolescence or even earlier," Kaufman says.

The association has put together an expert panel to consider recommendations about lipids such as cholesterol in Type I diabetes patients 12 and older, she says.

"Physicians need to be sure that the levels are normal," Kaufman says. "If not, they should consider intervention, such as lipid-lowering agents."

Another risk factor of special concern in young people is high blood pressure, she says, although there also is the need to monitor and intervene in the case of other risk factors, such as smoking.

"The risk begins earlier than has been thought, and we need to do good intervention in this cohort," Kaufman says.

The British study, called the Diabetes UK Cohort, included 23,751 patients diagnosed with Type I diabetes under the age of 30. The researchers followed the patients for an average of 17 years, recording deaths from stroke, heart attacks, and other cardiovascular diseases and comparing the rate of their occurrence with that of the general population.

In all, cardiovascular disease accounted for 4 percent of all deaths under the age of 40 and 8 percent over the age of 40 -- much higher than among people without diabetes.

"These observations emphasize the vital need to identify and treat known cardiovascular disease factors in young people with diabetes," Laing says.

More information

Learn more about diabetes and heart disease from the American Heart Association or the American Diabetes Association.

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WEDNESDAY, JANUARY 15, 2003 

Worms May Offer Clue to Obesity 

HealthScoutNews

Wednesday, January 15, 2003

WEDNESDAY, Jan. 15 (HealthScoutNews) -- Worm genes may help scientists understand how fat is stored and used in humans.

A study in tomorrow's issue of Nature examined the genetic makeup of one particular worm to come to that conclusion.

Massachusetts General Hospital scientists and their colleagues searched thousands of genes in the Caenorhabditis elegans. They found hundreds of promising gene candidates that may lead to a better understanding of fat storage and use in other kinds of animals.

C. elegans shares many genes with humans. The worm has let scientists learn more about diseases such as cancer, diabetes and Alzheimer's disease (news - web sites). Many of the genes that regulate fat storage and use in C. elegans have counterparts in humans and other mammals.

The study is the first survey of an entire genome for all genes that regulate fat storage. To identify these genes in C. elegans, the researchers inactivated genes one at a time and then looked for changes in fat content in the worms.

They identified about 300 genes that, when turned off, reduced body fat and about 100 genes that, when inactivated, increased fat storage. About 100 of those 400 worm genes have human counterparts.

More information

Here's where you can learn more about fat.

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Risk for Left-Behind Surgery Tools Higher in Obese 

By Alison McCook

Reuters Health

Wednesday, January 15, 2003

NEW YORK (Reuters Health) - In very rare instances, a patient will walk away from surgery carrying a memento of the experience inside their bodies, such as a sponge or surgical instrument.

Now research released Wednesday suggests that such potentially life-threatening mistakes occur more often in people who are overweight or are undergoing emergency surgery, or as a result of operations in which doctors had an unexpected change in procedure.

"This is a rare but serious problem," study author Dr. Atul Gawande of Brigham and Women's Hospital and Harvard University in Boston, Massachusetts told Reuters Health.

For the most part, health workers do not make this mistake because they are careless, Gawande added. In the majority of cases where tools of surgery are left in a patient's body, health workers had counted both sponges and instruments at the beginning and end of surgery. These counts were noted as being correct, he said.

"It's a problem that occurs despite us following proper procedures," Gawande noted.

In order to determine what situations may increase the risk of the patient leaving the operating room with tools in his body, Gawande and his colleagues compared the cases of 54 patients who experienced this problem to 235 patients who underwent surgery and did not.

Of the instruments left in bodies, 69% were sponges, and 31% were instruments.

The authors report their findings in the January 16th issue of the New England Journal of Medicine (news - web sites).

Gawande and his team discovered that people who retained sponges or instruments in their bodies were more likely than others to have undergone emergency surgery, and to have experienced an unanticipated change in procedure during the surgery. Patients who experienced this accident also tended to have a higher body mass index, a measure of obesity that factors people's height into their weight.

In an interview with Reuters Health, Gawande explained that emergency surgeries are often rushed and chaotic, and even if health workers count the number of tools--which can number in the 100s--they may not count them correctly.

The same explanation likely applies to situations where there is a change in procedure during surgery, the researcher noted, such as when doctors plan on operating to treat appendicitis but discover cancer. In those instances, new equipment is brought in and original counts have to be adjusted--both situations where errors can occur, Gawande said.

But even if the surgical tools have been miscounted, doctors can often look inside a patient and see an instrument or sponge, he added. When a patient is overweight or obese, however, the tool may be obstructed by fat, Gawande said. "But in a very lean person, you just look around and you find something."

These are not harmless mistakes, he noted. In some instances, a sponge can become infected, leading to a life-threatening body-wide infection. Some tools can perforate the bladder and bowel, Gawande added, or cause bleeding. Among the people included in the study, 69% of those who retained surgical tools needed to undergo an operation to remove them, and one died.

Thankfully, this accident does not occur often enough to justify implementing expensive measures to prevent future incidents, Gawande said. However, he recommended that doctors perform X-rays on patients who appear at high risk, such as those who are obese and were operated upon as an emergency, or whose doctors changed the surgical plan during the procedure. X-rays can detect surgical sponges as well as instruments, the researcher noted.

In addition, he said future technologies may be able to sniff out these errors before patients leave the operating room. One day, hospitals could be equipped with a technology similar to a sensor in a bookstore, he said, which activates when a person passes over a threshold carrying a book with a marker that has not been removed at the cash register. A comparable device could also activate itself if a patient containing a surgical tool leaves the operating room, Gawande suggested.

Source: The New England Journal of Medicine 2002;348:229-235.

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Improving the Odds Against Ovarian Cancer 

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 15, 2003

WEDNESDAY, Jan. 15 (HealthScoutNews) -- The odds of surviving early-stage ovarian cancer may increase significantly when surgery is followed by chemotherapy.

That's the heartening finding of two European studies published in today's issue of the Journal of The National Cancer Institute (news - web sites). Together, they represent the largest randomized studies done on the impact of chemotherapy on women with early-stage ovarian cancer.

Although both studies came to similar conclusions, there were differences.

In the first, conducted by the European Organization for Research and the Treatment of Cancer, the thoroughness with which doctors looked for renegade cancer cells at the time of surgery -- a process known as "cancer staging" -- was figured into whether or not chemotherapy offered any significant benefits.

"We know that after incomplete staging there is a chance of unrecognized small residual disease somewhere in the abdominal cavity of about 25 percent of patients," says study author Dr. J. Baptist Trimbos, chairman of the department of gynecology at Leiden University Medical Center in the Netherlands.

"We think that chemotherapy works [to extend the patient's life] primarily by affecting this unappreciated residual disease," he says.

In the second study, which did not take cancer-staging into consideration, researchers still found that, overall, ovarian cancer patients who followed surgery with chemotherapy not only lived longer, but were also able to survive disease-free far more often than those women who had surgery alone.

For medical oncologist Dr. Don Dizon, the studies offer new evidence that chemotherapy does hold an important place in the treatment of early-stage ovarian cancer. As many as 50 percent of women with early-stage ovarian cancer relapse after surgery, the researchers note.

"These are probably two of the largest randomized studies on early-stage ovarian cancer, which is really the bigger point, since most of the data we have previously relied on has been extrapolated from studies on advanced stage disease," says Dizon, a medical oncologist who specializes in gynecologic cancers at Memorial Sloan-Kettering Cancer Center in New York City.

Indeed, Dizon says, while doctors were fairly certain chemotherapy helped advanced ovarian cancer patients live longer, what remained in question was whether it could do the same for patients with early-stage disease -- and whether the additional toxicity of the chemotherapy was outweighed by any meaningful benefits.

"I'm not sure that these two studies answer these questions definitively, but it certainly indicates that there appears to be at least some benefit for some women to adding chemotherapy to the treatment of even early-stage ovarian cancer," Dizon says.

The first study involved 448 cancer patients recruited from across Europe. The group was randomly assigned to receive either four to six chemotherapy treatments beginning six weeks after surgery or medical observation with no chemotherapy.

In addition to observing the overall impact of both treatment approaches on cancer survival, doctors also looked at the role of cancer staging at the time of surgery.

What the study found: At five years, an equal number of patients were surviving ovarian cancer, with or without chemotherapy. However, 76 percent of the patients treated with chemotherapy were surviving disease-free, with no recurrences, as compared to 68 percent of those who did not receive the additional treatment.

Further, the researchers found those patients who did not receive optimal staging at the time of their surgery benefited most from the chemotherapy -- ostensibly because residual cancer was left inside the body.

"Clearly, the quality of cancer staging can be regarded as a new prognostic factor in early ovarian cancer," Trimbos says.

In the second study, called the International Collaborative Ovarian Neoplasm study, 477 women with ovarian cancer were randomly assigned to receive either chemotherapy or medical observation following surgery.

The conclusion: Checking in at five years, the women who received the chemotherapy had a 9 percent greater overall survival rate and an 11 percent greater recurrence-free survival rate than women who received no chemotherapy.

"Early-stage ovarian cancer is not going to be one unified diagnosis -- there are shades of gray within each case, with many factors influencing the survival outcome. However, based on these two studies, for at least some early-stage ovarian cancer patients, chemotherapy does appear to be a worthwhile addition to their treatment regimen," Dizon says.

More information

To learn more about ovarian cancer, visit The National Ovarian Cancer Coalition.

To find the latest research on ovarian cancer, visit The National Cancer Institute.

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Perplexed Over Pimples 

HealthScoutNews

Wednesday, January 15, 2003

(HealthScoutNews) -- Many adolescents view acne as a curse of the teen-age years. Unfortunately, there's no foolproof way to prevent or cure flare-ups, but certain skin care tips can help.

 The University of Michigan recommends you:

  • Keep your skin clean and use a clean washcloth every time.
  • Try an astringent lotion, de-greasing pads, or a face scrub.
  • Don't squeeze, scratch or poke at pimples. They can get infected and leave scars.
  • Wash after you exercise or sweat.
  • Wash your hair at least twice a week, and keep it off your face.
  • Use only water-based makeup. Don't use greasy or oily creams or lotions.
  • Ask your doctor for the name of a good acne soap.

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Immune System May Sway Ovarian Cancer Survival
 

By Amy Norton

Reuters Health

Wednesday, January 15, 2003

NEW YORK (Reuters Health) - Immune system T cells may play a vital role in whether a woman survives ovarian cancer, new study findings show.

Investigators say the findings support ongoing research efforts to fight cancer by boosting the body's built-in defenses. They also speculate that looking for T cells within ovarian tumors could help doctors predict a woman's prognosis and guide her treatment.

Their study found that among women with advanced ovarian cancer, those whose tumor samples contained T cells lived nearly three times longer than women whose tumors lacked the cells.

And among women who had a complete response to surgery and chemotherapy, those with T cell-containing tumors remained progression-free 10 times longer.

T cells help orchestrate the body's overall immune response, and can directly attack foreign, infected or cancerous cells. The belief is that, when T cells are able to infiltrate tumors, a strong immune response "kicks in" during treatment and lasts into the long-term, study author Dr. George Coukos explained.

And the hope, he told Reuters Health, is to use an immune-boosting treatment approach--such as a cancer "vaccine"--to enhance patients' natural T cell response, or to "generate a response from scratch" in patients who lack a spontaneous one.

Coukos, of the University of Pennsylvania in Philadelphia, and his colleagues report the findings in the January 16th issue of The New England Journal of Medicine (news - web sites).

The study involved frozen tumor samples taken from 186 women before treatment for advanced ovarian cancer, a disease with a typically dim prognosis. In the US, fewer than 25% of women with this stage of the cancer live for five years.

In this study, 38% of women whose tumors contained T cells survived for five years, compared with just 4.5% of those whose tumors lacked T cells.

Past research had found that some ovarian tumors contain T cells, but the meaning of this has been unclear. The new study ties the presence of these cells, independently, to ovarian cancer survival, according to Coukos.

The same association has already been found for several other cancers, including the skin cancer melanoma, and cancers of the breast, prostate and colon.

Based on this and past research, the study authors estimate that about half of women with advanced ovarian cancer have T cells in their tumors.

Finding out why only half of them do is an important question, Coukos said.

In addition, he and his colleagues point out, the presence--or lack thereof--of T cells in ovarian tumors could potentially be used to predict a woman's prognosis.

"We've discovered a very important prognostic marker we didn't know we had," Coukos said.

Source: The New England Journal of Medicine 2003;348:203-213.

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Cold Feet 

HealthScoutNews

Wednesday, January 15, 2003

(HealthScoutNews) -- Cold feet can be a sign of poor blood flow to your body's extremities. To improve the circulation of blood to your feet, Johns Hopkins Bayview Medical Center recommends you pay attention to the shoes you wear.

Choose comfortable and well-fitting pairs. The upper part of the shoes should be made of a soft, flexible material to match the shape of your foot. Leather shoes are best because the leather can reduce skin irritations. Make sure the soles are not slippery and preferably fairly thick. Well-padded soles lessen the pressure when you walk on hard surfaces.

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Stress in Pregnancy Tied to Premature Delivery 

By Jacqueline Stenson

Reuters Health

Wednesday, January 15, 2003

NEW YORK (Reuters Health) - While studies on the effects of stress during pregnancy have yielded conflicting results, the latest report finds that it may raise a woman's risk of premature delivery.

Pregnant women who said they were experiencing high levels of stress from events such as marital separation, problems with in-laws or issues at work were 80% more likely to have a preterm delivery than those who reported low stress levels.

Overall, there were 71 preterm births and 402 full-term births among women reporting high stress, compared with 39 preterm births and 416 full-term births in the low-stress group, according to findings published in the January 1st issue of the American Journal of Epidemiology.

Study author Dr. Nancy Dole, associate director of the Carolina Population Center at the University of North Carolina in Chapel Hill, said she wasn't surprised by the finding because other studies on this issue, though not all, have suggested such an association.

Dr. Peter Heyl, an associate professor of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk, Virginia, said he believes stress can increase a woman's risk of premature delivery, but just how much is unclear because studies have found varying degrees of impact.

"I think stress is a factor in a lot of pregnancies that end up with a preterm delivery," he said in an interview.

Still, the majority of pregnant women who are under stress will not have a premature delivery, Heyl emphasized.

Among those most at risk are women in low socioeconomic groups who may get inadequate prenatal care and have constant worries about critical issues such as paying rent and putting food on the table, he said.

"Stress is a fight-or-flight kind of phenomenon," Heyl said, explaining that pregnant women under stress may have increased steroid secretions in the womb that can stimulate cellular receptors that control uterine contraction and relaxation. "Chronic stress could over-stimulate those receptors," he said.

The new study involved 1,962 pregnant women who were being treated at two prenatal clinics in North Carolina. In addition to their medical exams, the women were instructed to complete and mail in a survey that asked various questions about their psychological state, stressful life events, social support and other issues that might impact their pregnancies.

A total of 231 women delivered their babies prematurely, defined as before 37 weeks of pregnancy.

Results also showed that women who felt a lot of anxiety about their pregnancies, including those who experienced vaginal bleeding or had a history of miscarriage or other pregnancy problems, were twice as likely to deliver prematurely than women reporting low anxiety. But even women in the high-anxiety group who did not have identifiable underlying medical issues still were at increased risk for preterm delivery. In addition, women who perceived racial discrimination in their lives were 40% more likely to have a preterm birth than those who did not feel discriminated against.

So what should stressed-out mothers-to-be do?

"There's a general feeling that if women recognize the stress in their lives and can do some stress reduction during pregnancy, that's probably a good thing," Dole told Reuters Health. "But will it prevent a preterm birth? We're not in a position to say that."

Though the study linked stress with premature delivery, it did not find that having strong social support--such as having someone to talk over problems with or take them to see the doctor--substantially decreased the risk. "Our findings are consistent with some of the research showing that there's little effect for social support," Dole said. "It may be that certain kinds of support are more important than others."

Heyl said he regularly counsels stressed patients to find ways to relax.

"I recommend any relaxation technique, short of wild dancing till 3 in the morning and drinking, of course," he said. Yoga in pregnancy, he added, is "wonderful."

Source: American Journal of Epidemiology 2003;157:14-24.  

New Clue to Outlook for Ovarian Cancer 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 15, 2003

WEDNESDAY, Jan. 15 (HealthScoutNews) -- Women with advanced ovarian cancer whose tumors contain T-cells live longer than women whose tumors lack these important infection-fighting white blood cells.

The findings, which appear in tomorrow's issue of The New England Journal of Medicine (news - web sites), may one day change the way treatments are structured for ovarian cancer patients.

According to the American Cancer Society (news - web sites), more than 14,000 women die of ovarian cancer every year. As with other cancers, the survival odds increase dramatically the earlier the malignancy is caught. If the cancer has not spread beyond the ovaries, 95 percent of women will still be alive in five years. Overall, however, only slightly more than half the women diagnosed with ovarian cancer will survive beyond five years.

Although there has already been a lot of work involving tumor-infiltrating T- cells, particularly with other types of cancers, the prognosis for patients was unclear.

"As far as ovarian cancer was concerned, people have demonstrated that tumor-infiltrated lymphocytes [white blood cells] could indicate tumor immune response, but no one knew if they played a role in determining [the] course of the disease," says Dr. George Coukos, senior study author and director of the gynecologic malignancy research programs at the University of Pennsylvania. "What we are showing for the first time is that, indeed, tumor-infiltrating lymphocytes that indicate tumor immune response play an important role. They have a dramatic effect."

In this study, the researchers evaluated 186 frozen tissue specimens from advanced ovarian carcinomas to see whether the T-cells were present.

The results were striking: The five-year overall survival rate for patients whose tumors contained T-cells was 38 percent. For patients who did not have the cells, that number plummeted to 4.5 percent.

Women with tumor-infiltrating T-cells lived without a progression of their cancer for almost four times as long as patients without the telltale cells. Their survival rate was 2.8 times longer.

The results held fast regardless of what kind of treatment the woman had received. "We found that the prognostic power of lymphocytes is completely independent of chemotherapy and surgery," Coukos says.

The news was even better for a subset of patients who had their tumors surgically removed and who had a complete response to chemotherapy. "If these patients also had lymphocytes, the long-term survival is extraordinary," Coukos says. "We found up to a 70 percent survival rate at 10 years, which is unheard of in ovarian carcinoma."

What does this mean for cancer patients? "We have a new marker that can predict the outcome," Coukos says. "The idea is that it can potentially help us to tailor the therapies for specific patients. Right now, we're treating everybody the same way and people may respond well but they may not respond and then we're stuck."

Some courses of chemotherapy suppress the immune system while others don't. The presence or absence of T-cells could influence which type to use.

An added advantage is that the test to determine the presence of lymphocytes is a simple one. "Any pathology lab can do it," Coukos says.

"That is the first step. It opens a huge door basically to new therapeutics," Coukos says. "It really provides a strong rationale that we should be very actively looking for immune therapies in ovarian cancer. What we are really showing is that there is an immune response and that that immune response makes a difference."

The next goal is to reproduce the 70 percent survival rate found in that subset of patients in all patients. "We need to try to make everybody look that good," Coukos says.

However, don't look for these improvements tomorrow.

"It's a good piece of work, but these results are very preliminary," cautions Dr. Giuseppe Del Priore, assistant director of gynecologic oncology at New York University Medical Center and director of the Cancer and Fertility Society. "Vaccine trials in many sites like melanoma have been somewhat successful, but in other tumors, not so successful. Even direct infusion of these types of cells into patients has not been universally successful."

"We proceed in tiny steps," he adds. "There is not going to be a home run hit anytime soon in ovarian cancer, but that doesn't mean we shouldn't stop trying and keep advancing slowly."

More information

For more on ovarian cancer, visit the National Cancer Institute or the American Cancer Society.

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Kids' Brain Tumor Rx Tied to Later Health Troubles 

Reuters Health

Wednesday, January 15, 2003

NEW YORK (Reuters Health) - Children who survive brain tumors may face a heightened risk of certain hormonal or cardiovascular problems years after cancer treatment, according to new study findings.

Still, researchers stress that many survivors of childhood brain tumors do not develop these conditions, particularly if their cancer treatment involved surgery alone.

They also point out that the long-range medical problems they found in some survivors--such as growth hormone deficiency, blood clots and osteoporosis--are either treatable or preventable.

The findings, reported in the February 1st issue of the journal Cancer, are based on more than 1,600 individuals treated for childhood brain cancer in the US during the 1970s and 1980s. Dr. James G. Gurney, of the University of Minnesota in Minneapolis, led the study.

Overall, the researchers found, 18% reported developing one hormone-related condition, while smaller percentages reported multiple hormonal problems. One fifth developed growth hormone deficiency, a condition that can be treated with replacement hormones.

In addition, brain cancer survivors were more likely than their siblings to develop an underactive thyroid or the brittle-bone disease osteoporosis, a problem related to estrogen deficiency. And of the 533 female cancer survivors who were 16 or older, about 6% said they had never had a menstrual period, compared with 0.3% of similarly aged siblings.

More than one quarter of female cancer survivors reported taking hormones in order to have their periods.

Cardiovascular problems were also more common among cancer survivors than siblings. Serious conditions, although infrequent, included stroke, chest pain and blood clots.

For reasons that are unclear, the risks of both hormonal and cardiovascular problems were related to cancer treatment with chemotherapy and radiation. In fact, the study authors report, long-range hormonal conditions were "quite rare" among study participants who received only surgery.

