JANUARY 17, 2003
Women Prone to Menopausal Symptoms
By Jennifer Thomas
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 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
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
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
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
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,"
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.
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.
Women's Sex Problems Overestimated
By Rick Callahan
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
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,"
Depression Stalking Younger Women
By Colette Bouchez
FRIDAY, Jan. 17 (HealthScoutNews) -- Serious depression is
on the rise -- but it's mostly younger women who are
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
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.
Steiner is senior research physician with the AHRQ, which is
part of the U.S. Department of Health and Human Services
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,
In all age groups, a total of 361,000 women were hospitalized
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
The proof, she says, is in the bottle -- alcohol and medicine,
"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
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.
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.
Can Get High-Altitude Lung Ailment: Study
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
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.
Childhood Brain Tumor Survivors
Prone To Later Problems
By Jennifer Thomas
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
sites)-like symptoms associated with cardiovascular
"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
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,
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
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.
To learn more about children and brain tumors, visit the Children's
Brain Tumor Foundation or the National
Deaf Children Early
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
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
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
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
Here's where you can learn more about cochlear
Living Well in the Golden Years
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.
Here's where you can learn more about the research into early
old age quality of life.
Ephedra Doses Tied to Stroke Risk
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
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
Ephedra, also known as ma huang, is used in some dietary supplements
marketed as weight-loss aids (news
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
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
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.
Hazards of Hip Fractures
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
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
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
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
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
The study looked at 559 people with hip fractures admitted
and discharged from hospitals in the New York Metropolitan
area in 1997 and 1998.
Here's where you can learn more about hip
(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.
Circuit' in Brain by Age 7
By Merritt McKinney
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
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.
Stepping on Something Sharp
(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
- Get medical help immediately.
Diabetic Eye Screen Said OK for Some
By Amy Norton
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
Based on the rates of severe retinopathy they found among study
participants, researchers estimate that many type 2
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
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
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
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
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
Source: The Lancet 2003;361:195-200.
Watch Out for PI
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
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
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.
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
- 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,
- A family history of primary
Here's where you can learn more about primary
JANUARY 16, 2003
Key Found to How Embryos Take Hold
By Amanda Gardner
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
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
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
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.
For more on infertility, visit the National
Infertility Association or the InterNational
Council on Infertility Information Dissemination.
Drug Abuse on the Rise
By Laura Meckler
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
sites), which released the report Thursday.
He was being joined by officials from the Food and Drug Administration
sites) in discouraging misuse of these drugs. The
education effort includes posters, brochures and print
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
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:
Food and Drug Administration: http://www.fda.gov
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.
Scandinavia Leads in Maternity
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
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
Can Strike at Balance
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
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.
Here's where you can learn more about stroke.
Plus Pot Smoking May Equal More Injuries
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
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
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
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
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
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
Source: Academic Emergency Medicine 2003;10:43-51.
Cultures May Get Too Much Oxygen In Labs
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.
Here's where you can get inside
Antibiotics Could Up Intestinal
Risk in Children
By Merritt McKinney
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
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
"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
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
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
A Complication in Stem Cell Diabetes
By Ed Edelson
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,
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
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,
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
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
sites). The technique has worked well in mice, Habener
And he stopped using the insulin-rich growth medium most laboratories
use a while ago because its contaminating effects became
clear, he adds.
You can learn more about stem cell research from the Joslin
Diabetes Center or from the National
Institutes of Health.
Be Merry, Blame the Beergut on Your Genes
By Claire Soares
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
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
The World Health Organization (news
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
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
Stiff Fingers Are Windows Into
By Kathleen Doheny
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
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
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
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
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.
For more on osteoarthritis, visit the National
Institute of Arthritis and Musculoskeletal and Skin
Diseases or the Arthritis
Repeal of Helmet Law Brings Higher
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
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
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.
Diabetics Need to Watch Their Eyes
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
The researchers say their screening recommendations would be
95 percent effective in detecting sight-threatening
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.
Here's where you can learn more about diabetic
Heart, Stroke Risk Starts Early
in Type I Diabetics
By Ed Edelson
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
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
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
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
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.
Learn more about diabetes and heart disease from the American
Heart Association or the American
JANUARY 15, 2003
May Offer Clue to Obesity
Wednesday, January 15, 2003
WEDNESDAY, Jan. 15 (HealthScoutNews) -- Worm genes may help
scientists understand how fat is stored and used in
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
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.
where you can learn more about fat.
for Left-Behind Surgery Tools Higher in Obese
By Alison McCook
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
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
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%
The authors report their findings in the January 16th issue
of the New England Journal of Medicine (news
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,
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.
The New England Journal of Medicine 2002;348:229-235.
the Odds Against Ovarian Cancer
By Colette Bouchez
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
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
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
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
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,"
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.
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.
(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
- 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
- Wash after you exercise
- 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.
System May Sway Ovarian Cancer Survival
By Amy Norton
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
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
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
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
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,
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.
The New England Journal of Medicine 2003;348:203-213.
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
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.
in Pregnancy Tied to Premature Delivery
By Jacqueline Stenson
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
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
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
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
"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."