In addition, stroke and blood clots occurring five or more years after cancer diagnosis were three times more common when cancer treatment involved surgery, radiation and chemotherapy, compared with radiation and surgery alone. However, Gurney's team stresses, these complications--regardless of cancer treatment--were uncommon.

They advise that survivors of childhood brain cancer be monitored for these potential problems for the long haul, since they can arise years after cancer treatment.

Moreover, they point out, both treatment and prevention of these long-range conditions is possible. The risk of cardiovascular problems, for example, can be cut with careful diet and exercise, and by not smoking.

Source: Cancer 2003;97:663-673.  

Latex Allergy Can Stick It to Diabetics 

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 15, 2003

WEDNESDAY, Jan. 15 (HealthScoutNews) -- A woman with diabetes suffered a severe allergic reaction simply because the stopper of the insulin container she used contained latex, British doctors report.

The case, detailed by Dr. David Orton and colleagues at Amersham Hospital in tomorrow's issue of The New England Journal of Medicine (news - web sites), should alert doctors to the possibility of such reactions in diabetic patients, the physicians say.

While the possibility of such reactions generally is assumed to be rare, studies have demonstrated that "natural rubber vial stoppers release sufficient latex protein into solution during storage to elicit positive intradermal skin reactions in latex-allergic persons," the report says.

"I could imagine it happening because the syringes we use are made of latex," says Dr. Edwin P. Schulhafer, a specialist who heads the Allergy, Asthma and Sinus Center of New York and New Jersey. But in this case, the syringe was latex-free and the allergic reaction was traced to the cartridge containing the insulin, made by Novo Nordisk.

"The manufacturer of the insulin preparations subsequently informed us that the cartridge bungs [stoppers] contained butyl rubber with added dry natural rubber latex," the journal report says. "Synthetic butyl rubber should pose no hazard to latex-sensitive persons, but the natural rubber latex added to the bungs to provide optimal durability must have been responsible for our patient's reactions."

The allergic response caused an itchy, unsightly rash at the injection sites that persisted for up to 48 hours, the physicians report.

To be sure that latex was the cause of the problem, the physicians compared the response when injections were made using a latex-free syringe, first directly from a glass vial and then through the latex-containing bung. A rash did not form after the first injection, but one appeared when the injected fluid came in contact with the bung.

Such a rash is typical of an allergic reaction to latex, which is derived from the sap of rubber trees, Schulhafer says. It is common among children with the birth defect spina bifida, apparently because they require frequent surgery for defects such as cleft palate, which brings them in contact with the latex gloves worn by medical personnel and with surgical catheters, he says.

"It is most common among health-care workers who wear latex gloves," he says. "The most common form of allergic reaction is a rash on the hands."

An allergic reaction can occur when a latex-sensitive individual uses a condom made of the material. Vinyl condoms are recommended for such individuals.

Officials at Novo Nordisk could not be reached for comment.

More information

More information about latex allergy is available from the National Institutes of Health. Get information on insulin from the Joslin Diabetes Center.

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Uninsured Skip Care Due to Medical Debt: Report 

By Todd Zwillich

Reuters Health

Wednesday, January 15, 2003

WASHINGTON (Reuters Health) - Nearly half of people without health insurance report being in debt because of unpaid medical bills, according to a national survey released Wednesday.

Nearly one quarter of people carrying medical debt in the survey said that their bills would prevent them from seeking medical care in the future for fear of being forced to pay. One in seven reported forgoing prescribed medications because of the cost of the drugs.

The problem is worse in rural areas, where up to 75% of uninsured patients visiting outpatient clinics said they could not afford to pay for their required prescriptions.

Experts said that the results, obtained in a 2000 survey of 6,884 uninsured persons in 18 states, underscores the urgency of providing health coverage to the growing number of uninsured persons in the US.

Outstanding expenses are also placing a burden on community hospitals and clinics that are owed money but still required to provide medical services to needy people, industry officials said.

"It puts to rest the myth of so-called free care," said Dennis P. Andrulis, a research professor at the State University of New York Downstate Medical Center in Brooklyn, New York and primary author of the report.

Close to 42 million Americans currently lack coverage, according to the most recent federal figures. Those numbers are widely expected to rise as states move to deal with budget deficits by cutting back eligibility for Medicaid health programs for the poor.

The US Congress is expected to consider ways to reduce the number of uninsured persons some time this year or early next year, congressional aides said Tuesday.

But lawmakers are still far apart on how to fix the problem, with most Republicans favoring tax credits to help uninsured people buy coverage on the private insurance market and most Democrats calling for more money to expand public health programs like Medicare and Medicaid.

About 30% of the survey's respondents said that they got help from hospital or clinic staff to find payment assistance for their medical care, often through state-funded public assistance programs or drug company programs offering free or discounted medications to low-income persons.

But close to half the respondents said they got no such help, according to the survey released by the Access Project, a health policy center affiliated with Brandeis University in Waltham, Massachusetts.

B.J. Reese, an uninsured 57-year-old woman from Charleston, West Virginia, said that she got no payment advice from her local hospital. She now owes $13,000 in medical bills after receiving care for rheumatoid arthritis and its complications, she said.

"Now I find myself unable to purchase large projects because of bad credit," said Reese.

Dan Hawkins, chief lobbyist for the National Association of Community Health Centers, said that unpaid bills are straining centers because rising health costs have caused private insurers to cut payment rates to most private hospitals.

The cuts require hospitals to reduce the amount of charity care to uninsured patients, forcing more of them to seek care at community health centers, he said.

A proposal last year from President Bush (news - web sites) to expand the number of centers nationwide would help ease the problem of uncollected fees, Hawkins said.

Bush also proposed $90 billion in federal tax health insurance tax credits over the next decade.

"It will not solve the health care crisis that we are facing today," Hawkins said.

Experts said they were looking to lawmakers in Washington to find a compromise that would mix tax credits with expansion of public programs in order to provide more people with health coverage.

"It's not clear that they are going to reach an agreement or a solution," Hawkins said.

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Low-Fat Diet Cuts Sex Hormones in Girls

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 15, 2003

WEDNESDAY, Jan. 15 (HealthScoutNews) -- Reducing dietary fat even modestly during puberty lowers the levels of certain sex hormones in preteen girls, a new study has found.

Researchers add, however, that they are not certain if the hormone dip will translate to a lower breast cancer (news - web sites) risk later in life.

High-fat diets have been linked with the development of breast cancer, although studies are inconclusive, says Joanne F. Dorgan, an epidemiologist at the Fox Chase Cancer Center in Philadelphia. "Most of the other studies have been done in adults, not girls," Dorgan says.

Dorgan led the study, appearing in today's issue of the Journal of the National Cancer Institute (news - web sites). The team randomly assigned 286 girls, aged 8 to 10, to be in the low-fat dietary intervention group or in the group that received educational materials from the American Heart Association (news - web sites), which calls for limiting fat to 30 percent or less of total calories.

Girls in the intervention group were instructed to limit total fat intake to 28 percent of calories (with less than 8 percent of that saturated), to eat fiber, and to limit cholesterol. All girls had high blood cholesterol levels.

The study was an ancillary study of the Dietary Intervention Study in Children to look at how to improve cholesterol.

The researchers wanted to find out if lower fat intake altered sex hormone levels that, in adults, may be related to the development of breast cancer.

Blood levels of the sex hormones were measured at the study start and at one, three, five and seven years. At the five-year mark, girls eating the low-fat diet had reduced levels of sex hormones compared with girls in the group not instructed to lower dietary fat. They had 29.8 percent lower estradiol, 20.7 percent lower estrone, and 28.7 percent lower estrone sulfate levels during the fist half of their cycles, and 27.2 percent higher testosterone levels during the second half of the cycles. By the seven-year mark, girls in the reduced fat group had half the progesterone levels during the second half of their cycles as did those in the other group.

"The results were stronger than I anticipated," Dorgan says.

"Experts in the field would expect some of these changes," says study co-author Victor Stevens, assistant director for epidemiology and disease prevention at Kaiser Permanente Center for Health Research in Portland, Ore. "But it surprised everyone that the differences were as large as they were."

Still, it's too soon to dispense public health advice for teen and preteen girls, Dorgan says.

The researchers don't think the hormone drop was enough to affect future fertility. "The menstrual cycles appear to remain normal," says Dr. Peter Kwiterovich, a professor of pediatrics and medicine at Johns Hopkins University School of Medicine and another co-author.

The researchers hope to get funding to bring back the subjects studied, who are now in their early 20s, for follow-up, Dorgan says. Findings from a parallel study conducted in boys will be reported separately.

Meanwhile, another expert in the field, Dr. Graham A. Colditz, a professor of medicine at Harvard Medical School (news - web sites), praises the study as "a rigorously conducted intervention. This has really shown quite clearly that differences in hormone levels have been achieved with this intervention. It breaks new ground."

Rather than focus on whether teen and preteen girls should lower fat intake or not, Colditz says, for now, the "real message" should be to maintain a healthy lifestyle, avoiding excess weight and exercising regularly.

More information

For more information on breast cancer risk, turn to the American Cancer Society, which also has a page on prevention.

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Scientists ID Key Gene for Long-Term Immunity 

Reuters

Wednesday, January 15, 2003

LONDON (Reuters) - Scientists in the United States have identified a key gene involved in long-term immunity against infections in a finding that could play an important role in vaccine research.

Without the gene, called SAP, the immune system cannot recognize and react to pathogens, making people more vulnerable to diseases.

"So this gene is clearly important for immune responses. Our work shows that the SAP gene is a central player in long-term antibody responses, and indicates that manipulation of SAP may have therapeutic benefits in generating better antibody responses," said Shane Crotty of the Emory Vaccine Research Center in Georgia.

Vaccines are usually given to healthy people to protect them from infection by bacteria, viruses or other pathogens. They work by stimulating the body's own immune system to generate a response to the pathogen.

If the germ invades the body again the immune system should be able to remember it and fight it without the person getting ill.

Crotty and his colleagues discovered the gene by measuring the immune response of genetically engineered, or knockout, mice that lacked SAP and normal mice. Their research is reported in the science journal Nature.

The immune systems in both groups of mice launched a similar initial response when the animals were infected with a virus. But afterwards, the knockout mice failed to produce enough plasma cells and memory B-cells, which are needed to make antibodies to destroy the virus and are crucial for long-term immunity.

The same types of cells remain in the body after the initial infection has been cleared and launch an attack it if reappears.

"What is so interesting about this gene is that it controls the generation of long-term memory, but it's not important for short-term immune responses. We haven't seen a gene that does this before," said Dr. Rafi Ahmed, senior author of the study.

The cells produced for long-term immunity are also essential for a successful vaccine because a vaccine cannot protect against infection unless it produces long-term immune memory.

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High-Risk Women Benefit Most From Tamoxifen

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Wednesday, January 15, 2003

WEDNESDAY, Jan. 15 (HealthScoutNews) -- For women who have an increased risk of developing estrogen-dependent breast cancer (news - web sites), preventive therapy with tamoxifen can significantly reduce their chances of getting the disease, according to an Italian study.

The study, which appears in today's issue of the Journal of the National Cancer Institute (news - web sites), found that high-risk women who took tamoxifen for more than five years decreased their risk of cancer by as much as 82 percent.

"High-risk women are deriving substantial benefit from tamoxifen for risk reduction," says Dr. Victor Vogel, the director of breast cancer prevention at the University of Pittsburgh School of Medicine and co-author of an editorial accompanying the study.

Tamoxifen is a type of medication known as a selective estrogen receptor modulator. It is used both in cancer treatment and in prevention. Many types of breast cancer are dependent on estrogen for growth. Tamoxifen works by taking the place of estrogen in cancer cells, essentially crowding the estrogen out. Since tamoxifen acts only as a weak estrogen in breast cancer cells, it slows or prevents cancer cells from growing.

Tamoxifen, however, can also cause serious side effects, including a small increase in the rate of uterine cancer and the potential for blood clots, so it's not recommended for preventive use in the general population.

In this study, researchers from the European Institute of Oncology in Milan, Italy, compared the rates of breast cancer between 2,700 women who took tamoxifen therapy for more than six years and 2,700 women who took a placebo during that time.

The researchers only included women who had had hysterectomies (surgical removal of the uterus) in this study, so there wouldn't be a concern about the increase in the rate of uterine cancer.

Women who were taller than 5 feet 3 inches, who first menstruated before age 13, who had no children or who had their first child after the age of 24, and who still had their ovaries were classified as having a higher risk of estrogen-dependent breast cancer.

In these high-risk women, tamoxifen reduced the risk of breast cancer more than 80 percent. Also, women who had used hormone replacement therapy had a lowered risk of breast cancer if they took tamoxifen, according to the study.

For low-risk women, the researchers report no statistically significant difference between the tamoxifen and placebo groups. The authors theorize that these low-risk women may have other factors that protect them against cancer, and don't need added protection from tamoxifen.

"This study is good confirmation of another study," says Dr. David Decker, chief of hematology and oncology at Beaumont Hospital in Royal Oak, Mich. "Tamoxifen does prevent breast cancer. It works best in women who are destined to develop estrogen [dependent] breast cancer."

Some women definitely shouldn't take tamoxifen, according to Vogel. Women who are at a low risk of developing breast cancer shouldn't take tamoxifen. Women over 65 and anyone with a history of clotting should forgo the drug because they're already at an increased risk of developing blood clots.

The Italian researchers add that their findings are preliminary and need to be confirmed in other studies.

More information

To read more about the risks and benefits of tamoxifen, visit the National Cancer Institute or BreastCancer.org.

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Alcohol May Boost Testosterone in Brain and Blood 

By Amy Norton

Reuters Health

Wednesday, January 15, 2003

NEW YORK (Reuters Health) - A testosterone surge in the brain could help explain the drunken behavior of some men and women, if new animal research is any indication.

Researchers found that alcohol gave a quick jolt to testosterone levels in the brains and blood of some male rats. They speculate that the findings may be important for understanding the "behavioral changes" that, for some people, go hand-in-hand with drinking.

"Marked increases in brain testosterone might be relevant to aggressive behavior in some individuals," Dr. Robert H. Purdy, the senior author of the new report, told Reuters Health. "You need to keep in mind the word 'some,' however."

Clearly, people differ in how alcohol affects them, noted Purdy, a scientist at the Scripps Research Institute in La Jolla, California.

He and his colleagues report their findings in the January issue of Alcoholism: Clinical & Experimental Research.

Alcohol's effects on testosterone have long been of interest, in part because of the higher rate of alcoholism among men. In addition, the associations between alcohol and violence, and between drinking and male sexual dysfunction, suggest that testosterone effects are at work.

The testosterone boost the new study found is in contrast to several past studies of animals and men in which intoxicating amounts of alcohol lowered blood levels of the male hormone. On the other hand, a recent study of postmenopausal women showed that alcohol sent up blood levels of testosterone, the researchers note.

In general, though, alcohol has been tied to dips in circulating testosterone and impaired reproductive function.

Still, it's possible that drinking gives testosterone levels a short-lived boost in some people, according to Dr. Dennis D. Rasmussen, a researcher at the University of Washington in Seattle who was not involved in the study.

"This study raises the possibility that episodes of alcohol consumption may...at least temporarily increase testosterone levels," Rasmussen said in a statement. Whether it does so, he noted, likely depends on a number of factors, including the amount of alcohol and the drinker's "personal characteristics."

So for some people, Rasmussen said, drinking may spur a testosterone surge that could lead to aggression or a revved-up libido--two behaviors famously associated with both drinking and testosterone.

He added, however, that the role of such testosterone changes in alcohol-related exploits--and whether the effect is different in men and women--is still not clear.

Why and how alcohol could both lower and raise testosterone levels is currently being investigated, Purdy said.

Source: Alcoholism: Clinical & Experimental Research 2003;27:38-43.

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Remember, Don't Drink During Pregnancy 

HealthScoutNews

Wednesday, January 15, 2003

WEDNESDAY, Jan. 15 (HealthScoutNews) -- Some pregnant women are ignoring warnings about the danger that alcohol poses to their unborn children.

In a study by University of Michigan Health System researchers, 15 percent of pregnant women said they drank alcohol at least once during their pregnancy. The report appears in the January issue of Alcoholism: Clinical and Experimental Research.

Most of the women in the anonymous survey of 1,131 pregnant women said they'd had less than one drink a week while they were pregnant. However, some said they drank more than that on a regular basis, and some admitted they had at least one binge drinking episode, in which they had at least five drinks at one time.

The study also found that women who smoke while they're pregnant were more likely to drink alcohol. Women in the early stages of pregnancy were also more likely to drink alcohol.

Despite the dangers of drinking, only about half the women recalled being asked about their drinking by the doctor providing their obstetric care.

The study authors write that their findings suggest that doctors and other health-care providers need to talk with women about their drinking behavior during prenatal visits. Doctors also need to counsel some women more intensely about their drinking during pregnancy.

More information

Here's where you can learn more about pregnancy and substance abuse.

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Viagra May Influence Blood's Stickiness: Study 

By Keith Mulvihill

Reuters Health

Wednesday, January 15, 2003

NEW YORK (Reuters Health) - An international team of scientists has announced that they believe they have hit upon an explanation for why a few men suffered heart attacks after taking the erectile dysfunction drug Viagra.

Their findings are published in the January 10th issue of the journal Cell.

"With regard to Viagra, we found that this drug encourages (blood) platelets to clump," the study's lead investigator, Dr. Xiaoping Du of the University of Illinois at Chicago, told Reuters Health in an interview.

Platelets are necessary for normal blood clotting and protect against blood loss by clumping together at the site of a vessel injury.

However, "clumping of platelets is (also) important in causing heart attack and stroke," he added.

This finding provides a possible causal link between Viagra and cardiac death, Du explained.

According to Du, Viagra works by elevating the levels of a compound in cells called cyclic guanosine monophosphate, or cGMP.

"For the past 20 years, cGMP has been believed to inhibit the clumping of platelets. We found that cGMP--and thus Viagra--actually promotes platelet clumping," said Du.

"This (was) not previously known," he added.

Based on the finding, Du's team believes that Viagra may be a risk factor for patients with pre-existing conditions such as atherosclerosis, although more studies are needed to further understand this issue.

In their investigation, the team of researchers conducted laboratory experiments on mouse and human cells that produce proteins involved in making platelets stick together.

They found that cGMP played a role in causing platelets to become more sticky.

Viagra is known to work by stopping the destruction of cGMP. While the drug alone did not cause the platelets to clump, it did cause clumping in the presence of other blood chemicals known to be more plentiful in damaged arteries, according to a press release from the University of Illinois. In fact, the effect was seen at concentrations lower than those used to treat erectile dysfunction, according to the release.

Source: Cell 2003;112:77-86.

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Medicine Mixups Common Among Kids in Hospitals 

HealthScoutNews

Wednesday, January 15, 2003

WEDNESDAY, Jan. 15 (HealthScoutNews) -- Medication errors are common in critically ill children taking multiple medications in hospitals.

That scary conclusion comes courtesy of an American study in the January issue of The Archives of Pediatrics and Adolescent Medicine.

The study found these children are at risk for adverse drug events (ADEs) -- problems that result from medications or the lack of an intended medication -- and potential ADEs.

Researchers reviewed medical records and interviewed staffers at a pediatric unit and a pediatric intensive care unit at a major American metropolitan medical center. The researchers studied 1,197 consecutive patient admissions representing 922 patients and 10,164 patient days, from Sept. 15, 2000, to May 10, 2001.

The study identified 76 ADEs and 94 potential ADEs in the study group. That works out to six ADEs per 100 hospital admissions and eight potential ADEs per 100 admissions.

Length of hospital stay and exposure to medications were factors associated with ADE or potential ADE occurrence. The researchers adjusted for length of stay and found medication exposure still had a major influence on ADEs and potential ADEs.

Of the ADEs identified in the study, 24 percent were judged to be serious or life-threatening. However, most of the ADEs weren't associated with major or permanent disability, the study says.

More information

The U.S. Agency for Healthcare Research and Quality has a tip sheet on preventing medical errors in children.

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TUESDAY, JANUARY 14, 2003 

'Bubble Boy' Treatment Produces Risks 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Tuesday, January 14, 2003

WASHINGTON - U.S. officials are suspending 27 more gene therapy studies while they investigate a possible serious risk: A second European toddler cured of the deadly "bubble boy disease" by gene therapy has come down with an apparent leukemia-like side effect.

It marks the second time in three months that health officials have interrupted gene therapy studies because of the grave side effect.

Bubble boy disease — an immune disorder formally called severe combined immunodeficiency, or SCID — is the only disease ever to be cured with gene therapy. But three months ago, a boy whose life was saved by a SCID gene therapy experiment in France when he was a baby came down with a leukemia-like syndrome at age 3.

Scientists have long warned that cancer is a possible risk from any gene therapy, such as that for SCID, that uses retroviruses, a type of virus that permanently invades cells, to deliver new genes into a patient's body. Still, no one given gene therapy for SCID or other diseases had ever had such a side effect.

That first sick toddler prompted U.S. and French scientists in October to stop gene therapy experiments for SCID, including three in this country.

Now a second child in the French SCID experiment has come down with that same leukemia-like side effect, Food and Drug Administration (news - web sites) scientists announced Tuesday.

Quietly notified by French researchers about a month ago, the FDA decided that the second serious side effect warranted the more serious response: temporarily stopping about 27 more U.S. experiments that use retroviruses to insert new genes into blood stem cells in hopes of fighting diseases other than SCID.

The FDA didn't release a list of the experiments but said they include some targeting such diseases as cancer and include several hundred participants.

The FDA said if researchers argue that any of the retrovirus experiments offered a sole option to people with life-threatening illnesses, the agency would work to let them restart on a case-by-case basis, with appropriate warnings to participants.

The three SCID gene therapy experiments, however, remain on hold for at least a few more months while officials investigate the second side effect, FDA officials said.

"We do think it's a prudent course," because "there are things going on here that we really don't understand," FDA gene therapy chief Dr. Phil Noguchi said.

The FDA will convene its scientific advisers next month to pore over the research and debate future steps.

"It's very unfortunate that with the first real success in a very difficult disease, that there's this downside," said American Society for Gene Therapy president Joe Glorioso, a University of Pittsburgh geneticist.

Without the gene therapy, these two boys almost certainly would have died of their SCID because they had no other treatment options, he noted. Yet without the gene therapy, he said, "it's unlikely these patients would have ever developed leukemia."

Both boys responded well to chemotherapy and are stable, but their long-term outlook is uncertain, Noguchi said. He released few details about the second patient, including his nationality, other than that he was cured of SCID as a baby and became ill with the cancer-like syndrome almost three years later.

SCID babies are born without the ability to produce disease-fighting immune cells. The best known victim was David, Houston's famous "bubble boy" who lived in a germ-proof enclosure until his death at age 12 in 1984.

There are some SCID treatments, including bone marrow transplants that can allow patients to live normal lives. But transplant success varies widely, and many children still die young.

So Paris' Dr. Alain Fischer generated great excitement when his gene therapy apparently cured nine of the 11 boys he treated who had the most severe SCID-type, called X-SCID. He drew bone marrow from the boys, culled immune cell-creating stem cells from it, and mixed in a virus containing the gene their bodies lacked. Injected back into their bodies, the stem cells worked properly.

On the Net: FDA announcement:

http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01190.html

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Study: New Moms Should Avoid Fries, Chips 

By Ned Stafford

Reuters Health

Tuesday, January 14, 2003

NUREMBERG (Reuters Health) - Pregnant women and nursing mothers should sharply limit--or even cease--eating French fries, potato chips or other foods that contain the chemical acrylamide, according to study released Tuesday by German researchers.

The researchers said they issued the warning for pregnant women and nursing mothers because fetuses and newborn babies are particularly susceptible to the potential harmful effects of acrylamide, a possible carcinogen. The results of the study were to be broadcast nationwide Tuesday evening on a German television news program.

The leader of the study, Prof. Fritz Soergel of the Institute for Biomedical and Pharmaceutical Research in Nuremberg, said that acrylamide is highly water-soluble. Therefore, fetuses and infants are more at risk than adults because of their generally higher body water levels. Furthermore, blood brain barriers in fetuses and newborn infants are not full developed, meaning that nerve-damaging acrylamide would be more likely to reach their young brains and cause damage.

Acrylamide first received global attention in April 2002 when Swedish researchers reported finding the chemical in fried and oven-baked foods, especially in potato chips and French fries. The findings were at first greeted with skepticism, but scientists in other nations have since produced similar results.

High levels of acrylamide have been found to cause cancer in rodents. Last September the US Food and Drug Administration (news - web sites) announced a plan to reduce or eliminate concentrations of acrylamide in potato and cereal products.

In Germany in the last few months, the potential health threat from acrylamide has become a major national issue, with Soergel gaining a reputation as an expert.

Soergel recommends that nursing mothers cease eating all potato chips, French fries or other potatoes fried in oil at temperatures over 180 degrees centigrade at least until the newborn baby reaches two months old. He believes pregnant woman should limit acrylamide consumption to no more than 20 micrograms per day, which he says would be the equivalent of about 10 grams of potato chips.

In an interview with Reuters Health, Soergel described acrylamide as a neurotoxic agent that he believes can cause cancer in humans. Soergel said that he and two colleagues--Prof. Rainer Weissenbacher, of the University of Munich, and Prof. Edgar Schoemig, of the University of Cologne--conducted their study during the past six weeks.

They used mass spectrometry to measure levels of acrylamide in the bodies of pregnant women and in the placentas after they gave birth, and also in nursing mothers and their breast milk.

Soergel said that tests showed anywhere from 10% to 50% of the acrylamide levels found in pregnant women was transferred via blood through the placenta to the fetus.

In breast milk, test showed up to 18.8 micrograms per liter of acrylamide, he said, adding that if a newborn baby drinks slightly over half a liter per day it would be consuming nearly 10 micrograms of acrylamide.

Soergel told Reuters that his team tested breast milk from only two nursing mothers and from the placentas of three women after they gave birth. However, he insisted that despite the small sample, the research team's main findings--that acrylamide can pass from a woman to a fetus and to a newborn through breast milk--remain valid.

"We wanted to very quickly have an idea," he said. "There is no doubt about these findings. It is so clear. The basic results will not be contradicted."

That said, he did concede that with a larger sample in the future, researchers will be able to more accurately determine levels of acrylamide that can pass through the placenta or into breast milk.

Soergel emphasized that non-fried potatoes, such as baked or boiled, are extremely healthy and should not be avoided by pregnant woman or nursing mothers. Potatoes fried at temperatures "substantially lower" than 180 degrees centigrade would have only very low levels of acrylamide and would therefore be safe to eat, he said. When pressed what temperature would meet his "substantially lower" requirements, he said 140 degrees.

"What I want to avoid is that mothers avoid potatoes altogether," he said.

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Filtering Water in Cloth May Cut Cholera

By Paul Recer

AP Science Writer

The Associated Press

Tuesday, January 14, 2003 

WASHINGTON - Simply filtering water through old sari fabric may be enough to reduce cholera cases by about half in rural villages in Bangladesh, researchers say.

In a study appearing this week in the Proceedings of the National Academy of Sciences (news - web sites), scientists filtered pond and river water through nylon mesh and through old, much-washed sari cloth. They concluded that the sari solution worked best and could save lives in villages where the waterborne disease annually sickens thousands of people.

"Sari cloth is cheaper and we found that it is much more effective than the nylon mesh," said Rita R. Colwell, a professor of microbiology at the University of Maryland, College Park, and primary author of the study.

Colwell said researchers discovered in laboratory studies that most of the cholera bacteria in ponds, rivers and other standing water is attached to or in the gut of a copepod, a type of zooplankton commonly found in standing water.

When people drink unfiltered water, she said, they swallow the copepods and introduce cholera bacteria into their system. The germ grows in the human gut, releasing a toxin that causes extreme diarrhea and cramping.

Filtering the copepod out of drinking water reduced the rate of cholera by at least half, Colwell said. There also was some evidence that other types of germs were removed because women in the villages with sari-filtered water reported fewer incidences of diarrhea and other digestive problems, she said.

In modern hospitals, cholera is easily controlled, but the untreated disease kills 50 percent to 80 percent of those infected. It is most lethal for children under 5 and for the elderly.

Colwell said the rural Bangladesh villages are many hours of hard travel away from good medical care and finding a simple way to combat cholera could have a major impact on the lives of people there.

Dr. John Mekalanos, a cholera expert and professor at the Harvard Medical School (news - web sites), said, "Anytime you can reduce a life-threatening disease by (50 percent) with something this simple it could make a big difference in the region and elsewhere in the world."

There were 184,000 cases of cholera reported from 58 countries in 2001, according to the World Health Organization (news - web sites). More than 2,700 people died. However, Bangladesh was not included in these statistics, said Colwell, and it is thought the cholera rate and the number of deaths from the disease are very high. Mekalanos estimated that there are a million cases of cholera in Bangladesh annually and thousands of unreported deaths.

In the study, Colwell and her colleagues selected 65 villages where cholera was a major threat. In 27 of the villages, women were instructed to use bits of sari cloth, folded eight times, as a filter when they captured household water from ponds, lakes or rivers. Twenty-five villages used the nylon filters, and 13 villages received no filtering instructions and continued to gather water in the traditional way. There were about 44,000 people in each part of the study.

After 18 months, the rate of cholera in villages using the sari filters was about .65 cases per 1,000 people per year. The rate was about .79 cases in the villages using nylon filters, and about 1.16 cases per 1,000 people in the control villages.

Colwell said the researchers found that the majority of those who got sick in the sari-filtered villages had visited villages where they drank unfiltered water.

She said the rate of cholera was extremely low among people who drank only the sari-filtered water.

"We found in the laboratory that we could remove more than 99 percent of the bacteria with the sari cloth," said Colwell.

A sari, the garment favored by most Hindu women, is made of lightweight, gauzelike cotton fabric.

Colwell said experiments showed that old sari cloth filtered better than new cloth. As the sari is washed repeatedly, she said, the spaces between threads in the cloth mesh narrow and trap finer particles.

"We tried other material, but the sari was by far the most effective," said Colwell. And it is available in most Bangladesh households. "Every woman there wears a sari," she said.

On the Net:

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

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Low Fat Pre-Teen Diet May Cut Breast Cancer Risk 

Reuters Health

Tuesday, January 14, 2003

 

NEW YORK (Reuters Health) - Adolescent girls who follow a relatively low-fat diet starting in puberty have lower blood levels of hormones that are linked to breast cancer (news - web sites) in adulthood, new research reveals.

However, whether these findings translate into a lower risk of breast cancer later in life is not clear, according to the report in the January 15th issue of the Journal of the National Cancer Institute (news - web sites).

"Although we do not know if lower hormone levels during adolescence will influence breast cancer risk in adulthood, adolescence is a time of rapid growth and maturation of the breasts. Estrogens and progesterones contribute to the regulation of this process," Dr. Joanne F. Dorgan, the study's lead investigator, said in a prepared statement.

Therefore, lower hormone levels might slow down the rate of cell division, which can lead to cancer-causing mutations, explained Dorgan, who is with the Fox Chase Cancer Center in Philadelphia, Pennsylvania.

Elevated body fat is another risk factor for premenopausal breast cancer, although it is not clear how extra pounds may contribute to the risk.

To investigate the relationship between fat intake during puberty and blood levels of hormones associated with breast cancer, the research team studied 286 girls aged 8 to 10 years. The girls were already enrolled in a study testing a diet to lower levels of LDL or "bad" cholesterol.

About half of the group attended individual and group nutrition counseling sessions on how to follow a low-fat diet, in which 28% of calories came from fat and no more than 8% from saturated fat. General nutrition guidelines suggest that healthy adults consume no more than 30% of total calories from fat, of which a maximum of 10% is from saturated fat.

The other half of the group received written material from the American Heart Association (news - web sites) and did not take part in nutrition counseling.

After five years, girls in the counseling group had lower levels of specific forms of estrogen linked to breast cancer. For instance, estradiol levels were about 30% lower and estrone levels were about 20% lower, the study found. Levels of progesterone, which may also increase the risk of breast cancer, were also lower, the study found.

Finally, these girls reported eating fewer calories, less fat and saturated fat, and more fiber, compared with girls in the other group. These dietary interventions may also lower breast cancer risk, although study findings have been mixed.

"These results suggest that the modest reductions in total fat, saturated fat, and perhaps energy intake during adolescence may alter the function of the hypothalamic-pituitary-ovarian axis, which regulates ovarian hormone production," researchers conclude.

"Whether these differences ultimately influence breast cancer risk is currently unknown."

Source: Journal of the National Cancer Institute 2003;95:132-141.

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Sweet Nothings

 

HealthScoutNews

Tuesday, January 14, 2003

(HealthScoutNews) -- Contrary to what many people believe, white sugar is no better or worse for you than any other sugar.

According to Harvard Medical School (news - web sites), all sugars -- including honey, molasses and corn syrup -- are created equal from a nutritional standpoint. But too much sugar of any kind can be bad for your health. Sugar is packed with calories, which may give you energy, but it has no vitamins, minerals or nutrients. And on top of all that, sugar is rotten for your teeth.

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Care for Seniors Improves, but Large Gaps Remain 

By Karen Pallarito

Reuters Health

Tuesday, January 14, 2003

 NEW YORK (Reuters Health) - America's seniors are getting better medical care than they did in 1998, yet more than one in four Medicare beneficiaries still do not receive services that could prevent disease and prolong their lives, according to a study in the January 14th issue of the Journal of the American Medical Association (news - web sites).

That alarming statistic is documented in a study comparing the current quality-of-care with results of an earlier study. While the new findings show significant progress on key measures of care provided in the hospital and in doctors' offices, many best practices have yet to gain widespread adoption.

"There's a real quality gap," said David Shulke, executive vice president of the American Health Quality Association, which represents the nation's quality improvement organizations (QIOS). Medicare contracts with QIOs to speed up the pace of change in healthcare delivery.

The study tracks national and state-level changes in performance on 22 quality indicators between 1998-1999 and 2000-2001. The authors believe that this is the first national study to show quality improvements over time for multiple conditions and patient care settings.

One of the largest areas of improvement was in the percentage of Medicare beneficiaries who received a prescription for beta-blockers after a heart attack. The percentage of heart attack patients who received that preventive treatment rose from 72% to 79%.

"So that's a real improvement," said senior author Dr. Steven Jencks, who is Assistant Surgeon General.

On the outpatient side, the most dramatic improvement was in the percentage of seniors receiving a pneumococcal vaccine, which rose 10% points to 65%.

On the other hand, nearly "22% of people who are obvious, exceptional candidates for beta-blockers are not getting them," Jencks noted. And roughly 35% of seniors aren't getting vaccinated against pneumococcus bacteria, which can cause pneumonia and other serious infections.

"If a third of kids were not immunized against measles or polio (news - web sites), we would declare a national crisis and with good reason," Jencks told Reuters Health.

Although federal health officials say the results are an encouraging sign that improvement is possible, the study suggests that providers must change systems of care to bridge the quality gap.

And they don't have to be costly changes, Jencks said. As an example, he cites the length of time it takes to get pneumonia patients started on antibiotics. Thirteen percent wait more than eight hours, the study found, even though many practitioners agree its best to administer those drugs as soon as patients reach the hospital.

The simple solution is starting those drugs in the emergency room, instead of waiting until the patient is admitted. "It doesn't take longer to give the antibiotic promptly than to give it late, but it costs you money because the patient has to stay in the hospital longer," he said.

Schulke, who represents the QIOs, said federal health officials' push for public reporting of quality data should "accelerate the pace of improvement further."

For now, seniors should be both encouraged and worried, he said. "You should be worried of the existence of a quality gap...and you should be vigilant."

Source: Journal of the American Medical Association 2003;289:305-312.

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Gulf War Chemicals Linked to Testicular Damage

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews

Tuesday, January 14, 2003

TUESDAY, Jan. 14 (HealthScoutNews) -- A combination of three chemicals given to Gulf War (news - web sites) troops to protect against diseases and nerve gas may have damaged the soldiers' testes and reduced their sperm production.

That's the contention of a new Duke University study, published in the Journal of Toxicology and Environmental Health, that showed the chemicals caused extensive cell degeneration and cell death in the testes of laboratory rats.

Rats given the chemicals and exposed to stressful situations suffered more extensive damage. This suggests that the chemicals, combined with the moderate stress likely experienced by some soldiers during the 1991 Gulf War, caused the most severe deterioration in testicular structure and sperm production, says Mohamed B. Abou-Donia, a Duke pharmacologist and the study's lead researcher.

The findings could provide clues about why some veterans of the Persian Gulf War have suffered from infertility and sexual dysfunction, Abou-Donia says.

Researchers gave lab rats the insect repellant DEET, the insecticide permethrin and the anti-nerve gas agent pyridostigmine bromide in doses designed to mimic the human equivalent of what the soldiers received.

The rats showed no outward signs of ailments, Abou-Donia says, but under a microscope, the testicular damage could clearly be seen. As a result, he suggests, cases of testicle damage among soldiers could have been overlooked.

"In the real-life situation, veterans came back and looked normal, and the only way doctors could tell damage was to look at the testes," Abou-Donia says. "So they ended up saying it [concern about infertility] was all in the veterans' heads, only their imaginations."

Earlier studies found much higher doses of each of the three chemicals given separately proved almost harmless, Abou-Donia says. Combining two of them was more toxic, and the three together, the most toxic, he says.

However, Abou-Donia adds the results of the latest research, which examined the rats immediately after giving them the chemicals and subjecting them to stress, doesn't answer whether the damage is reversible. Further study would be needed to determine the possibility of recovery, he says.

In the study, financed by the U.S. Department of Defense (news - web sites), the researchers found the most pervasive cell damage within basal germ cells and spermatocytes, which develop into mature sperm. The three chemicals combined with stress caused these cells to detach from one another, slough off and develop holes known as "vacuoles," part of the process that leads to cell death. And the more cells that die, the more sperm production is reduced, Abou-Donia says.

Similar cell degeneration occurred in the seminiferous tubules, where developing sperm are produced, and in Sertoli cells that support and nurture the developing germ cells, Abou-Donia says.

The study showed the chemicals and stress interrupted most of the stages of sperm development and eliminated some altogether.

Steve Robinson, a Gulf War veteran who is now executive director of the National Gulf War Resource Center, an information clearinghouse, says the study's findings come as no surprise.

"Although this particular study is unfortunate news, it's confirmatory news," Robinson says. "It will at least close the door so [veterans] know the reason."

Robinson, who researched Gulf War-related illnesses for the Defense Department until 2001, says he hears regularly from Gulf War veterans concerned about infertility.

"It's been on veterans' minds," he says. "The evidence is mounting that exposure from the Gulf War is the reason why veterans are sick, and veterans have been saying this all along. But science is just now catching up."

As the United States prepares for a potential second round of war in Iraq, Robinson says the study demonstrates the need for caution in giving soldiers chemicals.

"I think what it says is number one, we have to be extremely concerned about the use of investigational new drugs and vaccines in combination with pesticides used in military applications during war," Robinson says.

More information

To find out more about Gulf War syndrome (news - web sites), try GulfLink, from the Office of the Special Assistant for Gulf War Illnesses or the National Gulf War Resource Center.

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Americans' Activity Wanes as Weight Soars: Survey 

Reuters Health

Tuesday, January 14, 2003

NEW YORK (Reuters Health) - A new survey sheds light on why so many Americans may be packing on the pounds.

The Gallup Poll found that the number of US adults who reported regular, vigorous exercise--at least 20 minutes of activity that produces a surge in heart or breathing rates--declined to 45% in 2002 from 52% in 2001.

While there was no change in moderate exercise such as walking or gardening at least once a week, the majority of Americans--54%--are now considered sedentary or low activity, compared with 48% the previous year.

And just 25% of adults said they followed recent recommendations to participate in weight-training activities at least once a week. Weight training can help adults maintain strong bones as they age. However, just 18% of adults 50 years and older said they worked out with weights at least once a week.

The results, based on interviews with 1,001 people 18 and older performed in November 2002, may help to explain why rates of obesity in the US have reached a record high. A recent study by the US Centers for Disease Control and Prevention (news - web sites) (CDC) documented a rise in rates of overweight and obesity among adults and children between 1988 and 2000.

Among adults, the rate of extreme or morbid obesity nearly tripled over the past decade, while more and more children are being diagnosed with previously grown-up, obesity-linked conditions such as high cholesterol and type 2 diabetes, according to the report.

Upcoming Gallup polls will examine how men, women, old and young people exercise.

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Spasticity Tougher to Treat Than Thought

HealthScoutNews

Tuesday, January 14, 2003

TUESDAY, Jan. 14 (HealthScoutNews) -- Spastic muscle cells are significantly different than normal muscle cells, and that means spasticity may be more difficult to treat than previously believed.

That's the discouraging finding of a study published online today in the journal Muscle and Nerve.

Spasticity refers to an involuntary increase in muscle stiffness, which is often caused by damage to the part of the brain that controls movement. It's estimated about 500,000 Americans have spasticity caused by cerebral palsy.

Spasticity can also be caused by degenerative diseases, stroke and head or spinal cord injuries.

It's often difficult for doctors to treat a person with spasticity, due partly to a lack of information about the mechanical, physiological and biochemical features of spastic muscle.

While the increased stiffness in spastic muscles has previously been linked to solely to brain or spinal cord damage, this new study found spastic muscle cells are shorter and stiffer than normal muscle cells.

The study says that spastic muscle cells develop passive tension at much shorter lengths and their elastic modulus (a measure of material stiffness) is greater than that found in normal muscle cells.

The study researchers collected muscle fibers from healthy people and from children with cerebral palsy to compare 38 normal muscle fibers and 15 spastic muscle fibers. They used mechanical tests to measure the fibers' elastic properties and also measured fiber stress.

More information

Here's where you can learn more about spasticity.

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Thalidomide Slows Blood Cancer 

By Merritt McKinney

Reuters Health

Tuesday, January 14, 2003

NEW YORK (Reuters Health) - The drug thalidomide, which was banned in the 1960s for causing severe birth defects, slows the progression of a blood cancer called multiple myeloma in some people with the disease, study findings show.

"Many studies have shown so far that thalidomide is active for people with advanced myeloma," Dr. S. Vincent Rajkumar told Reuters Health in an interview.

Despite the promising effects of thalidomide in people with blood cancer, doctors have not known how long the response to thalidomide would last and whether the drug would improve survival, said Rajkumar, who is at the Mayo Clinic in Rochester, Minnesota.

"It appears that the drug has a response that is durable," Rajkumar said.