American Journal of Epidemiology 2003;157:14-24.
Clue to Outlook for Ovarian Cancer
By Amanda Gardner
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
sites), may one day change the way treatments
are structured for ovarian cancer patients.
According to the American Cancer Society (news
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
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
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,"
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
"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."
For more on ovarian cancer, visit the National Cancer Institute
or the American Cancer Society.
Brain Tumor Rx Tied to Later Health Troubles
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
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
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.
Allergy Can Stick It to Diabetics
By Ed Edelson
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
sites), should alert doctors to the possibility
of such reactions in diabetic patients, the physicians
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
"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
The allergic response caused an itchy, unsightly rash at the
injection sites that persisted for up to 48 hours, the
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.
information about latex allergy is available from the
National Institutes of Health. Get
information on insulin from the Joslin Diabetes Center.
Skip Care Due to Medical Debt: Report
By Todd Zwillich
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
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
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
sites) to expand the number of centers nationwide
would help ease the problem of uncollected fees, Hawkins
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
"It's not clear that they are going to reach an agreement
or a solution," Hawkins said.
Low-Fat Diet Cuts Sex Hormones
By Kathleen Doheny
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
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
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
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
"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
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.
For more information on breast cancer risk, turn to the American
Cancer Society, which also has a page on prevention.
ID Key Gene for Long-Term Immunity
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
Without the gene, called SAP, the immune system cannot recognize
and react to pathogens, making people more vulnerable
"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
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
"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
High-Risk Women Benefit Most From
By Serena Gordon
Wednesday, January 15, 2003
WEDNESDAY, Jan. 15 (HealthScoutNews) -- For women who have
an increased risk of developing estrogen-dependent breast
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
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
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
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
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
The Italian researchers add that their findings are preliminary
and need to be confirmed in other studies.
To read more about the risks and benefits of tamoxifen, visit
Cancer Institute or BreastCancer.org.
May Boost Testosterone in Brain and Blood
By Amy Norton
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
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
"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
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
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.
Alcoholism: Clinical & Experimental Research
Don't Drink During Pregnancy
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
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.
Here's where you can learn more about pregnancy
and substance abuse.
May Influence Blood's Stickiness: Study
By Keith Mulvihill
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
"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,
"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
"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.
Mixups Common Among Kids in Hospitals
Wednesday, January 15, 2003
WEDNESDAY, Jan. 15 (HealthScoutNews) -- Medication errors are
common in critically ill children taking multiple medications
That scary conclusion comes courtesy of an American study in
the January issue of The Archives of Pediatrics and
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
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
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.
The U.S. Agency for Healthcare Research and Quality has a tip
sheet on preventing medical
errors in children.
JANUARY 14, 2003
Boy' Treatment Produces Risks
By Lauran Neergaard
AP Medical Writer
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
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
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:
New Moms Should Avoid Fries, Chips
By Ned Stafford
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
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
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,"
Filtering Water in Cloth May Cut
By Paul Recer
AP Science Writer
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
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
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
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,"
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
Fat Pre-Teen Diet May Cut Breast Cancer Risk
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
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
"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
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"
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
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,"
"Whether these differences ultimately influence breast
cancer risk is currently unknown."
Source: Journal of the National Cancer Institute
(HealthScoutNews) -- Contrary to what many people believe,
white sugar is no better or worse for you than any other
According to Harvard Medical School (news
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.
for Seniors Improves, but Large Gaps Remain
By Karen Pallarito
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
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
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,"
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
Gulf War Chemicals Linked to Testicular
By Gary Gately
TUESDAY, Jan. 14 (HealthScoutNews) -- A combination of three
chemicals given to Gulf War (news
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,
In the study, financed by the U.S. Department of Defense (news
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,
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,
The study showed the chemicals and stress interrupted most
of the stages of sperm development and eliminated some
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
"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
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.
To find out more about Gulf War syndrome (news
sites), try GulfLink,
from the Office of the Special Assistant for Gulf War
Illnesses or the National
Gulf War Resource Center.
Activity Wanes as Weight Soars: Survey
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
sites) (CDC) documented a rise in rates of overweight
and obesity among adults and children between 1988 and
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.
Spasticity Tougher to Treat Than
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.
Here's where you can learn more about spasticity.
Slows Blood Cancer
By Merritt McKinney
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
"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,"
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
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
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,"
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
The study was funded in part by the Celgene Corporation in
Warren, New Jersey, which markets thalidomide in the
Source: Mayo Clinic Proceedings 2003;78:34-39.
May Boost Testosterone Levels
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.
Here's where you can learn more about alcohol
abuse and alcoholism.
Errors More Likely in the Sickest Children
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
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
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
"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
New Combo Fuels Fight Against Abdominal Cancer
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
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
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.
The U.S. National Cancer Institute (news
sites) has more about hyperthermia
in cancer treatment.
Bypass, Mood Brightens in Men but Not Women
By Alison McCook
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
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,
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
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
"It may also indicate that women's experience with this
surgery, overall, was less positive than for men,"
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
(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
- Drive erratically, stop,
turn, swerve suddenly or react slowly.