The study included 32 patients with multiple myeloma. With conventional treatment, average survival with this type of cancer is 3 to 4 years. There are treatments for multiple myeloma, but there is no cure. Everyone in the study had either failed to respond to earlier treatment or had relapsed.

Thalidomide is by no means a cure for multiple myeloma, but cancer responded to the drug in 31% of the participants, according to a report in the January issue of the journal Mayo Clinic Proceedings. Among people who responded to the drug, their cancer did not progress for about 16 months.

A little more than a year may not seem like much time, but Rajkumar noted that for patients with a disease that has an average survival time of just 3 to 4 years, an extra year "would mean quite a bit."

Thalidomide was not without side effects, however. Sleepiness, constipation and a type of nerve pain called neuropathy were the most common side effects of the treatment. According to Rajkumar, though, "most people were able to handle the side effects." He noted that doctors can adjust a person's dose of the drug to reduce side effects.

Rajkumar added that chemical cousins of thalidomide are being developed that may provide similar benefits without the side effects.

Although several studies have demonstrated the promise of thalidomide as a cancer therapy, how the drug fights cancer is somewhat of a mystery, Rajkumar said.

One theory, he said, is that it slows cancer by affecting the blood supply, while another possibility is that it stimulates the immune system.

The mechanism of the drug is "very hard to pin down exactly," Rajkumar said.

Right now, thalidomide is approved in the US only for the treatment of one type of leprosy. However, once a drug is approved for one use, doctors may prescribe it to treat other conditions.

The study was funded in part by the Celgene Corporation in Warren, New Jersey, which markets thalidomide in the US.

Source: Mayo Clinic Proceedings 2003;78:34-39.

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Booze May Boost Testosterone Levels 

HealthScoutNews

Tuesday, January 14, 2003

TUESDAY, Jan. 14 (HealthScoutNews) -- Acute administration of alcohol can cause a rapid increase in testosterone concentrations in the plasma and brains of rodents.

The findings, just published in the January issue of Alcoholism: Clinical and Experimental Research, offer evidence that there may be individual differences in behavioral reactions to alcohol. Most previous research has found that alcohol inhibits the secretion of testosterone in male humans and animals.

The study may help provide new insights into understanding individual differences in the behavioral and endocrine pathology of alcohol abuse.

The study, led by The Scripps Research Institute, examined the way that two different groups of rats formed testosterone after the acute administration of alcohol.

More information

Here's where you can learn more about alcohol abuse and alcoholism.

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Drug Errors More Likely in the Sickest Children 

Reuters Health

Tuesday, January 14, 2003

NEW YORK (Reuters Health) - Children who are the most ill are more likely than other youngsters in the hospital to experience drug mistakes, in which the wrong drug or dose is administered, researchers report.

However, such youngsters are also more likely to be involved in "near misses" in which potentially hazardous drug mistakes are caught before they are given to the patient or do not end up harming the child. This suggests that such drug mix-ups occur because ill children are receiving more medications, and are not the reason why the children are the sickest in the hospital--as some studies have suggested.

"Based on our results, adverse drug events appear to be a marker of more severe disease rather than a cause," said Dr. Mark T. Holdsworth, from the University of New Mexico in Albuquerque. "Previous reports that have suggested the opposite probably did not use the right control group--children with potential adverse drug events."

Adverse drug events are any mistake that could result in "significant injury," including giving a child the wrong drug or too little or too much of the correct drug, according to the report in the January issue of the Archives of Pediatric and Adolescent Medicine.

"Several studies have investigated adverse drug events in hospitalized adult populations," Holdsworth told Reuters Health. "When we began our study, there really weren't any reports that had characterized the incidence and severity of adverse drug events in children."

Holdsworth's team analyzed data from 992 children admitted to a large metropolitan hospital one or more times between September 15, 2000 and May 10, 2001.

The researchers found that adverse drug events occurred in 6% of hospital admissions and potential adverse drug events occurred in 8% of admissions. Of the 76 adverse drug events that occurred, 18 were considered to be serious or life-threatening. Still, only four of the cases resulted in major or permanent disability.

"Our findings indicate that the incidence of adverse drug events in children is similar to what has been reported in adults," Holdsworth said.

The risk of both adverse drug events and potential adverse drug events increased as the child's disease severity and medication exposure increased, the investigators report.

"We think that adverse drug events are important events and efforts should be made to bring the incidence down," Holdsworth said. "However, I'm not sure, based on our findings, that reducing the rate will have a dramatic impact on the costs and morbidity of adverse drug events in pediatric inpatients. Clearly, further studies are needed," he added.

Source: Archives of Pediatric and Adolescent Medicine 2003;157:60-65.

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New Combo Fuels Fight Against Abdominal Cancer

HealthScoutNews

Tuesday, January 14, 2003

TUESDAY, Jan. 14 (HealthScoutNews) -- A treatment that combines surgery with the insertion of heated chemotherapy drugs directly into the abdomen can improve survival rates in people with abdominal cancer.

That good news comes from a study in the January issue of the Archives of Surgery.

Wake Forest University Baptist Medical Center researchers looked at 109 people with peritoneal carcinomatosis who were treated between 1991 and 1997.

All the study participants had surgery to remove as much of the tumor and surrounding cancerous tissue as possible. That was immediately followed by intraperitoneal hyperthermic chemotherapy (IPHC).

With IPHC, the patient's core temperature is cooled to just above 93 degrees F. When surgery is completed, catheters are placed into the abdomen. These catheters deliver heated chemotherapy drugs directly to the abdominal cavity.

The chemotherapy drugs are heated to a maximum of 105 degrees F. During the two- hour procedure, the abdomen is massaged to improve the distribution of the chemotherapy drugs.

The people in this study who received this treatment had a median overall survival of 16 months. Normally, most patients with peritoneal carcinomatosis survive three to six months without treatment.

Surgery alone to treat this kind of cancer has proven ineffective, as have brachytherapy, systemic chemotherapy and external beam radiation therapy.

More information

The U.S. National Cancer Institute (news - web sites) has more about hyperthermia in cancer treatment.

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After Bypass, Mood Brightens in Men but Not Women 

By Alison McCook

Reuters Health

Tuesday, January 14, 2003

NEW YORK (Reuters Health) - After surgery to reroute blood around blocked arteries, men tend to be in better spirits and have better physical functioning than women, new research suggests.

It's not clear why women may feel more depressed than men after the surgery, but the researchers suspect it may be due in part to traditional gender roles.

Women tend to have more caretaking responsibilities and tasks to do around the house than men, and may feel they should pick up where they left off as soon as they return home.

"Women therefore may try to go back to their normal level of activity because of their family responsibilities, while men instead may take more time," proposed Dr. Viola Vaccarino, of Emory University in Atlanta, Georgia.

In the study, all patients underwent coronary bypass surgery, during which doctors transplant blood vessels from another part of the body onto the heart to reroute blood around blocked arteries.

More than 180,000 of these procedures, 30% of the total number performed in the US in 1999, were conducted on women, according to Dr. Viola Vaccarino of Emory University in Atlanta, Georgia and her colleagues.

However, interviews with women up to two months after bypass surgery revealed that they had a reduction in physical functioning and an increase in depression compared with the month prior to the procedure.

In contrast, men who underwent the same procedure showed no decrease in their physical functioning, and also saw a decrease in depression during their recovery period, compared to before the surgery.

The weeks following bypass surgery can be a "vulnerable time," the researchers note, during which patients are at relatively high risk of complications and returning to the hospital. The current findings suggest that "women have a more difficult recovery compared with men," they write in the January 15th issue of the Journal of the American College of Cardiology.

The current study findings are based on interviews with 1,113 patients immediately after coronary bypass surgery and between six and eight weeks later. Three hundred and nine study participants were women.

During the recovery period, 21% of women were readmitted to the hospital, compared with 11% of men.

Along with differences in recovery from the procedure, women also tended to be older, have other heart problems, and demonstrate lower physical functioning than men during the month prior to surgery. These factors did not influence their differences in recovery, however.

In an interview, Vaccarino suggested that women may have more trouble recovering from the bypass surgery than men because the surgery is less effective in women than men. "Our results could be in line with a less optimal response from this procedure in women than in men, at least in the short term," she said.

In terms of why women tended to feel more depressed during their recovery than men, the researcher suggested that since the women were functioning less well than before surgery, they may have experienced a decline in their moods.

"It may also indicate that women's experience with this surgery, overall, was less positive than for men," Vaccarino noted.

The researcher added that further studies are needed to pinpoint the reasons for the differences in recovery by gender, and to determine if the differences persist beyond the two-month recovery period.

Source: Journal of the American College of Cardiology 2003;41:307-314.

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Spot Drunk Drivers 

HealthScoutNews

Tuesday, January 14, 2003

(HealthScoutNews) -- Even though you may not drink and drive, others do. Drunk drivers are responsible for thousands of traffic accidents every year, many of them fatal. Learning to recognize when a motorist is inebriated may protect you from a tragedy.

The U.S. National Safety Council offers these guidelines. Drivers may be drunk if they:

  • Weave haphazardly between lanes.
  • Drive erratically, stop, turn, swerve suddenly or react slowly.
  • Drive without headlights at night.
  • Narrowly avoid hitting other cars.

If you suspect a driver is drunk, drive defensively:

  • Be prepared to take quick, evasive action.
  • Keep your distance or pull over and let the driver pass you.
  • If the car is headed toward you, pull to the right, stop, honk your horn and flash your headlights.
  • As soon as possible, notify the police or highway patrol.

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Diet, Exercise Add to Cholesterol Drug Benefits
 

By Merritt McKinney

Reuters Health

Tuesday, January 14, 2003

NEW YORK (Reuters Health) - For reducing the risk of heart attack and other complications of heart disease, cholesterol-lowering drugs are good, but a combination of medications, diet and exercise is better, new research suggests.

In a study of people with heart disease, those who took cholesterol-lowering drugs called statins, stuck to a very-low-fat diet and exercised regularly were 67% less likely to have a heart attack or stroke or to die during the 5-year study than people who only took statins.

"Cholesterol-lowering drugs are only partially effective," study author Dr. K. Lance Gould, told Reuters Health.

The beneficial effects of cholesterol drugs "can be enormously enhanced" by making major lifestyle changes, according to Gould, who is at the University of Texas Medical School at Houston, in Houston, Texas.

"Coronary heart disease can be substantially prevented, stabilized, or in effect reversed by intense lifestyle and drug treatment," Gould said.

Participants in the study were not randomized into separate treatment groups. Instead, the researchers divided the 409 people with coronary artery disease into three groups based on which treatment plan they chose to follow.

Besides taking statins, people in the "maximum" treatment group exercised at least half an hour 4 to 5 days a week and stuck to a diet in which 10% or less of calories came from fat. This diet is more rigorous than what is advocated by the American Heart Association (news - web sites) (AHA), which recommends that no more than 20% to 30% of calories come from fat.

The "moderate" treatment group included people who followed the AHA diet and took statins or who stuck to a very-low-fat diet without taking cholesterol-lowering drugs. The "poor" treatment group either did not change their diet or take cholesterol drugs or they smoked.

Five years after the study began, about 20% of people on the standard treatment (statins plus the AHA diet) had died, had a heart attack or other cardiac event or needed artery-clearing treatment. In contrast, less than 7% of people who stuck to the most rigorous treatment plan had died or had a cardiac event. Not surprisingly, the rate was highest--more than 30%--in people in the poor treatment group.

Results of the study appear in the January 15th issue of the Journal of the American College of Cardiology.

Although the total fat allowed in the most strenuous diet is low, Gould told Reuters Health that the program is "actually easy and flexible." He noted that it allows for chicken, fish, turkey, Egg Beaters (a yolkless egg product), low-fat dairy products, vegetables, fruit and low-fat starch foods.

Because the researchers did not randomly assign participants into treatment groups, the results must be taken with a grain of salt, according to Dr. William W. Parmley at the University of California at San Francisco. The study cannot prove that lifestyle changes accounted for the improvements, he notes in an editorial that accompanies the study.

Despite these concerns, Parmley said that he agrees with the researchers that using a combination of lifestyle changes and medication rather than relying on "only a pill" is a better approach for treating heart disease.

Source: Journal of the American College of Cardiology 2003;41:263-274.

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Those at Risk for Stroke Unaware of Warning Signs 

By Suzanne Rostler

Reuters Health

Tuesday, January 14, 2003

NEW YORK (Reuters Health) - Adults with the highest stroke risk are the least likely to know the warning signs, according to a survey released Tuesday that confirms previous findings.

Researchers conducted telephone interviews with more than 2,000 adults, who were asked to name up to three warning signs and three risk factors for stroke. The responses were compared to those of earlier surveys.

The good news is that the number of adults who correctly named at least one warning sign of a stroke rose to 70% in 2000 from 57% in 1995. Warning signs include sudden numbness in the face, arm or leg, particularly on one side of the body; trouble speaking; difficulty seeing in at least one eye and sudden severe headache.

Similarly, the number of adults who correctly named at least one risk factor rose to 72% from 68% over the same period, according to the report in the January 15th issue of the Journal of the American Medical Association (news - web sites).

But blacks, men and those aged 75 years and older--all of whom are at higher risk for stroke--were less likely to know warning signs and risk factors, such as smoking, high blood pressure, obesity and family history of stroke. Adults with a diagnosed risk factor tended to know they were at risk of stroke, and older adults had more knowledge about stroke in general.

The study underscores the need to improve stroke awareness among those at risk and among the general public, who may witness a stroke and be able to contact emergency services, Dr. Alexander Schneider, the study's lead author, said in an interview.

Historically, there has been no effective treatment for stroke. But in the last decade, the US Food and Drug Administration (news - web sites) approved the use of tissue plasminogen activator (tPA) for ischemic stroke, which occurs when blood flow to the brain is blocked and is the most common type of stroke. Because the medication is only effective if it is given within the first three hours of a stroke, it is crucial for people suffering a stroke to recognize what is happening to them.

"Ideally, we should prevent stroke from occurring and knowing the risk factors of stroke may help people make lifestyle changes to reduce their modifiable stroke risk factors," said Schneider, who is with the University of Cincinnati in Cincinnati, Ohio.

He said that stoke is the leading cause of adult disability and the third leading cause of death in the US, accounting for more than $45 billion in direct and indirect costs.

One avenue for reaching people is television. According to the report, adults cited television as their main source of information on stroke, followed by magazines and newspapers. About 20% said their doctor was a primary source of stroke information.

Teaching elementary and secondary school students about stroke as part of their health education is another strategy, Schneider suggests.

"The importance of stroke needs to be considered alongside traditional health care priorities such as heart disease, cancer and AIDS (news - web sites)," he said.

Source: Journal of the American Medical Association 2003;289:343-346.

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Extensive Lung Cancer Screening Not Worth the Cost 

By Merritt McKinney

Reuters Health

Tuesday, January 14, 2003

NEW YORK (Reuters Health) - Though ads tout CT scans as a way to detect lung cancer in its early stages, the costs of the screening test outweigh the benefits, researchers report.

The benefits of CT scans for screening for lung cancer are "still murky," the study's lead author, Dr. Parthiv J. Mahadevia, told Reuters Health in an interview.

In a computer model that predicted what would happen if 100,000 current, former or quitting smokers underwent annual CT lung scans, there were more than 500 fewer lung cancer deaths--a 13% drop--said Mahadevia, who was at Johns Hopkins University in Baltimore, Maryland, when he conducted the study.

As a result of the screen, however, more than 1,000 people would undergo unnecessary invasive procedures or surgery, Mahadevia said. If just half of all people in the US between ages 45 and 75 who had ever smoked were to undergo the screening, it would cost at least $115 billion a year, according to the model.

Based on the model, Mahadevia said that advertising CT lung scans directly to consumers "is not advisable at this time."

Only about 15% of people with lung cancer are still alive five years after diagnosis, in part because the disease is usually not detected until it has progressed to an advanced stage. There is some preliminary evidence that a type of scan called helical computed tomography (CT) can detect early lung cancer, but the evidence is far from conclusive.

In the interview, Mahadevia noted that the National Cancer Institute (news - web sites) is funding a large trial of CT lung scans, but the results will not be ready for another 7 to 10 years.

"What do we do in the interim?" Mahadevia said.

Based on the computer model put together by Mahadevia and his colleagues, relying on CT lung scans for widespread screening is not the answer. A report on the model is published in the January 15th issue of the Journal of the American Medical Association (news - web sites).

Although the test may be able to detect some cases of lung cancer, its imprecision as a screening tool can be harmful, Mahadevia said. He explained that besides cancer, the scan often detects benign lung nodules. Unfortunately, Mahadevia said that many people may undergo expensive and potentially risky invasive procedures or surgery only to find out that they have harmless lung nodules, not cancer.

Besides the cost and risk of surgery, false-positive results may lead to unnecessary anxiety, according to the Maryland researcher. He explained that once an abnormality shows up on a scan, it is common practice to follow it for several months or even a couple of years to see whether it is growing.

"You won't know right away whether you have lung cancer or not," Mahadevia said.

These harmful physical and psychological effects are something that marketing of the scan does not emphasize, Mahadevia said.

For smokers who are worried about getting lung cancer, the most important step they can take is to quit smoking, Mahadevia advised.

Although the study does not support the widespread use of CT lung scans to screen for lung cancer at this time, the screen can be useful, according to Mahadevia.

"We're not down on the technology," Mahadevia said. It is perfectly reasonable, he noted, for a doctor to use the CT lung scan and other tests to diagnose lung cancer in a person who has symptoms of lung cancer, such as coughing up blood.

The research should prompt "some hesitation and thoughtful consideration" about whether to use this type of lung scan as a cancer screen at this time, according to Drs. Victor R. Grann and Alfred I. Neugut of Columbia University in New York.

Until more information, including the results of the trial run by the National Cancer Institute, is available, doctors, patients and policy makers should take a conservative approach toward using this screen, Grann and Neugut recommend in an accompanying editorial.

Source: Journal of the American Medical Association 2003;289:313-322,357-358.

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MONDAY, JANUARY 13, 2003 

More U.S. Infants Sleep in Parents' Beds

 

By Deanna Bellandi

Associated Press Writer

The Associated Press

Monday, January 13, 2003

CHICAGO (AP) — More infants in the United States are sleeping in their parents' beds — a practice that can be deadly for babies.

The percentage of infants who usually slept in a bed with an adult more than doubled from 5.5 percent to 12.8 percent between 1993 and 2000, according to a study led by Marian Willinger of the National Institute of Child Health and Human Development.

The practice is strongly influenced by cultural factors

The study found black infants were four times as likely as white babies to share an adult's bed, and Asian babies were almost three times as likely. Infants whose mothers were under 18 were more likely to bed-share; the practice was also more common in poor households.

"They may not have a crib or bassinet for the baby, so the only place the baby can sleep is in the bed," said Dr. Angelita Covington, an Atlanta pediatrician. Some parents, she said, may take their babies into their beds because it is a practice passed down through generations.

Covington, who works in a community health center that sees mostly poor people, said she discourages bed sharing.

The study, which appears in the January issue of Archives of Pediatrics and Adolescent Medicine, warns that babies can fall out of bed and get hurt, or can suffocate when an adult rolls over or the child becomes trapped between the mattress and the bed frame. Other research suggests bed-sharing can raise the risk of sudden infant death syndrome.

According to a 1999 study by the Consumer Product Safety Commission (news - web sites), an average of 64 young children die each year while sleeping in bed with their parents or other adults.

Some have suggested bed-sharing has benefits, such as promoting breast-feeding.

In this study, researchers from the National Institutes of Health (news - web sites) concluded there needs to be more study on the benefits or hazards.

The study was based on a telephone survey of a nationally representative group of 8,453 people.

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New Simplified C-Section Less Painful, Saves Blood

 

By Michael Leidig

Reuters Health

Monday, January 13, 2003

VIENNA (Reuters Health) - Doctors from the Vienna General Hospital (AKH) have developed a new technique for performing a cesarean section that is less painful and faster than traditional methods.

The "cesarean light" takes 20 minutes and has successfully been tested on 1,000 women at the Department of Gynecology at the Vienna AKH over a period of two years.

Professor Elmar Armin Joura of the gynecology department of the Vienna university medical teaching hospital said that women lose half as much blood with the new technique.

"We realized that many of the steps involved in the old technique were unnecessary and that a simplification would be beneficial to women," Joura told Reuters Health.

Under the new technique, the abdomen is opened using blunt cutting techniques rather than sharp dissection as with the traditional method. The skin is cut with a knife, but gentle pulling apart is used for all other tissues. The separation takes place at the point of greatest weakness to avoid damaging blood vessels, and so contributes to the reduction of blood loss.

"If the cut is made at the right level, we found that we had wonderful exposure of the lower segment of the uterus," Joura said.

Furthermore, the new technique involves only three continuous layers of stitching, and so uses less material and is faster. Traditional methods, which involved seven layers of stitching, also compromised blood flow and thus the natural healing process.

Fewer stitches lead to fewer adhesions in the abdomen, allowing the tissue to heal naturally, Joura said.

Women are also encouraged to drink immediately after the operation because this has been found to improve their bowel function. They also take solid foods within six hours and data has shown that this measure considerably reduces the need for subsequent painkillers. Moreover, they are allowed to get out of a bed within eight hours of the operation.

Joura said that the follow-up data showed that fertility was not compromised and was even better than with the old technique.

Papers on the new technique have been published in the journal of Obstetrics and Gynecology and the AKH has had so many requests for information that it has now produced a video on the subject.

Fifteen percent of all births in Austria now involve a Cesarean section, compared with 10% ten years ago.

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Hospitals Try to Reduce Medical Errors

By Allison Schlesinger

Associated Press Writer

The Associated Press

Monday, January 13, 2003

PITTSBURGH - Like other hospitals in the country, the Children's Hospital of Pittsburgh recognizes that potentially deadly errors can be caused by indecipherable handwriting, a memory lapse or other mistakes.

So, the hospital has joined a small percentage of the nation's medical centers in installing a computerized system for doctors to prescribe medication, order a blood test or check a patient's weight.

The system, known as a computerized provider order entry and electronic medical records system, could replace many paper forms, such as prescription pads, said Dr. Eugene Wiener, the hospital's medical director.

The Leapfrog Group, a coalition of more than 100 organizations that provide health care benefits, has identified this kind of system as a key way hospitals can reduce medical errors and prevent deaths caused by mistakes.

While fewer than 5 percent of the nation's hospitals have fully implemented similar computer systems, nearly one-quarter of the hospitals the Leapfrog Group has surveyed say they will have a computerized order system in place by next year, said the group's executive director, Suzanne Delbanco.

"There's a big growth that we're about to see, but right now it is rare," she said.

Children's Hospital doctors, who learned how to use the system during the last three months of 2002, enter prescription orders into the system instead of writing them by hand, eliminating infamously hard-to-read medication instructions.

The system also gives doctors, nurses and other care providers access to a patient's medical history, tells them about a patient's allergies, and alerts them to adverse drug interactions and other information that a care provider might not know or might have forgotten.

Sloppy handwriting, transcription mistakes and overlooked allergies can have dangerous consequences. Delbanco said they lead to some of the more than one million serious medication errors that happen every year in the United States.

More hospitals haven't shifted to a computerized provider order entry system because it's expensive, it's a difficult transition and it can be hard to convince everyone in the institution to use it, said Pat Wise of the Healthcare Information Management Systems Society, a Chicago-based organization that advocates healthcare technology.

Installation can cost hospitals anywhere from $500,000 to $15 million, depending on variables such as a hospital's size and how many records are already being stored electronically, Delbanco said.

Saint Joseph Mercy Hospital in Ann Arbor, Mich., which took two years to develop its own system before care providers started using it in 1993, initially spent $21 million to start the system and spends between $1.7 million and $2.5 million every year to upgrade it, said Gene Eavy, the hospital's director of pharmacy.

But the system lets the hospital save money in other areas, such as worker productivity, Eavy said.

Before Saint Joseph's started to use the system, it took six hours to get a prescription filled because it was hand-delivered from the doctor to the pharmacy and then had to be transcribed. Today, it takes less than 30 minutes, Eavy said.

More importantly, in less than a decade, the hospital has reduced medical errors by 68 percent. Officials estimate that each medical error costs the hospital $4,800.

"Many people call us and want to know how much (the system) costs, and that's certainly part of it — but that's just part of it," Eavy said. "One of the biggest hurdles to overcome is the cultural hurdles and encouraging doctors who have been in practice for a long time to use the system."

For a new system to be successful, it's important that the hospital's management set a deadline for each nurse, doctor and care provider to use the system, Wise said. If not, the system might be missing important patient information, thus defeating its purpose.

In October 2001, Franklin Memorial Hospital in Rocky Mount, Va., started using a system that combined pharmacy, radiology, patient management and accounting information. The goal is to improve patient care and eliminate the traditional patient chart, said Greg Walton, a spokesman for the hospital's parent, Carilion Health System.

So far, nurses and doctors have been happy with the system, but Walton said he's concerned that hospitals with new systems will mistakenly believe it will eliminate all medical errors.

"Health-care problems will not be solved with this technology. This technology will not solve fundamental health-care problems in this country or any country," Walton said.

On the Net:

The Leapfrog Group: http://www.leapfroggroup.com

The Children's Hospital of Pittsburgh: http://www.chp.edu

Healthcare Information Management Systems Society: http://www.himss.org

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Study Shows Oscillating Power Toothbrushes Superior

 

By Bill Berkrot

Reuters

Monday, January 13, 2003

NEW YORK (Reuters) - Use of a certain kind of power toothbrush each day could keep the dental hygienist at bay.

People who wake up in a cold sweat at the thought of dental assistants with sharp instruments hacking away at plaque on their teeth, or those simply interested in the most efficient method of daily dental care, should use a power toothbrush with rotational/oscillation action, according to a new report.

The finding, announced at a symposium in Boston on Saturday, comes from the oral health wing of the Cochrane Collaboration, an international nonprofit organization that compiles and reviews data from healthcare studies.

Rotational oscillation toothbrushes--those that rotate in one direction and then the other--removed up to 11% more plaque and reduced bleeding of the gums by up to 17% more than manual or other power toothbrushes, according to results compiled by the Manchester, England-based Cochrane Oral Health Group, which analyzed data from clinical trials conducted over 37 years.

The Cochrane study extracted data from reports on 29 clinical trials involving 2,547 participants in North America, Europe and Israel. Some of the trials dated back to 1964, while others contained data from as recently as 2001.

The trials compared the effectiveness of all forms of manual and six types of power toothbrushes with mechanically moving heads used over one-month and three-month periods.

According to the findings unveiled at the conference sponsored by the Forsyth Center for Evidence-Based Dentistry, only the rotational oscillation toothbrushes proved more effective than manual toothbrushes in reducing plaque and gingivitis. The results did not explain why the rotational oscillation toothbrushes were more effective than power toothbrushes with only circular or side-to-side motion.

While the study does not deal with long-term benefits to dental health, Richard Niederman, a periodontist and director of the Forsyth Center, called it "a huge first step."

The next step, he said, would be a review of use of the toothbrushes over three or five years.

"They reduce bacterial plaque that causes disease," he said of the rotating oscillating brushes. "The next thing to see is do they really reduce cavities or periodontal disease?"

The motion of power toothbrushes is up to 100 times that of manual brushing, Niederman said.

Dr. Kenneth Burrell, senior director of the Council on Scientific Affairs for the American Dental Association, said the findings, if they prove accurate, could be useful in helping dentists make recommendations to their patients.

"That still doesn't mean that every man, woman and child should abandon the toothbrush that they're currently using," Burrell said.

"Someone using the simplest manual toothbrush with good knowledge of how to brush and conscientious brushing can do just as well as somebody using a power toothbrush regardless of the design," Burrell said.

There are two parts that make up the effect of toothbrushing, Burrell explained. "One is the device you use, and the other is the person attached to device."

If you brush incorrectly, it doesn't matter what kind of toothbrush you use, he said.

"What this review is telling you is that an average person putting in an average effort is going to see a better effect than using other brushes."

Said William Shaw, who helped compile the data for the Cochrane Collaboration: "If you can afford a rotational oscillating power toothbrush and it feels good to you, it offers modest improvement in ability to clean your teeth."

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Exercise Enemy Is Lack of Commitment

By Ira Dreyfuss

Associated Press Writer

The Associated Press

Monday, January 13, 2003

WASHINGTON - The fitness instructor has heard the exercise excuses, and she doesn't accept them.

As director of training for the Bally Total Fitness health club chain, Seven Boggs' job is to keep people who took up exercise with the new year from giving up.

Bally naturally tries to keep track of who is going out America's gym doors as well as who is coming in. Every year, 100 million Americans resolve to get fit, and 40 percent break their resolutions by February, the company said.

"The number one excuse I get is time. The person doesn't have the time to work out," Boggs said. "The second is a lot of folks don't see the results as quickly as they want. The average person wants quick everything."

For Boggs, time is an excuse. She believes the real problem is commitment — "to make each person understand that the only way they will have time is if they make time." She suggests that early risers can head to the club before they head to work, and night owls can stop at the club before they settle in at home.

This year's resolutions assume new importance in light of new studies on obesity. The Centers for Disease Control and Prevention (news - web sites) found 20.9 percent of adults were obese in 2001, up from 19.8 percent in 2000. The constant rise in obesity is a big reason why CDC also found diabetes is rising, researcher Ali Mokdad said in a study in the Jan. 1 issue of the Journal of the American Medical Association (news - web sites).

A study in JAMA one week later documented the danger in terms of shortened lifespan. At the extreme, very obese black men around 20 years of age could die up to 20 years sooner than their normal-weight counterparts, a researcher said.

Another report, in the Annals of Internal Medicine, found that at 40, people who were overweight but not obese could die at least three years sooner than those who are slim. Dutch researchers found that association in residents of Framingham, Mass.

Other researchers have found that even if people don't lose weight, they can reduce their chances of an early death by taking up exercise. Studies at the Cooper Institute, a Dallas-based research organization that focuses on exercise, have found that the highest risk of early death is among the 20 percent of people who get the least physical activity.

People who want fast results have to be re-educated. "They have to understand that their body works on a monthly basis. Every 4 or 5 weeks, they see results," she said.

Clubs realize that members join largely because they notice a weight gain, especially after the holidays. They hope to retain members by combining diet with the exercise, and having trainers monitor both.

The programs start with an assessment of fitness and body fat, so the client has a benchmark against which to measure any progress.

At the 24 Hour Fitness chain, for instance, new exercisers bring the trainer a diary that shows everything they have eaten for the past three days.

At Bally's, trainers measure the client's resting metabolic rate — how many calories are burned while sitting still — and base the meal and exercise plans on that. The trainers use a device that analyzes the client's exhaled breath for its proportion of oxygen. The body uses oxygen as it burns calories, so people with higher metabolic rates use more oxygen — and exhale less of it.

To keep new members from dropping out, clubs are promoting personal trainers as exercise nannies. "If you embrace (clients), there is a lot less likelihood of them falling off the wagon," said Kevin Steele, vice president of health services for 24 Hour Fitness.

An exercise buddy might stand in for a trainer in keeping the new exerciser from backsliding, said researcher Jessie Jones of California State University, Fullerton. The commitment to work out with someone can help to turn exercise into a habit, she said: "As long as they have a buddy system, they can get around the laziness."

The activity must be fun, because people don't get lazy at what they like to do, said Colin Milner, chief executive officer of the International Council on Active Aging, an advocacy group for seniors.

And new exercisers ought to build in extra motivation, such as an occasional dessert, even if they have to burn off the calories later, Milner said. His rationale: "I've been good all week long, there's no reason why I should not reward myself."

A club's baseline assessment and the attention of a personal trainer can help a beginner adjust to exercise, but other experts say simpler and cheaper methods also can work.

A pedometer, a device that counts footsteps, shows how much physical activity a person gets just by walking around. Simply walking more can be an easy way to get healthful activity in your life, said Steven Blair, president and chief executive officer of the Cooper Institute.

A sedentary person might start with 2,500 steps a day. "We say that's your baseline, and now set a goal," Blair said.

A typical goal would be to increase the walking, in 500-step increments, until the person reaches a typical target of 10,000 steps a day.

On the Net:

CDC news release on obesity and diabetes: http://www.cdc.gov/od/oc/media/pressrel/r021231.htm

CDC physical activity and health site: http://www.cdc.gov/health/physact.htm

Abstract of JAMA article on obesity and years of life lost: http://jama.ama-assn.org/issues/v289n2/abs/joc20945.html

Abstract of Annals article on obesity and years of life lost: http://www.annals.org/issues/v138n1/abs/200301070-00008.html?hp

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Study: Doctors Not Aware Enough of Manic Depression

 

By Opheera McDoom

Reuters

Monday, January 13, 2003

LONDON (Reuters) - British psychiatrists are almost unanimous in believing that doctors need to know more about manic depression, according to a study released on Monday.

Now called bipolar disorder, the condition is an unpredictable mental illness that causes cycling between directly opposite states of mood in the patient and affects about 1% of the British population.

"For too long the service needs of people with bipolar disorder have been poorly understood and treatment efforts chronically underfunded," said Amanda Harris, joint acting chief executive of the Manic Depression Fellowship.

The study found 90% of psychiatrists thought doctors should know more about the condition and over 80% thought the public should too.

"Most sufferers have the potential, with optimal treatment, to return to normal function and contribute to the economy, yet stigma, prejudice and ignorance continue to persist around this illness," Harris said in a statement.

The survey said that by educating the general public, in particular families and partners, on the symptoms of bipolar disorder, more people could be encouraged to seek medical help sooner.

Previous research in Britain and other European countries has shown that only a small percentage of patients and carers were given educational materials when the diagnosis of bipolar disorder was made.

In the study, carried out by an independent research company for the Fellowship, around one third of the psychiatrists surveyed said over half the cases of bipolar disorder are initially misdiagnosed.

Diagnosis is difficult because the patient may show symptoms of only one of the states of mood on first visit to a doctor, and at other times could appear normal.

The research surveyed a representative sample of 76 psychiatrists across Britain in October last year.

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Crash-Scene Research Eyes Hidden Injuries

By Siobhan McDonough

Associated Press Writer

The Associated Press

Monday, January 13, 2003 

WASHINGTON - Rattled but apparently not badly hurt, Marie Helen Jadotte walked away from a car wreck, going to a hospital only at a police officer's insistence. She was shocked to hear she had a life-threatening liver injury.

In fact, in the frantic rush after an accident, serious injuries often can go undetected without close observation by emergency crews.

Now a government-supported program linking hospitals around the country is seeking to document injury patterns from automobile crashes. The goals are to help doctors spot hidden injuries and aid engineers in designing safer vehicles.

"The more we understand patterns, the better we treat people," said Dr. Jeffrey Augenstein, trauma surgeon and professor of surgery at the William Lehman Injury Research Center at the University of Miami.

The Crash Injury Research and Engineering Network, or CIREN, links 10 trauma centers by a computer network containing information on crashes, injuries and treatment, from streetside aid to hospital surgery and long-term follow-up.

In one pattern detected by the network, experts noticed that in side-impact crashes, there's a greater potential for aorta injuries even without the chest being crushed. The shape of the chest changes and puts stress on the aorta, Augenstein said. The aorta is the main artery carrying blood from the heart.

It also was learned that with older seat-belt systems, if drivers wore only the shoulder strap, they could suffer severe liver injuries in a low-speed crash because of pressure caused by having the shoulder belt wrapped around the abdomen. If the lap belt is worn, pressure is on the pelvis and parts of the body more able to withstand the sudden stop, Augenstein said.

More recently, CIREN has taken a close look at side air bags, noting that in some vehicles the bag only protects the driver's or passenger's chest, leaving the head exposed. There is no federal requirement for side air bags.

Jadotte, a Miami home health nurse, credits the research with helping to save her life.

It was a sunny morning in June 1997, the day before her 40th birthday, and she was driving between patients' homes. Her Mazda plowed into another car at an intersection.

She resisted a police officer's recommendation that she be taken to the nearest trauma center. But the officer had noticed Jadotte was wearing only the shoulder strap part of the seat belt. He had recently learned from case studies of the risk of liver injury, and persuaded her to go to the hospital.

Doctors found she had a lacerated liver and abdominal bleeding. "I was immediately stunned," she said.

Six days and several surgeries later, Jadotte woke up in a hospital bed. "It was life-threatening," she said. "Looking back now I had no idea."

CIREN started in 1998, based on research from the early 1990s at four hospitals.

The trauma center at the University of Miami, a founding participant, was one of the first in the country to document a child's death from an air bag, Augenstein said.

Findings in Miami and other places led to a campaign informing parents of the hazard. The National Highway Traffic Safety Administration (news - web sites) recommends that children 12 and under not ride in the front seat.

While traffic accidents are common — in 2001 they killed roughly 42,000 Americans and hurt 3 million — surprisingly little information may be conveyed to doctors from the typical crash scene.

"Many times, we'd go in blind," recalls Augenstein. Rescue crews "would drop the patient off and then we'd say, 'We'll figure it out.'"

The network produces detailed analysis of 500 crash victims a year, helping doctors figure out what's wrong with trauma patients and providing information to automakers.

Among the details emergency crews are asked to watch for and document: whether the driver or passenger was wearing a seat belt and if so, whether the entire device was worn; whether the air bag deployed; whether the steering wheel was bent; whether the vehicle rolled over or hit a pole.

"We now have a clear conversation about the crash, and not just the blood pressure," says Augenstein.

Without such coordination, it's "like treating hypertension and not asking any questions. Just giving drugs."

CIREN centers are in Seattle; San Diego; Milwaukee; Ann Arbor, Mich.; Newark, N.J.; Baltimore; Washington; Falls Church, Va.; Birmingham, Ala., and Miami.

Seven centers are financed by the government; the others, by Mercedes-Benz, Ford and the Froedtert Hospital & Medical College of Wisconsin.

On the Net:

National Highway Traffic Safety Administration: http://www.nhtsa.dot.gov

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Study: U.S. Schools Failing in Nutrition

By Suzanne Rostler

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - When it comes to offering healthy meals, US middle schools are not making the grade, a study suggests.

The report found that students consume an average of 31 grams of fat in school lunches--nearly one half of the 65 grams of fat that is recommended as a maximum each day, based on a 2,000-calorie diet. These lunches also contained about 10 grams of saturated fat, the amount recommended for the entire day.

Breakfasts, which were available at some schools, contained an average of 14 fat grams while snacks sold in student stores and as individual items in cafeterias contained between 6 and 13 grams of fat each, report researchers in a recent issue of Preventive Medicine. Bag lunches brought from home contained about 21 grams of fat.

The findings reveal that US schools are not meeting US Department of Agriculture (USDA) nutrition recommendations that school meals contain about 30% of their calories from fat, 15% from protein and 50% to 60% from carbohydrates.

And because food sold in student stores and vending machines tends to compete with food sold in the cafeteria and is not regulated by the USDA, it may be contributing to unhealthy eating habits.

Indeed, their study found that the most popular a la carte entrees in schools were baked desserts, fast foods, chips and frozen desserts and contained 9 grams to 16 grams of fat each. While students in wealthier school districts were more likely to buy these items, schools in poor districts stocked more fatty items, the study found.

"Students' access to soda machines, unhealthy foods sold in student stores and a la carte lines, food rewards like pizza parties and candy, and a lack of physical activity throughout the day all contribute to the obesity epidemic," Michelle M. Zive, a registered dietitian from the University of California in San Diego and the study's lead author, said in an interview.

She suggests that schools offer students low-fat versions of popular items, lower the prices of low-fat foods and offer soda only after lunch or after school. Additionally, longer lunch periods would allow students to eat their entire meal.

"Oftentimes, fruits and vegetables are thrown away because of lack of time to eat (them)," Zive explained.

The researchers collected data on three to five days worth of food brought from home and served at 24 middle schools in San Diego, California, and interviewed students about their daily menu choices. More than half (57%) of the students were white and 39% of students were eligible for free or low-cost meals.

All of the schools participated in the National School Lunch Program and 46% served breakfast.

"The school food environment...is in continuing need of improvement," the researchers conclude.

Source: Preventive Medicine 2002;35:376-382.

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Searching for Cancer Cures in the Ocean

By Jill Barton

Associated Press Writer

The Associated Press

Monday, January 13, 2003 

FORT PIERCE, Fla. - Scientists plunging to deep corners of the ocean are finding rare sponges that they hope, against astronomical odds, could lead them to a cure for cancer or other diseases.

Researchers at Harbor Branch Oceanographic Institution pull hundreds of new specimens from the sea every year, hoping at least one of them will be tougher than the cancer cells they carefully grow in a laboratory.

The team journeys to polluted and pristine waters throughout the year to collect sea life from a submarine with mechanical claws and arms, pulling in bunches of orange, yellow and brown sponges that have developed their own systems of self protection. Most of the sponges have never been seen before.

"Nature can crank these things out, but to make them in a laboratory would be very difficult," said Amy Wright, division director at Harbor Branch.

The National Cancer Institute (news - web sites) estimates that about 65 percent of all cancer drugs come from marine life and plants — their bark, roots, leaves and fruits. One of the more widely used anticancer drugs, Taxol, comes from the bark of Pacific yew trees.

But it usually takes thousands of tests to find one promising lead.

In 18 years of studies, only one sponge discovered by Harbor Branch has been promising enough to lure a pharmaceutical company's interest. A compound within the sponge, called Discodermalide, has stopped cancer cells from reproducing in early tests. In 1990, the institution secured a patent for the compound, hailed as its most important discovery.

Harbor Branch focuses on marine sponges because they are stationary and develop toxic chemicals to ward off predators, Wright said. The hope is that the chemicals within the sponges will kill cancer cells without hurting healthy human cells.

The research institution is one of about a half-dozen looking to marine life for cancer cures, and it specializes in deep-water discoveries. To accomplish dives of up to 3,000 feet, Harbor Branch built three submersibles that are launched from its research vessels.

One of the vessels, named after the institution's founder, Seward Johnson, is 204 feet long and can travel any of the world's oceans. The research vessels take crews of up to 40 people, including 15 scientists, into the Atlantic Ocean, Caribbean and Gulf of Mexico several times throughout the year.

Teams of researchers typically stay out to sea for two to three weeks, using a submersible each day to search for rare sponges.

The group looks for anything out of the ordinary. The scientist who discovered the sponge that yielded Discodermalide found it in surprisingly shallow waters about 500 feet deep during a scuba dive in the Caribbean.

The nonprofit institution operates under two five-year grants from the National Institutes of Health (news - web sites) worth a total of $750,000 a year, along with five smaller grants from the National Science Foundation (news - web sites) that pay about $160,000 annually.

During the scientists' research cruises, samples collected from the submersibles are put in a large freezer on the research vessel.

Once they return to Harbor Branch, researchers grind up small pieces of the specimens with ethyl alcohol. They then pour the mixture through a filter into test tubes, producing extracts as brightly colored as the sponges they collect.

The extracts are dropped into vials containing laboratory-grown cancer cells. If the extract kills 50 percent or more of the cancer cells, it undergoes more testing, but the vast majority don't continue to yield encouraging results.

"Those cancer cells can tolerate a lot. They're tough," said research specialist Pat Linley. Linley grows lung cancer, pancreatic cancer and breast cancer (news - web sites) cells in the lab and would be the first to see whether a new discovery could hold as much promise as Discodermalide.

Swiss pharmaceutical giant Novartis Pharma is working to develop a drug from the compound. Tests show that in lower concentrations, the compound is at least as effective as the widely used anticancer drug Taxol, Wright said.

"It's like a funnel where you feed in lots of materials and you end up with very few winners," said Gordon Cragg, chief of the natural products branch at the National Cancer Institute. "But of course the ultimate reward is when you do end up with something good."

He said between 1960 and 1982, the National Cancer Institute collected 35,000 plant samples and made 114,000 extracts to test against cancer. Only two of those extracts produced "interesting" leads, Cragg said.

Developing anticancer drugs is particularly difficult because cancer cells are so similar to human cells, and it's hard to kill one and not the other, Cragg said. Current chemotherapy drugs kill cancer cells but also aren't selective enough, which is why they can cause nausea, vomiting and hair loss.

"But there are slight differences and what you have to try to take advantage of are those small differences," Cragg said. "The big hope is you can kill off the cancer cells without hurting the patient too much."

On the Net:

Harbor Branch Oceanographic Institution: http://www.hboi.edu

National Cancer Institute: http://www.nci.nih.gov/

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Weight Control Programs Could Trim Bottom Line

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - A new study confirms that being overweight and obese can also weigh on the wallet.

In an analysis of data from a large US company, obesity accounted for as much as $1,500 annually in excess medical costs per person. While the study did not investigate the reasons for the higher costs, the researchers speculate that obesity-related disorders such as high blood pressure and elevated cholesterol may be to blame.

The study puts a price tag on excess body weight and suggests that companies looking to tighten their belts should invest in weight control and weight maintenance programs for employees. According to the report, obesity accounts for 5% of medical costs paid by US companies.

"Given that the prevalence of obesity continues to increase in western countries, effective weight control programs would help avoid a substantial amount of medical costs associated with overweight/obesity and related diseases," Dr. Feifei Wang from the University of Michigan in Ann Arbor and colleagues conclude.

The findings are published in the January/February issue of the American Journal of Health Promotion.

The researchers analyzed data on weight, height, age, gender, and annual medical costs on adults enrolled in a health insurance plan through General Motors Corporation. Adults were put in one of six body mass index (BMI) categories ranging from underweight to morbidly obese. BMI is a calculation of weight in relation to height, and is believed to more accurately reflect a person's risk of disease than weight alone.

Annual medical costs for normal-weight individuals, or those with a BMI of 19 to 25, were estimated at $2,225. Costs rose in tandem with weight: overweight adults with a BMI of 25 to 30 accounted for $2,388 and the most obese adults--with a BMI of 40 or more--accounted for $3,753.

The researchers caution that more research is needed. For one, the adults in the current study represent "a unique manufacturing population with its own demographic characteristics." Additionally, information on weight and height were self-reported, a technique that is always subject to bias.

Nonetheless, "the graded effects of higher-level BMI in medical costs are clear," the study concludes. "Controlling weight and obesity-related health conditions (such as hypertension, high blood cholesterol, and high blood sugar) could potentially help control increased medical costs."

Source: American Journal of Health Promotion 2003;17:183-189.

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Blood Treatment May Fight Heart Disease

By Lauran Neergaard

The Associated Press

Monday, January 13, 2003

 

WASHINGTON - Draw a vial of blood from someone with advanced heart failure. Zap the blood with heat and other stresses, then inject it back in hopes the altered blood cells will trick the patient's immune system into fighting the heart-destroying disease.

Dr. James Young was highly skeptical that the pilot experiment would work, but desperate patients were lining up. So he tried it, and to his surprise the monthly treatment kept a significant number out of the hospital and even seemed to delay death.

Now Young, heart-failure chief at The Cleveland Clinic, is about to study 2,000 more patients to prove if the therapy really works. It's a dramatically different approach to fighting an intractable killer, and one that doctors are watching closely because many other attempted treatments have recently failed.

"Intrigued's a good way to put it," said Dr. Wilson Colucci, cardiovascular chief at Boston University Medical Center, who works with the American Heart Association (news - web sites). "This comes along at a time when specialists are wondering what else we can offer."

Almost 5 million Americans have congestive heart failure. Their hearts are weakened by age, damage from a survived heart attack or some other disease and thus can't pump strongly. Eventually patients are pressed even to walk across a room. Fluid seeps into their lungs and blocks breathing.

When medications fail, they have few options. Just half survive five years.

Attempts to find new medications have largely stalled. The latest therapy — special pacemakers that make damaged hearts pump more forcefully — is helping many patients feel better and stay more active. But those devices don't attack heart failure's underlying causes, and there's no evidence yet that they lengthen life.

Enter the blood-zapper, made by Canada's Vasogen Inc. Called immune modulation therapy, it's based on a theory that heart failure is fueled when the immune system goes awry and causes too much inflammation, much as inflammation-run-amok also causes arthritis and even heart attacks.

That theory took a hit in 1999 when two drugs that target the inflammatory molecule that is considered heart failure's main culprit failed to work. Stunned scientists speculated that many other inflammatory molecules must play roles, too. Hence Vasogen's immune modulation therapy attempts to broadly block inflammation.

A small vial of blood is drawn from a heart-failure patient and put into a machine that stresses the cells by heating them to 108 degrees, zapping them with ultraviolet light and mixing in a little ozone gas.

Injected back into the body, the stressed cells soon commit suicide. The hope, Young explains, is that that little burst of unexpected cell death will signal the immune system to suppress inflammation, thus temporarily halting heart damage.

In a 73-person pilot study, only one death occurred among patients given six months of Vasogen treatment compared with seven deaths among patients given dummy shots. The blood zapper cut hospitalizations almost in half, too.

"Your energy level would increase within days," recalled Cindy Markowitz, 56, of Youngstown, Ohio, a teacher who missed fewer days of school during the pilot study and desperately sought out another experimental therapy when the trial ended. "I really started sliding down again after I went off the Vasogen, and I never thought that was fair. If they give you something that works, they shouldn't make you stop taking it."

This spring, 2,000 more patients will get either 15 months of the experimental treatment or dummy shots when Young, along with Houston's Baylor College of Medicine and the University of Montreal, studies whether immune modulation therapy really works, and how well.

The pilot study was promising but very small, cautions American Heart Association spokesman Dr. Clyde Yancy. And given previous anti-inflammatory failures, the new experiment may be the last chance to prove inflammation is a cause, not a byproduct, of heart failure, he says.

More important, Yancy stresses, is that between a third and a half of heart-failure patients today don't take medications already proved to save lives, a combination of pills called ACE inhibitors and beta blockers. More advanced patients are supposed to consider a third pill, called spironolactone.

"We definitely need to push the envelope, identify new strategies," said Yancy, a cardiologist at the University of Texas Southwestern Medical Center. "But for the ordinary individual that is affected with heart failure, the first, second and third steps must be to get people on ... best available therapy."

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

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Docs Prescribing Fewer Antibiotics for Children

By Charnicia E. Huggins

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - Doctors seem to be paying attention to public health messages urging them to stop writing so many antibiotic prescriptions, study findings suggest. Their rates of antibiotic prescribing to young children have drastically declined since 1995, researchers report.

The "use of media effort is making a difference," Dr. Natasha B. Halasa of Vanderbilt University School of Medicine in Nashville, Tennessee told Reuters Health, citing the "mid-90s campaign for judicious use of antibiotics."

"That message is coming across," she added.

Due to the overuse and frequent misuse of antibiotics--to treat colds, flu and other viral illnesses, for example--many bacteria have developed resistance to the drugs and have consequently become much more difficult to treat.

To curb this increasing problem of antibiotic resistance, national and international organizations, including the US Centers for Disease Control and Prevention (news - web sites) (CDC) and the American Academy of Pediatrics, have published guidelines for appropriate antibiotic use, and some groups have created campaigns and educational materials targeting doctors and parents alike.

Halasa and her colleagues investigated the effect of these campaigns on antibiotic prescribing for children aged 4 years and younger, among whom antibiotic use is most common. Their findings are based on 1993 to 1999 data from the National Ambulatory Medical Care Survey.

Antibiotic prescribing was highest in 1995, when nearly 1,200 antibiotic prescriptions were written per 1,000 children, and fell 41% by 1999, when just under 700 prescriptions were written per 1,000 kids.

Overall, children were prescribed antibiotics in nearly one out of every three visits to the doctor, the investigators note in a recent issue of The Pediatric Infectious Disease Journal.

White children were initially almost three times more likely to receive antibiotic prescriptions than their black peers, but they were also more likely to visit the doctor, the report indicates. From 1998 to 1999, however, office visits and antibiotic prescribing rates were similar for black and white children.

The initial discrepancy may have been due to a number of factors including a lack of access to primary care or differences in the sites where care was given, the report indicates. Previous studies have also indicated that white children visit the doctor more often than their black peers. Thus, the finding that prescribing rates were similar in later years suggests that "pediatricians and family physicians did not discriminate once the kids were there," Halasa said.

Nearly half of the antibiotic prescriptions were intended to treat otitis media, or middle ear infections, the report indicates. Antibiotic prescriptions were also commonly written for upper respiratory infections--even though the drugs are known to be ineffective for most of those infections--and for pharyngitis (throat inflammation), bronchitis and sinusitis, the report indicates.

Antibiotic prescriptions for upper respiratory infections did decrease during the study period, however, as did the number of prescriptions for middle ear infections, which largely accounted for the overall reduction, the researchers note.

The report only looked at office-based settings, but the findings suggest that public health education messages about decreasing antibiotic prescribing rates "seem to be working," Halasa said.

The hope is that decreasing antibiotic use will halt rising rates of antibiotic resistance in the short term, and eventually decrease those rates in the future, according to the author. "Hopefully over time we'll see (antibiotic resistance) stop," she said.

The study was funded by a grant from the CDC.

Source:: Pediatric Infectious Disease Journal 2002;21:1023-1028.

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Study: Most States Cut Medicaid Funding

By Laura Meckler

Associated Press Writer

The Associated Press

Monday, January 13, 2003

WASHINGTON - States facing tight budgets and growing Medicaid costs are cutting back on prescription drugs and dental care while increasing co-payments for people who use the program, an independent study released Monday says.

The study found that all states except Alabama have cut spending or plan to cut spending this year on Medicaid, the health insurance program that serves 42 million poor, disabled and elderly Americans. That includes 32 states that made cuts when the fiscal year began last summer and have found it necessary to cut yet again.

"For most states, there aren't any easy solutions left," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, which released the study.

Based on a 50-state survey, her group found that 45 states plan tighter controls on payments for prescription drugs, 37 states plan to reduce or freeze payments to doctors and hospitals, 27 states plan to restrict eligibility for the program, 25 states plan to cut benefits such as dental or vision care and 17 states plan to increase co-payments required of beneficiaries.

That's on top of similar cuts made last year.

On average, Medicaid spending is projected to grow by 9 percent this year, almost twice as fast as legislatures assumed when writing their 2003 budgets, the survey found.

Overall, states are facing massive budget shortfalls totaling at least $60 billion going into the next fiscal year. Medicaid makes up an average of 15 percent of state budgets.

Legislation introduced last week would provide $10 billion immediately to help states with Medicaid costs. A similar bill, sponsored by Sens. Susan Collins, R-Maine, and Jay Rockefeller, D-W.Va., was approved easily last year by the Senate but never passed the House.

During the fiscal crisis of the early 1990s, states were more willing to cut spending on education and to raise taxes than they are now, which puts Medicaid at particular risk, said John Holahan of the Urban Institute, who authored a companion study looking in depth at seven states.

In addition, in the early '90s, states had one-time options that are no longer available, such as funneling patients into cost-saving managed care plans.

Cutting Medicaid spending is particularly painful for states because the program is financed jointly by state and federal governments. That means states forgo federal money with every Medicaid dollar they cut from state budgets.

Medicaid covers 30 million people in low-income families, including one in five U.S. children. It also provides health and nursing home payments for 7 million people with disabilities and supplements Medicare for 6 million elderly living in poverty.

While most beneficiaries are children and their parents, the bulk of the money is spent on the elderly and disabled.

On the Net:

Kaiser Commission on Medicaid and the Uninsured: http://www.kff.org/docs/sections/kcmu/about.html

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Antioxidants May Help Patients After Surgery

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - Giving vitamins C and E to critically ill patients may lower their risk of developing some complications after surgery but not others, according to a new study.

Researchers found that trauma patients who received these antioxidant vitamins spent less time in the intensive care unit following surgery and were less likely to have multiple organ failure, which can occur weeks after surgery. They also spent less time on a mechanical ventilator, report researchers in a recent issue of the Annals of Surgery.

However, there were no differences in terms of pneumonia, lung function or kidney failure.

"The lack of adverse effects, coupled with the minimal expense, supports that this combination is a reasonable therapeutic intervention in critically (ill) surgical patients," conclude Dr. Avery B. Nathens from Harborview Medical Center in Seattle, Washington, and colleagues.

The study was funded through a grant from the Centers for Disease Control and Prevention (news - web sites) and by Wyeth-Ayerst Laboratories.

Free radicals that are generated by an acute injury are thought to raise the risk of multiple organ failure among critically ill surgical patients. Studies have shown that patients admitted to the intensive care unit have lower blood levels of vitamins E and C, and lower blood levels of antioxidants have been linked with a higher risk of organ dysfunction.

To investigate whether antioxidants--compounds that neutralize damaging free radicals--could lower the risk of these complications, researchers randomly assigned patients to antioxidant vitamins or no additional treatment from the time they were admitted to the intensive care unit. The study continued until they left the unit or until 28 days had passed--whichever was shorter.

About 300 patients received vitamin E through a feeding tube and vitamin C intravenously every eight hours. Most of the patients were admitted for trauma, although some had serious infections.

Multiple organ failure occurred in 4% of patients overall, and those receiving antioxidant therapy were less likely to experience organ failure. Overall, 6% of patients not given antioxidants developed multiple organ failure compared with 3% of those given antioxidants.

There was no difference between the two groups in the rate of acute kidney failure, another complication of surgery for trauma patients.

"These data suggest the potential for benefit if antioxidants are administered prophylactically, before the onset of significant organ dysfunction and infection," the researchers conclude.

Source: Annals of Surgery 2003;236:814-822.

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Psychiatric Drug Use Surges for Children

By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, January 13, 2003

CHICAGO (AP) — The number of U.S. children and adolescents on Ritalin (news - web sites), antidepressants or other psychiatric drugs surged between 1987 and 1996, a trend some experts say is continuing.

The study did not determine whether the youngsters were properly diagnosed and treated. Some experts have warned that American children are being overmedicated. But others say not all youngsters who really need treatment are getting it.

The study expands on previously published data on preschoolers and includes findings on young people through age 20.

University of Maryland researcher Julie Magno Zito and colleagues reviewed data on nearly 900,000 patients enrolled in Medicaid programs in two states and a health maintenance organization in the Northwest. By 1996, about 6 percent of all participants had prescriptions for psychiatric drugs.

Psychiatric drug use tripled in the HMO patients and in those in a Medicaid program in the Midwest. It doubled in the second Medicaid program, in a mid-Atlantic state. The states were not identified.

Stimulants such as Ritalin for treating attention deficit disorders were the most commonly prescribed psychiatric drugs for children in 1996, followed by antidepressants and mood-stabilizing drugs for "acting out."

The findings probably reflect nationwide practice, and other figures suggest the trend has continued since 1996, Zito said.

"Increased usage of these medications demands a better understanding of why they are being used and how effective the medications are proving to be," she said. "Safety for young children must also be assessed because children are not `little adults' when it comes to drug safety."

The study appears in January's Archives of Pediatrics and Adolescent Medicine.

An accompanying editorial said that viewed optimistically, the findings may reflect a broader awareness of mental problems in youngsters.

But the editorial author, Dr. Michael Jellinek of Massachusetts General Hospital, said the study reveals some disturbing trends, including increases in drug use in children at a time when research supporting such use was scant.

He also said the figures do not indicate whether the diagnoses of conditions such as attention deficit disorders, anxiety and depression were valid and whether the children received counseling.

Dr. David Fassler, a child and adolescent psychiatrist in Vermont, said the increases are not "out of range," given a 1999 government report suggesting that about 20 percent of U.S. youngsters have signs of psychiatric ailments.

"The real issue is ... are the right kids getting treatment?" said Fassler, an American Psychiatric Association trustee. He said other research shows that "the majority of children with psychiatric problems still are not receiving the treatment they need."

On the Net:

Archives: http://www.archpediatrics.com

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More U.S. Deaths from Gastrointestinal Disease

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - Although the number of people who die from gastrointestinal illness is small overall, it is increasing, new study findings show.

With the advent of drinking water disinfection during the early part of the 20th century, the number of people who die from intestinal infections such as shigellosis and amebiasis has plummeted.

"However, the proportion of Americans who are at high risk for severe enteric (intestinal) disease because of low immunity or advanced age is increasing each year," write Drs. Christina A. Peterson and Rebecca L. Calderon of the Environmental Protection Agency (news - web sites) (EPA) in Research Triangle Park, North Carolina.

The proportion of death certificates listing gastrointestinal disease as a contributing cause of death more than doubled between 1989 and 1996, the authors report in the January issue of the American Journal of Epidemiology.

Specifically, the investigators found that in 1996, 0.37% of deaths were linked to gastrointestinal disease.

"This is 2.6 times the 1989 value of 0.14%," Peterson and Calderon note.

Men and women over age 65 were the most likely to have gastrointestinal disease listed as a cause of death on their death certificate.

"Viral enteric diseases contributed to an increasing number of deaths among people in the 35- to 55-year age groups during the study period, probably because of the impact of HIV (news - web sites) and AIDS (news - web sites) in that population," the authors write.

In other findings, the investigators report that non-white Americans were more likely to die of gastrointestinal disease than whites.

"While enteric disease caused many fewer deaths in the 1990s than in the 1920s, these diseases remain an important and often preventable contributor to mortality in the United States," the authors conclude.

Source: American Journal of Epidemiology 2003;157:58-65.

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FDA: Patients Often Get Requested Drugs

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, January 13, 2003

WASHINGTON - Request a medication, and a doctor usually hands over a prescription — half the time for a drug a patient sought after seeing it advertised, says a Food and Drug Administration (news - web sites) survey of physicians.

Preliminary results of the FDA survey, released Monday, show doctors cited some benefits that accrue from the nation's barrage of drug advertising, such as patients learning about new treatments or asking more thoughtful questions about medication options.

But 59 percent of physicians said having seen a drug commercial added no benefit to a patient's subsequent doctor visit.

The same percentage of physicians recounted a patient's requesting a prescription for a brand-name drug because of an ad. Eight percent of doctors said they felt very pressured to prescribe what the patient wanted, and one in five felt somewhat pressured.

Only 40 percent of doctors believed their patients understood the possible risks and side effects of drugs based on ads.

Most of the time a patient requests a medication, he or she gets a prescription, said the FDA drug chief, Dr. Janet Woodcock. Of the 59 percent of physicians who recalled being asked for a specific brand-name product, about half prescribed that drug, she said.

Why didn't the other half? The main reason was the patient needed a different medication. Also cited were side effects that the patient initially was unaware of and the availability of less expensive alternatives, including over-the-counter options or even lifestyle changes such as diet.

How the drug industry advertises, and how strictly the FDA regulates those ads' truthfulness, are highly contentious issues. Just last month, congressional investigators announced that misleading ads often are off the air by the time FDA gets around to chastising their makers, and a critic charged that FDA warnings ordering untruthful ads to be pulled have dropped by almost two-thirds in the last year.

Direct-to-consumer drug advertising has tripled, to $2.7 billion worth a year, since the FDA loosened drug promotion rules in 1997. Drug makers argue the ads inform people about the latest treatments. Critics argue the ads too often make pills seem a panacea, and the most expensive drugs are advertised while cheaper, unadvertised ones might work better.

The FDA's survey of 500 physicians is to help the agency to understand better why doctors prescribe the way they do and whether some advertising rules need changing to ensure better public understanding of a drug's pros and cons.

A recent patient survey by the National Consumers League found ads can be important to alerting people to new therapies, and many patients use them only as starting points for more information because they realize ads are trying to sell drugs.

The FDA's findings that patients often are confused about drug risks suggests the government should require easier-to-understand side effect information on ads, said the league's president, Linda Golodner. She noted that magazine and newspaper ads often list all a drug's possible side effects in virtually unreadable, jargon-filled fine print.

"We believe that most evidence clearly shows that direct-to-consumer advertising plays a valuable role in educating consumers and prompting them to seek treatment," said Jeff Trewhitt of the industry's Pharmaceutical Research and Manufacturers of America. He cited another survey estimating that ads have prompted 25 million Americans to initiate health discussions with their doctors.

The FDA survey has an error margin of plus or minus 4.4 percentage points.

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Non-Whites in US at Greater Risk from Breast Cancer

By Suzanne Rostler

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - US women who are black, American Indian, Hawaiian, Pakistani or belong to certain other non-white ethnic groups are more likely to be diagnosed with advanced breast cancer (news - web sites) than whites, conclude researchers who conducted a large, national study.

And economic, social and cultural factors that delay diagnosis or affect treatment seem to be the root cause of the disparity, they said. Therefore, targeting factors such as access to health insurance may improve breast cancer survival rates, according to their report in the January 13th issue of the Archives of Internal Medicine (news - web sites).

"These findings present a challenge to society, as elimination of many of these discrepancies is, at least in theory, quite possible," Dr. Christopher I. Li from the Fred Hutchinson Cancer Research Center in Seattle, Washington, and the study's lead author, told Reuters Health.

He said access to health care is the main factor that influences mortality and likelihood of being diagnosed with advanced breast cancer, but cultural factors and personal habits can also affect a woman's risk.

The study included data on nearly 125,000 US women from 17 different races and ethnic groups who had been diagnosed with breast cancer. Blacks, American Indians, Hawaiians, Vietnamese, Mexicans, South and Central Americans and Puerto Ricans were 20% to 200% more likely to die after a breast cancer diagnosis compared with non-Hispanic white women.

Blacks, American Indians, Hawaiians, Indians, and Pakistanis, Mexicans, South and Central Americans and Puerto Ricans were 1.4 to 3.6 times more likely to receive a diagnosis of advanced breast cancer compared with non-Hispanic whites, the study found.

Non-Hispanic white women tended to be older by the time they were diagnosed with breast cancer, suggesting that certain hormonal risk factors may differ by race and ethnicity. Non-Hispanic white women, for instance, are more likely to use hormone replacement therapy (HRT), which can raise the risk of postmenopausal breast cancer, Li explained.

In other findings, blacks, Hispanic whites and American Indians were more likely to have larger tumors, and the cancer was more likely to have spread to lymph nodes compared with non-Hispanic whites and Asians and Pacific Islanders.

Treatment was also found to vary by race and ethnicity, with black, American Indian, and Hispanic white women more likely to refuse surgery or undergo a type of surgery not recommended by national cancer guidelines than non-Hispanic whites. Such women were also less likely to receive radiation treatment than non-Hispanic whites.

"It is the responsibility of the physicians to counsel patients with breast cancer on their treatment options, but racial and ethnic barriers may inhibit these conversations from being thoroughly completed."

The authors also cite some of the limitations of the study, including a lack of data on socioeconomic status, access to healthcare, use of mammograms, and chemotherapy and use of hormones in regards to mortality rates. The researchers were also unable to categorize the majority of Hispanic whites into a particular subgroup.

Source: Archives of Internal Medicine 2003;163:49-56.

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Taking Aim at Trans Fatty Acids

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Monday, January 13, 2003

MONDAY, Jan. 13 (HealthScoutNews) -- Just as most Americans are finally digesting the nutrition labels appearing on all processed foods, the Food and Drug Administration (news - web sites) sits poised to add another term on the back of your favorite box of cookies or package of lunch meat.

That term is "trans fatty acid." And some time early this year, the FDA is expected to start requiring that manufacturers include these levels along with listings for other types of fat content already mandated on food labels.

"This is a good thing, because it will provide consumers with more information about the foods they are consuming so they can make better food choices," says Cindy Moore, director of nutrition therapy at the Cleveland Clinic Foundation, and a spokeswoman for the American Dietetic Association.

Trans fatty acids or -- "TFAs" -- are a type of saturated fat that occurs naturally in small amounts in foods like beef and dairy products.

But trans fatty acids can also be the end result of a manufacturing process that turns healthy liquid fats -- like vegetable oil -- into unhealthy solid fats needed to produce many foods, particularly baked goods and snacks. As such, they show up in a wide variety of products you commonly eat, often in large amounts.

"If you eat any commercially prepared foods, particularly baked goods, chances are you are getting a fair amount of TFAs in your diet," Moore says.

This matters, she adds, because studies now show that trans fatty acids can increase some specific health risks -- particularly the risk of heart disease.

"The higher your intake of trans fatty acids, the higher your ratio of LDL (bad) cholesterol to HDL (good) cholesterol. And that plays out in terms of the risk for heart disease," Moore says.

But it's not only your heart that can suffer. The very latest studies show that high levels of trans fatty acids can also increase your risk of Type II diabetes.

In fact, all things being equal, the negative effects of TFAs on your health are even greater than those of the much-ballyhooed saturated fats -- the traditionally bad, "heart-hurting" fats found in foods like butter and cream.

"All fats are bad, and no high fat foods are good for your health. But if you have to choose between a food high in saturated fats and one high in trans fat, the one high in trans fat would probably be slightly worse for you in terms of your heart health," says New York University nutritionist and dietitian Samantha Heller.

But how much trans fatty acid is considered too much? In an effort to answer this question, the FDA asked the National Institute of Medicine (news - web sites) to study the issue and come up with a number that could make its way onto food labels.

That report, issued last fall, found that no level of trans fatty acids is considered "safe."

Since trans fatty acids are present in so many foods, the institute's report also concluded that eliminating TFAs from your diet would cause such a dramatic change in your eating habits that it could lead to deficiencies of needed nutrients.

The suggested compromise: Strive to keep trans fatty acids as low as possible. And in this respect, the new labels can help.

"If we look for foods that are low in TFAs and low in saturated fats, we are definitely making smarter food choices," says Heller.

Although the TFA regulation is likely to become mandatory sometime in the next few months, it could take up to 15 months before the new labels begin appearing in stores.

In the meantime, Moore says you can still make smarter food choices by reducing your intake of any foods that list "partially hydrogenated oils" in their ingredient list.

"Most partially hydrogenated oils are trans fatty acids, and the less we consume of these ingredients, the better off our heart and our health will be," she says.

Currently the FDA-required food labels list total fat content, along with breakdowns for the following types of fat:

·         Saturated fats -- found in animal meats, including beef, veal, lamb and pork, as well as poultry, butter, cream, whole milk, and whole cheeses. Plant sources include coconut and palm kernel oil and cocoa butter.

  • Polyunsaturated fats (the "good" fat) found in plant oils such as safflower, sesame, sunflower, corn and soybean, as well as nuts and seeds.
  • Monounsaturated fats (another "good" fat) found in canola, olive and peanut oil and avocados.

According to the American Heart Association (news - web sites), choosing foods high in polyunsaturated and monounsaturated fat may help lower your blood cholesterol when used in place of saturated fat.

What To Do

For more information on healthy eating, visit The American Dietetic Association. You can also find specific information on fat content and its dietary effects by visiting the American Heart Association.

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Newer Antidepressants May Increase Bleeding Risk

By Merritt McKinney

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - A widely prescribed class of antidepressant drugs may increase the risk of bleeding in the gastrointestinal tract, according to a new study from Denmark.

But one of the study's authors stressed that bleeding was still rare in people taking antidepressants known as SSRIs, or selective serotonin reuptake inhibitors. SSRIs include Paxil (paroxetine), Prozac (fluoxetine) and Zoloft (sertraline).

"Our study showed that SSRIs are probably a risk factor for upper gastrointestinal bleeding," Dr. Henrik Toft Sorensen told Reuters Health. However, the study is not the final word on the subject, according to Sorensen, who is at the University of Aarhus in Denmark.

One of the limitations of the study, Sorensen said, was that researchers were not able to take into account smoking and drinking, both of which can increase the risk of gastrointestinal bleeding.

Since gastrointestinal bleeding was still rare in people taking SSRIs, "the risk should be balanced against any therapeutic effect for the depression," Sorensen said.

The study included about 26,000 residents of a Danish county who had been prescribed an antidepressant--SSRI or other types--during the first half of the 1990s.

Among people who were taking an SSRI, but not any other medications that could increase the risk of bleeding, episodes of upper gastrointestinal bleeding were more than three times more common than in similar people who were not taking the drugs. This risk jumped even higher in people who were taking an SSRI in combination with a nonsteroidal anti-inflammatory drug or low-dose aspirin, both of which can increase bleeding risk on their own.

All types of SSRIs seemed to increase the risk of bleeding the same amount.

Antidepressants that were not SSRIs but that still acted on serotonin were also associated with an increased risk of gastrointestinal bleeding, but not as much as SSRIs. In people who were taking non-SSRI antidepressants, however, their risk of bleeding stayed the same even after they stopped taking the drugs, suggesting that some other factors may have influenced their risk.

In contrast, the risk of bleeding returned to normal once people stopped taking SSRIs. This suggests that this class of drugs may be to blame for the increased risk of bleeding, according to the researchers.

The study, which is published in the January 13th issue of the journal Archives of Internal Medicine (news - web sites), is not the first to suggest that SSRIs may increase the risk of bleeding.

To battle depression, SSRIs keep levels of the chemical serotonin high. Serotonin is not important only to the brain, however. Blood components called platelets use serotonin to stop bleeding.

Since platelets cannot make serotonin on their own, researchers suspect that SSRIs increase the risk of bleeding by sucking serotonin from the blood to the brain.

Source: Archives of Internal Medicine 2003;163:59-64.

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Income, Education Don't Always Dictate Teen Obesity

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Monday, January 13, 2003

MONDAY, Jan. 13 (HealthScoutNews) -- The obesity epidemic among teens can't be explained by low family income and education levels alone, a new study finds.

Penny Gordon-Larsen, an assistant professor of nutrition at the University of North Carolina at Chapel Hill, and her colleagues analyzed data collected from more than 13,000 American teens enrolled in a longitudinal study. The researchers found that while obesity was lower among white teens from higher income and better educated households, the association did not bear out for black teen girls whose households were educated and had high incomes.

For years, the perception has been that as income and education rise, the levels of obesity decline as teens learn to make better nutritional choices and have the income to pay for such things as access to health clubs, Gordon-Larsen says.

However, more recently, researchers are finding that's not the case across all ethnic and racial groups.

In the new analysis, published in the latest issue of Obesity Research, the researchers found more evidence that boosting income and education doesn't work for all groups of people, Gordon-Larsen says. "For black females, overweight remained elevated across all income and education levels." The rates of obesity did decline as income and education rose for white, Hispanic and Asian girls, the researchers found.

When they looked at the boys in the study, the researchers found a less dramatic relationship between income and education and obesity. "The differences we see are not as striking," Gordon-Larsen says. Still, they found higher rates of obesity among black and Hispanic teen boys compared to white and Asian boys.

"You can't get rid of overweight by increasing people's income and education," Gordon-Larsen says. "We need to look beyond income and education."

So-called environmental factors -- such as access to parks for exercise -- must be taken into consideration to stem the obesity epidemic among young people, she adds. Cultural awareness of the importance of exercise must be raised in some groups, she says.

"We need to look at modifiable factors that we can do something about -- and to pay particular attention to disadvantaged neighborhoods," Gordon-Larsen says. Another idea is to boost opportunities for healthy eating, she adds.

Another expert, Marilyn Winkleby, an associate professor of medicine at Stanford University School of Medicine who has also researched the topic, is not surprised by the study's conclusions.

"She's (Gordon-Larsen) saying that even when you get to higher levels of socioeconomic status and education among blacks and Hispanics, overweight is still a problem," Winkleby says.

Winkleby believes the onus should not be only on the individual to change environmental factors. Rather, society has an obligation to change to make it easier for people to maintain a normal weight.

For instance, she says, schools might change policies as far as the availability of soft drinks on campus. She notes that large-sized soft drinks, in particular, have hundreds of empty calories and too much sugar.

"You can make available safe places for people to exercise," she adds. "Open the [school] gyms at night -- the kids will go."

More information

For more information on childhood obesity, see the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention.

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US Drug Approval May Take Longer in 2003

By Karen Pallarito

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - As the US Food and Drug Administration (news - web sites) juggles a growing list of demands, it may take longer for drug manufacturers to get approval to market new medicines, according to a report released Monday.

Although drug approval times have dropped 25% since 1992, that time may lengthen as drug companies vie for attention from the FDA, say researchers from Tufts Center for the Study of Drug Development. The Tufts Center, which compiled the report "Outlook 2003," is affiliated with Boston's Tufts University and conducts research on pharmaceutical issues.

Dr. Kenneth Kaiten, director of the Tufts Center, said the FDA will be hard pressed to meet all the demands facing the agency in a timely manner.

"In addition to meeting demands for faster drug application reviews and providing greater oversight of post-approval safety data, the FDA will provide closer scrutiny to the ethical conduct of clinical trials," he said.

FDA Commissioner Mark McClellan will need to focus on improving internal systems, retaining technical staff, and transferring oversight for biotechnology products to the FDA's Center for Drug Evaluation and Research from the agency's Center for Biologics Evaluation and Research, the report said.

Meanwhile, mounting economic pressures and high research and development costs will force drugmakers to improve the efficiency of the drug development process, it said.

A 2001 study by the Tufts Center found the cost of developing and bringing a new drug to market was a whopping $802 million, on average. Industry critics, however, say the number is inflated.

The Tufts Center also expects companies to expand investment in drug discovery and development technologies, such as genomics, proteomics and "combinatorial synthesis"--a method of developing compounds for testing. "Even though this will increase R&D costs in the short run, efficiencies will be realized in the long-term as firms gain greater knowledge of the numerous targets generated by these technologies," the report noted.

On the policy front, Tufts Center researchers say double-digit increases in annual pharmaceutical spending and growing use of drugs to manage chronic diseases will help boost disease management efforts.

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Blacks Don't Treat Stroke Risk Factors

 

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Monday, January 13, 2003

MONDAY, Jan. 13 (HealthScoutNews) -- The black population, at twice the risk for stroke compared to white Americans, needs a big heads-up on prevention, a new Chicago study has found.

A report looking at 1,086 black men and women who had been out of the hospital for only about six weeks after having strokes found that even those people were not effectively treating the risk factors for stroke, particularly high blood pressure.

"They had seen doctors in the hospital and had one or two follow-up visits afterwards, yet even despite this, a lot of the patients were unaware of the risk factors in their profile, particularly high blood pressure," says study author Sean Ruland, a neurologist at the Rush Medical College in Chicago.

"This study is particularly distressing because these are men and women who have been treated, and they are already under scrutiny. Further, they have significant risks of having another stroke. One quarter of all strokes are recurrent strokes," says Dr. Stanley Tuhrim, director of the stroke program at New York City's Mount Sinai Hospital.

Yet, he adds, the results are "probably typical of the general African-American population."

The study, funded in part by the National Institutes of Health (news - web sites), appears in tomorrow's issue of Neurology.

Ruland's findings were culled from another study comparing the effectiveness of an anti-clotting agent to aspirin in stroke and heart attacks. For this study, Ruland looked at rates of awareness, treatment and control of risk factors for stroke, including hypertension, diabetes and cholesterol levels among the men and women stroke victims whose average age was 62.

Of the three, high blood pressure was the most common risk among these patients.

Eighty-seven percent of the stroke patients in the study had high blood pressure, Ruland and his colleagues found, yet a fourth of those patients took no hypertension medicine. And, he says, even among those who did take hypertension medicine, 70 percent still had elevated blood pressure. Further, of the 143 patients with no reported hypertension or use of medications, more than half had elevated blood pressure, above 130/85.

Blood pressure is a measurement of how the blood travels through the arteries. The top number, called systolic, represents the blood pressure when the heart is beating, and the bottom number, called diastolic, represents the pressure when the heart is resting between beats. The higher the blood pressure, the harder the heart has to pump and the more strain there is to arteries that have to carry blood moving under greater pressure. Over time, the increased wear on the body can lead to health problems, particularly stroke and heart attacks.

"Clearly, African-Americans have a higher prevalence of hypertension than do white Americans. It seems to be the only explanation why they are at increased risk of stroke," Tuhrim says.

About 40 percent of the stroke victims had diabetes, and about 85 percent were taking medication for their illness. A history of high cholesterol or use of cholesterol-lowering medicine was reported by 39 percent of the study participants.

Ruland says underuse of proven effective therapies is a serious problem for blacks and points to several possible reasons: physician attitudes, problems with patient access to care, unawareness of the importance of routine screening, and compliance with treatment.

"Physicians may not have the time for necessary care and follow-ups or aren't aware of the current guidelines for hypertension treatment," Ruland says.

Last year, the Joint National Committee of the National Heart, Lung, and Blood Institute lowered to 130/85 the threshold for treating hypertension. Previously it had been 140/90, Ruland says.

Other problems are that hypertension has few if any symptoms, so unless people are vigilant about taking their blood pressure they might not know they have it.

Lastly, Ruland says, people whose blood pressure readings are high in his office are often in denial that they have high blood pressure.

"They tell me they just sat in traffic for an hour or walked up a hill," he says when he reports that they have high blood pressure. "I've heard everything in the book."

He recommends that people with a reading above 130/85 should monitor their own blood pressure regularly, several times a week until it reaches the recommended level. He tells patients to buy a blood pressure cuff from the pharmacy or have it checked at one of the many public places that offer blood pressure readings.

More information

Access the most recent blood pressure recommendations issued by the National Institutes of Health. A list of risks for strokes can be found at the National Stroke Association.

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Scientists Focus Anthrax's Deadly Aim on Cancer

By Merritt McKinney

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - Anthrax can be deadly, but scientists are working on a way to harness its destructive power to fight cancer. In mouse studies, several different types of tumors dramatically shrank after being injected with an altered form of the anthrax toxin.

What works in mice does not always work in people, so it is too soon to say whether anthrax will ever be tested in people, according to Dr. Stephen H. Leppla, who led the research along with Dr. Thomas H. Bugge.

But in an interview with Reuters Health, Leppla, who is at the National Institute of Dental and Craniofacial Research in Bethesda, Maryland, called the research a "new strategy" for fighting cancer.

The researchers focused on an enzyme called urokinase plasminogen activator, which Leppla said is "a very specific marker for tumor cells." Virtually all tumor cells have this enzyme on their surface, he said, but it only rarely appears in normal cells.

Leppla and his colleagues had previously found that the anthrax toxin only becomes activated when the cell it is targeting carries an enzyme called furin on its surface. Once the anthrax toxin is activated by its contact with furin, it is able to start devastating cells.

Now, the researchers report that they have found a way to make the anthrax toxin target tumors, not healthy cells. The results of the research are being published in the advance online edition of the journal Proceedings of the National Academy of Sciences (news - web sites).

Leppla and Bugge's team tinkered with the anthrax toxin so that it was triggered not by furin, but by urokinase plasminogen activator, the enzyme found almost exclusively on tumor cells. Several different types of human tumors that had been transplanted into mice rapidly diminished after being injected with the modified toxin.

Although the altered form of anthrax ravaged tumor cells, it left normal cells alone.

The results so far are encouraging, Leppla said, but there is a long way to go. Scientists still have to figure out the best way to give the modified anthrax toxin as well as what is the most appropriate dose in animals. Leppla said a company has licensed the technology, but it is too soon to say whether any anthrax-based therapies will make it to human clinical trials.

Source: Proceedings of the National Academy of Sciences advance online edition 2003;10.1073/pnas.0236849100.

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Protein Nabbed as Cancer Ally

HealthScoutNews

Monday, January 13, 2003

MONDAY, Jan. 13 (HealthScoutNews) -- A protein fragment that thwarts the effectiveness of a tumor-fighting gene may prove to be an important target for new cancer treatments.

That's the hopeful conclusion of a study in the February issue of Nature Genetics.

Researchers say the protein fragment, iASPP, is in a class of proteins called apoptotic enhancers (ASPP). These proteins stimulate programmed cell death (called apoptosis) through the p53 gene.

However, this study found the iASPP protein fragment hinders the ability of the p53 gene to exert its normal cell-killing power. They say it appears that iASPP plays a major role in turning normal cells into cancerous cells.

In experiments on different kinds of cells, the researchers found that when iASPP levels were reduced, the p53 gene was better able to prevent tumor cell growth. That's a strong indication that iASPP is an impediment to controlling cancer.

The study findings add more information to the effort to fight cancer by focusing on the p53 gene, a major genetic factor in controlling tumor growth.

In many forms of cancer, the p53 gene is mutated and ineffective, which lets tumors spread.

More information

Here's where you can learn more about the p53 gene.

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Treating Sleep Disorder Eases Heartburn, Too

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - Nighttime heartburn is common among people with a sleep disorder called obstructive sleep apnea, and a device used to treat this disorder may ease patients' heartburn as well, according to a new study.

People with sleep apnea stop breathing for short periods during sleep. Most commonly due to upper airway obstruction, the condition can cause loud snoring, repeated near-wakening and increased blood pressure.

About 10% of people who suffer from gastroesophageal reflux disease (GERD), the clinical term for heartburn, have symptoms at night. People with nighttime symptoms tend to have a much worse quality of life than those whose symptoms occur only in the daytime. As many as 76% of people with obstructive sleep apnea also suffer from nighttime GERD symptoms, although the reason for the association between the two conditions is not clear.

Small studies have suggested that nasal continuous positive airway pressure (nCPAP), a pressurized mask that is used to treat sleep apnea, can also help cut down on the amount of stomach acid that backs up into the esophagus. To investigate further, Dr. John O'Connor of Duke University in Durham, North Carolina and colleagues conducted a larger study in 181 patients with sleep apnea and nighttime GERD symptoms.

Patients were followed for between 5 and 98 months. During that time they were interviewed about the quality of their sleep and symptoms of nocturnal GERD and sleep apnea.

Among patients who followed through with the treatment, nCPAP decreased the frequency of nocturnal GERD by 48%.

In addition, 75% of the patients who used the CPAP device "had an improvement" in their nocturnal GERD symptoms, the authors report.

In all, 16 patients stopped using the mask due to discomfort or nasal dryness, according to the report.

"Although our study demonstrated that CPAP treatment relieved both sleep apnea and GERD symptoms, there needs to be further research to determine the optimal treatment combination including CPAP, dietary modifications and acid suppressing medications," O'Connor said in a prepared statement.

Source: Archives of Internal Medicine (news - web sites) 2003;163:41-45.

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The Price of Fat

HealthScoutNews

Monday, January 13, 2003

MONDAY, Jan. 13 (HealthScoutNews) -- People who are overweight and obese rack up as much as $1,500 more in medical costs each year than people with healthy weights.

So concludes new research in the January/February issue of the American Journal of Health Promotion.

The two-year study included nearly 200,000 General Motors workers. It found the average annual medical costs for people with normal weight was $2,225, compared to $2,388 for overweight people and $3,753 for people who were the most severely obese.

The study found that 40 percent of the GM workers were overweight, 21.3 percent of them were obese, 37 percent had healthy weights and 1.5 percent were underweight.

This is the first study to examine the relationship between medical costs and the six weight groups outlined in the U.S. National Heart, Lung, and Blood Institute's weight guidelines.

The researchers say their findings show the economic burden caused by obesity. In 1994, it was estimated that the direct medical costs of obesity in the United States total $51.6 billion. Being overweight and obese leads to many chronic diseases.

More information

Here's where you can learn more about obesity.

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Bowel Disease More Common After Appendectomy

By Merritt McKinney

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - People who have had their appendix removed are more likely to develop the digestive disorder Crohn's disease, results of a new study suggest.

It's not clear if appendicitis increases the risk of Crohn's disease, or if people at risk for Crohn's disease are more likely to develop appendicitis. However, the findings may help shed light on both conditions, according to the lead author of the study, Dr. Roland E. Andersson.

"The importance of the study is that it links appendicitis, which is a common disease, with Crohn's disease, which is a rare disease," Andersson, of County Hospital Ryhov in Jonkoping, Sweden, told Reuters Health.

The study "opens a new field for research," he said, because "if we can understand appendicitis, we may also increase our understanding of Crohn's disease."

Crohn's disease is a type of inflammatory bowel disease with symptoms that include pain, abdominal cramps, diarrhea, bleeding and weight loss. Drugs and surgery to remove the portion of the intestine affected by the disease may relieve symptoms, but there is no cure.

No one knows for sure what causes appendicitis, Andersson said. Although some people think that the condition develops when a person does not get enough fiber, this connection has not been proven, he said.

Some studies have suggested that people with ulcerative colitis, another type of inflammatory bowel disease, are less likely than people without the disease to have ever had an appendectomy.

This has led some people to believe that "taking away the appendix will change your immune system so that you will be protected against ulcerative colitis," Andersson said. He noted that some doctors are even trying appendectomy as a treatment for ulcerative colitis.

The current study, which is reported in the January issue of the journal Gastroenterology, found that people who had their appendix removed were 47% more likely to develop Crohn's disease than those who did not have the surgery. However, the risk of developing the relatively rare condition was still low overall.

The increased risk was present not only soon after surgery, but also 10 years later.

It may seem odd that appendectomy is associated with a decreased risk of ulcerative colitis but an increased risk of Crohn's disease since both are inflammatory bowel diseases. The apparent contradiction "makes sense," though, according to Andersson. He explained that ulcerative colitis and Crohn's disease are marked by opposite inflammatory responses.

The study compared more than 200,000 people who had had an appendectomy and a matching group of similar people who had not had the surgery.

Source: Gastroenterology 2003;124:40-46.

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Baby Brush Strokes

HealthScoutNews

Monday, January 13, 2003

(HealthScoutNews)-- It's never too soon to start cleaning your baby's teeth. In fact, you should begin practicing dental hygiene on your baby when the infant's first tooth appears, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

Here's what you should do: Start by wiping the tooth with a clean, damp cloth every day. Once additional teeth come in, switch to a soft toothbrush, and brush your child's teeth twice a day. Until kids are two years old, there's no need to use toothpaste with fluoride, unless your child's doctor or dentist says otherwise.

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European Team Launches Hunt for Alzheimer's Genes

By Michael Leidig

Reuters Health

Monday, January 13, 2003

REGENSBURG (Reuters Health) - Researchers hope to find genes responsible for Alzheimer's disease (news - web sites) by systematically studying data from hundreds of families across Europe.

Doctors, historians, statisticians, epidemiologists and computer experts from seven European countries will analyze data on Alzheimer's patients and their relatives going back for several generations in an attempt to identify genes responsible for the disease.

Neurologist Hans Kluenemann, from the department for psychiatry and psychotherapy at the Regensburg medical university and head of the interdisciplinary network, told Reuters Health that doctors will be able to develop new therapies for Alzheimer's once they identify the genetic defects that cause the disease.

"A study of Alzheimer's patients and several generations of their relatives will be at the heart of the project," he said at the launch of the project in Regensburg attended by scientists from Spain, Italy, Belgium, Finland, Sweden, Germany and the Netherlands.

Data from church registries, which have been digitized, will be used to check whether ancestors of patients also had Alzheimer's disease. Among the data banks to be used is one belonging to the diocese of Passau, with six million entries on the local population going back to the year 1580.

"We will use these church registries to get information about the ancestors of Alzheimer's patients and so find out whether they might have had Alzheimer's disease, too," Kluenemann said.

"The blood of Alzheimer's patients will be studied. A computer will be used to identity the specific genetic features, which are only found in the Alzheimer's patients and not in their relatives.

"These genes will then be examined individually. In this way, we will be able to identify the genetic defect that leads to Alzheimer's," said Kluenemann.

Several hundred families across Europe will be studied as part of the project, which is the first ever of this scale on the continent. A study in Calabria, Italy, led to the identification of the Alzheimer's gene PS1.

"Our aim is to pool our resources so that we have sufficient financial means, qualified staff and DNA samples, to be able to conduct research at the highest level," he said.

Kluenemann said that the project would take several years to complete.

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Winter's Itch

HealthScoutNews

Monday, January 13, 2003

(HealthScoutNews)-- If you are an allergy sufferer, you may be breathing a huge sigh of relief that winter weather has set in for a while. But winter doesn't necessarily offer a reprieve for some allergy sufferers. Chilly temperatures can also trigger a condition that often goes undiagnosed: cold-induced urticaria.

Urticaria is characterized by an outbreak of hives. It will affect about one in four Americans at least once in their lifetime, according to the American Academy of Allergy, Asthma and Immunology (AAAAI).

Hives -- pale, red and itchy swellings on the skin -- are often brought on by a rapid change in temperature. They are a result of histamine -- a chemical found in the top layers of the skin -- which is also to blame for many allergic reaction symptoms.

If you have urticaria, the AAAAI recommends you see an allergist, who may prescribe antihistamines.

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Arthritis Drug Helps in Heart Disease, Study Finds

By Maggie Fox

Reuters

Monday, January 13, 2003

WASHINGTON (Reuters) - Anti-inflammatory drugs used to treat arthritis may also reduce the risk of heart disease by keeping the arteries limber, Swiss researchers said on Monday.

Their findings add to a growing body of research that suggests inflammation plays an important role in heart disease--perhaps as important as a fatty diet.

Still under debate is what causes the inflammation--an infection of some sort, or perhaps the way the body deals with too much fat in the blood. But drugs designed to reduce inflammation do seem to help against heart disease.

Studies aimed at finding out why are spotty at best, said Dr. Frank Ruschitzka, a cardiologist at University Hospital in Zurich, Switzerland.

He tested 14 of his patients, giving all of them their standard lipid-lowering drugs, blood-thinning aspirin and other medications. For two weeks, half got Celebrex on top of everything else and half got a dummy pill. Then he swapped the two groups.

Celebrex, known generically as celecoxib and marketed by Pharmacia and Pfizer, is a member of a new class of drugs called COX-2 inhibitors. They work in the same way as aspirin, ibuprofen and other so-called non-steroidal anti-inflammatory drugs or NSAIDS, but supposedly without some of the side-effects such as stomach bleeding.

It would take years to tell whether taking COX-2 inhibitors reduced the risk of heart disease, so Ruschitzka and colleagues instead measured markers of heart disease, such as endothelial function--a measure of how efficiently blood vessels are working--levels of C-reactive protein, which is associated with both inflammation and heart disease, and levels of the fat that blocks arteries--oxidized low-density lipoprotein.

All three improved while the patients were on COX-2 inhibitors, the researchers report in this week's issue of the journal Circulation.

"The increase which we have seen is well within the range of what we have seen in other cardiovascular medications such as statins and ACE inhibitors," Ruschitzka said in a telephone interview.

"There are only a few drugs out there that improve endothelial function. This is not a small increase."

Ruschitzka, who said his study was not funded or directed by any drug company, said more and bigger studies need to be done before heart patients are advised to add anti-inflammatory drugs to their regimens.

"What we clearly see is that atherosclerosis (hardening and clogging of the arteries) is an inflammatory disease," he said. It is caused not only by the deposition of cholesterol stuff. There is inflammation going on."

Doctors have been onto this idea and are studying whether perhaps the inflammation is caused by infection of some sort.

Results are mixed, although some studies have suggested that taking antibiotics may reduce the risk of heart disease. But there are many different antibiotics that work against different bacteria and no one has zeroed in on the right target.

"Inflammation and infection may be two different stories. Inflammation may be caused by non-infectious agents," Ruschitzka said.

For instance, immune cells often try to pull particles of fat out of the blood. They engulf the particles, becoming what are known as foam cells, and sometimes get caught in blood vessel walls. This process can cause inflammation.

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Depression Linked to Early Onset of Perimenopause

Reuters Health

Monday, January 13, 2003

NEW YORK (Reuters Health) - Women with a history of depression may enter the pre-menopausal period known as perimenopause sooner than women who have never suffered from depression, according to a report published in the January 13th issue of the Archives of General Psychiatry.

Perimenopause is a term for the years before a woman's last menstrual period, when menstruation tends to be irregular.

At a major menopause meeting in 2001, Dr. Lee S. Cohen and colleagues from Harvard Medical School (news - web sites) in Boston presented findings from a study of 34 middle-aged women that suggested a link between depression and early perimenopause onset.

In the current study, Cohen's team provides updated results after analyzing data from 332 women with and 644 women without a history of major depression. The follow-up period was three years.

The authors found that women with a history of depression were 20% more likely to enter perimenopause early than women without this history. However, the most severely depressed women were twice as likely to enter perimenopause sooner than their non-depressed peers.

Compared with non-depressed study participants, women with a history of depression had higher follicle-stimulating hormone and luteinizing hormone levels and lower estrogen levels, the investigators note.

Women with a lifetime history of depression, as well as an earlier perimenopause onset, may spend a prolonged amount of time in a low-estrogen state, which has been tied to a number of health problems, the researchers note.

"Our research may encourage more screening for depression symptoms and history by gynecologists," lead author Dr. Bernard L. Harlow said in a statement. "Similarly, psychiatrists may also focus more attention on menstrual cycle changes and perimenopausal symptoms while screening late reproductive-aged patients with recurrent mood disorder."

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Source: Archives of General Psychiatry 2003;60:29-36.

SUNDAY, JANUARY 12, 2003

When a Bump on the Head Is Serious

HealthScoutNews

Sunday, January 12, 2003

SUNDAY, Jan. 12 (HealthScoutNews) -- As many as one third of all children will have a concussion before they finish high school.

That startling statistic comes from the Ontario Brain Injury Association, which adds this calming note: Most of these will be mild, and the children will recover with no lasting damage.

However, how can you know if your child has just a bump on the head or a concussion that needs treatment?

The American Academy of Neurology (news - web sites) defines a concussion as a change in mental status caused by a head injury. Major symptoms of a concussion include confusion and amnesia. Loss of consciousness may or may not occur.

The academy divides concussions into three types. Grade one is the most common, but also the hardest to diagnose because it happens so quickly. There will be momentary confusion that won't last longer than 15 minutes, and no loss of consciousness. With grade two concussions, there is also no loss of consciousness, but the symptoms of confusion and inattention last longer than 15 minutes. A concussion is considered grade three if there is a loss of consciousness.

Other symptoms of a concussion include headache, vision disturbances, dizziness, loss of balance, ringing in the ears, difficulty concentrating and nausea.

Anyone with a grade two or three concussion needs to be immediately evaluated by a doctor, and should be symptom-free for at least two weeks before returning to sports activities, according to the academy.

More information

To read more, visit the American Academy of Family Physicians.

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Layer Up, It's Cold Outside

HealthScoutNews

Sunday, January 12, 2003

SUNDAY, Jan. 12 (HealthScoutNews) -- It's that time of the year when even a quick trip outside can cause a chill, and longer jaunts can be downright dangerous.

What's a body to do when the bitter winds blow, the mercury plummets and the ice and snow start to accumulate?

The experts at Michigan State University (MSU) recommend paying very close attention to what you wear and especially to how your clothing is layered. Layering, they say, accomplishes two things:

It traps heat between each layer and keeps you warmer, and it lets you remove clothing as you warm up, to prevent overheating.

Three basic layers are recommended. The underlayer, the one closest to the skin, should be made of a material that wicks moisture away from the body. Cotton is a poor choice because it tends to absorb and hold moisture, which can result in heat loss. Many people find that a turtleneck for the upper body and tights or long underwear for the lower body work well for this first layer.

The insulating layer of clothing is next. The purpose of this layer is to insulate the body and conserve heat. The favorite fabric choices for this layer have long been wool and fleece, but there is also a range of new-age materials emerging. One of the reasons that wool has retained its popularity is that it can conserve heat, even when it's wet. A lightweight wool sweater makes an excellent layer for the upper body.

Unless you're going to be out in very extreme temperatures, or be exposed to moderate cold for a very long period of time, such as while hunting, fishing or attending a lengthy sporting event, you may not need an insulating layer for the lower body.

The final layer is the outer shell. This shell provides a barrier to wind and moisture and helps conserve body heat. The best material for such a shell should be a breathable, water-resistant fabric, such as the material from which many windbreakers and jackets are made. Wind or rain pants for the lower body complete the cold weather protection.

MSU experts point out that two other items are important in maintaining body heat in cold weather -- a wool or knit cap for the head and mittens or gloves for the hands. A large amount of heat is lost through the head, so a head covering is invaluable for conserving heat. Heat also escapes from the extremities, especially the hands. Unless the hands have to be used in an activity, mittens are the preferred hand cover because the fingers are not isolated and help keep one another warm.

With a little attention to weather and wardrobe, keeping the body warm on cold days is easy.

More information

Learn more about hypothermia in winter from World Book Medical Encyclopedia.

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SATURDAY, JANUARY 11, 2003

Epilepsy Drug Succeeds Where Others Fail

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Sunday, January 11, 2003

SATURDAY, Jan. 11 (HealthScoutNews) -- Any parent can relate to the agony of watching a child suffer severe epileptic seizures because there's no medicine that works, but there is hope on the horizon.

A recent study shows the drug Keppra can relieve seizures in some children who were not helped by other treatments.

Researchers tested Keppra, an epilepsy drug currently approved by the U.S. Food and Drug Administration (news - web sites) for use in adults, in 39 children ranging in age from infancy to 14 who had hard-to-control seizures.

They found Keppra reduced seizures by 50 percent in one-third of the children. Seizures stopped completely for three children and nine children had a more than 90 percent reduction in seizures.

"Cleary this is a medicine that has a role in treating childhood epilepsy," says study author Dr. James W. Wheless, director of the Texas Comprehensive Epilepsy Program at the University of Texas Medical School at Houston. "Overall, it was a drug that had a very nice safety profile."

The study was published in a recent issue of the Journal of Child Neurology. Studies involving larger numbers of children are ongoing, Wheless says, and that data should be ready for analysis early this year.

Epilepsy is a brain disorder in which neurons periodically produce sudden bursts of electrical energy that disrupt other brain functions. The frenzied neural discharges can cause symptoms ranging from strange sensations and emotions to convulsions, muscle spasms and loss of consciousness. Roughly 300,000 U.S. children have the disorder, and those who have refractory epilepsy have seizures that are so severe and so frequent that traditional medications don't work.

"The patients in this study have basically run out of treatment options, so it's encouraging that Keppra was effective and controlled seizures in 30 percent of our patients," Wheless says.

For most epileptics, symptoms come on with little or no warning, says Dr. Gregory Barkley, medical advisor to the Epilepsy Foundation. They have to worry if they'll have a seizure while driving, or during a business meeting, or while caring for their children.

"Imagine if at some point today, for one minute and without warning, you suddenly couldn't remember what you were thinking about, stared blankly and fell to the ground," Barkley says. "People with epilepsy have that hanging over them like the sword of Damocles all the time."

Heavy doses of anti-seizure medications can control seizures in many patients -- but not all. About one-fourth of patients still suffer occasional or frequent bouts, Barkley says.

And even the rare seizure can significantly disrupt life -- most states require a person to be seizure-free for at least six months to drive.

"Even with all the advances we've made, there are still hundreds of thousands of people with epilepsy whose seizures are not controlled by current medication," Wheless says.

Keppra, the brand name for levetiracetam, was approved about three years ago for use in adults. While doctors do prescribe it for children, they aren't sure of the safest and most effective dosages, particularly because many children with epilepsy are taking multiple medications, Wheless explains.

"Although Keppra is not currently approved for use in children, we wanted to study Keppra because it has a favorable efficacy, a lack of drug interactions, ease of use and is well-tolerated," he says.

The current study showed the drug has about the same rate of success in children as in adults, he adds. About one quarter of parents also reported improvement in their child's behavior and cognition.

Epilepsy doesn't necessarily cause problems with cognition or behavior, Barkley says. However, because it's a disorder of the brain, epilepsy can affect all sorts of brain functions. In addition, high dosages of epilepsy medications can cause side effects that affect thinking and behavior.

About 10 percent of parents reported their children were more irritable and aggressive while taking Keppra. These symptoms disappeared shortly after the dosage was lowered or stopped.

"What makes Keppra an attractive drug is that it is often very effective, it's simple to use, doses are effective within a few days and most people do not complain of many side effects," Barkley says. "This drug has shown its benefit in many patients who were not helped by other drugs."

More information

For more information about epilepsy and treatments, visit the Epilepsy Foundation or the National Institute of Neurological Disorders and Stroke.

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GERD Yourself Against Heartburn

HealthScoutNews

Sunday, January 11, 2003

SATURDAY, Jan. 11 (HealthScoutNews) -- It's called heartburn, but your heart has nothing to do with it.

The condition is actually caused by gastroesophageal reflux disease (GERD). The term gastroesophageal refers to the stomach and esophagus.

Reflux means to flow back or return. So, gastroesophageal reflux is simply the return of the stomach's contents back up into the esophagus. GERD typically affects the lower esophageal sphincter, the muscle connecting the esophagus with the stomach. Many people, including pregnant women, suffer from heartburn caused by GERD.

Physicians also think some people suffer from GERD and associated heartburn due to a condition called hiatal hernia. That happens when the upper part of the stomach moves up into the chest through a small opening in the diaphragm, the muscle separating the stomach from the chest.

Recent studies show the opening in the diaphragm acts as an additional sphincter around the lower end of the esophagus. The research also shows a hiatal hernia can trap acid and other digestive contents above this opening. These substances then flow easily back into the esophagus, causing that painful, burning sensation in the middle of the chest known as heartburn.

Dietary and lifestyle choices may contribute to GERD. Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, coffee or alcoholic beverages may cause reflux and heartburn.

Obesity is also associated with these symptoms. In most cases, heartburn can be relieved through diet and lifestyle changes. However, some people may require medication or surgery.

More information

The National Heartburn Alliance has more food for thought on what to eat to avoid heartburn.

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Winter Full of Risks for Seniors

HealthScoutNews

Sunday, January 11, 2003

SATURDAY, Jan. 11 (HealthScoutNews) -- Now that winter has rolled into town, senior citizens should be on their guard.

Because of the cold weather, ice and flu season, winter is the most dangerous time of the year for older people. Doctors at the Johns Hopkins Geriatrics Center treat many more accidental injuries during the winter than other times of the year, says Dr. Bruce Leff, an associate professor of medicine at the center.

"Whenever we see a big snowstorm in Baltimore, we know that soon we will get some patients with hip fractures," Leff says.

To avoid slipping and sliding on the ice, seniors should walk carefully, even if they don't see ice, and consider using a cane or walker, he says. Those with greater risk of severe hip injury after a fall should consider wearing hip pads.

The rest of us should "use common sense" in making the winter easier for seniors with mobility problems, Leff says. Plowing and salting walkways is essential. Those who live with seniors should keep pathways clear in the house.

"In winter, many more clothes and stuff come out of the closet. Shoes are everywhere, and that could be a problem," he says.

The cold weather during the winter is also dangerous for people with emphysema or those who take certain medications that can inhibit their ability to handle temperature changes. Because of the general risk of hypothermia during extended exposure to cold, seniors should stay warm.

Another serious winter risk for seniors is the flu virus. Because influenza can lead to more serious conditions in older people, Leff advises all seniors to get a flu shot.

More information

The Illinois Department of Aging has these tips for seniors during the dangerous winter months.

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