- Drive without headlights
- Narrowly avoid hitting
If you suspect a driver is drunk, drive defensively:
- Be prepared to take quick,
- 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
- As soon as possible, notify
the police or highway patrol.
Exercise Add to Cholesterol Drug Benefits
By Merritt McKinney
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
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
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
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
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
at Risk for Stroke Unaware of Warning Signs
By Suzanne Rostler
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
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
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
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,
"The importance of stroke needs to be considered alongside
traditional health care priorities such as heart disease,
cancer and AIDS (news
sites)," he said.
Source: Journal of the American Medical Association
Lung Cancer Screening Not Worth the Cost
By Merritt McKinney
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
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
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
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
In the interview, Mahadevia noted that the National Cancer
sites) is funding a large trial of CT lung scans,
but the results will not be ready for another 7 to 10
"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
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,
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
For smokers who are worried about getting lung cancer, the
most important step they can take is to quit smoking,
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
JANUARY 13, 2003
U.S. Infants Sleep in Parents' Beds
By Deanna Bellandi
CHICAGO (AP) More infants in the United States are sleeping
in their parents' beds a practice that can be deadly
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
According to a 1999 study by the Consumer Product Safety Commission
sites), an average of 64 young children die each
year while sleeping in bed with their parents or other
Some have suggested bed-sharing has benefits, such as promoting
In this study, researchers from the National Institutes of
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.
Simplified C-Section Less Painful, Saves Blood
By Michael Leidig
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
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
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
Joura said that the follow-up data showed that fertility was
not compromised and was even better than with the old
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.
Hospitals Try to Reduce Medical Errors
By Allison Schlesinger
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
"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,
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
"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
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
Shows Oscillating Power Toothbrushes Superior
By Bill Berkrot
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
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
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
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
Exercise Enemy Is Lack of Commitment
By Ira Dreyfuss
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
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
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
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
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
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
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,"
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:
Abstract of Annals article on obesity and years of life lost:
Doctors Not Aware Enough of Manic Depression
By Opheera McDoom
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
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.
Crash-Scene Research Eyes Hidden
By Siobhan McDonough
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
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
"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
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
"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
"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
Study: U.S. Schools Failing in
By Suzanne Rostler
NEW YORK (Reuters Health) - When it comes to offering healthy
meals, US middle schools are not making the grade, a
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
"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
"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.
Searching for Cancer Cures in the
By Jill Barton
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
"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
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
But it usually takes thousands of tests to find one promising
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
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
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
sites) worth a total of $750,000 a year, along with
five smaller grants from the National Science Foundation
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
"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
sites) cells in the lab and would be the first to
see whether a new discovery could hold as much promise
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/
Weight Control Programs Could Trim
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
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.
Blood Treatment May Fight Heart
By Lauran Neergaard
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
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
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
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
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
"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."
Editors Note Lauran Neergaard
covers health and medical issues for The Associated
Press in Washington.
Docs Prescribing Fewer Antibiotics
By Charnicia E.
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
"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
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
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
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.
Study: Most States Cut Medicaid
By Laura Meckler
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
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
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
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
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
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
Antioxidants May Help Patients
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
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
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
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.
Psychiatric Drug Use Surges for
By Lindsey Tanner
AP Medical Writer
CHICAGO (AP) The number of U.S. children and adolescents
on Ritalin (news
sites), antidepressants or other psychiatric drugs
surged between 1987 and 1996, a trend some experts say
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
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
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,
"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
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
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
"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:
More U.S. Deaths from Gastrointestinal
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
"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
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
sites) and AIDS (news
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.
FDA: Patients Often Get Requested
By Lauran Neergaard
AP Medical Writer
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
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
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
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
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
Non-Whites in US at Greater Risk
from Breast Cancer
By Suzanne Rostler
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
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
"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
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.
Taking Aim at Trans Fatty Acids
By Colette Bouchez
MONDAY, Jan. 13 (HealthScoutNews) -- Just as most Americans
are finally digesting the nutrition labels appearing
on all processed foods, the Food and Drug Administration
sites) sits poised to add another term on the back
of your favorite box of cookies or package of lunch
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
"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
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,"
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
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
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
The suggested compromise: Strive to keep trans fatty acids
as low as possible. And in this respect, the new labels
"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
"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
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
Newer Antidepressants May Increase
By Merritt McKinney
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
Since gastrointestinal bleeding was still rare in people taking
SSRIs, "the risk should be balanced against any
therapeutic effect for the depression," Sorensen
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
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.
Income, Education Don't Always
Dictate Teen Obesity
By Kathleen Doheny
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
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,
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
"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 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."
For more information on childhood obesity, see the American
Academy of Pediatrics and the U.S. Centers
for Disease Control and Prevention.
US Drug Approval May Take Longer
By Karen Pallarito
NEW YORK (Reuters Health) - As the US Food and Drug Administration
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
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.
Don't Treat Stroke Risk Factors
By Janice Billingsley
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
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
"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
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
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,
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.
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
Scientists Focus Anthrax's Deadly
Aim on Cancer
By Merritt McKinney
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
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.
Protein Nabbed as Cancer Ally
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
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.
Here's where you can learn more about the p53
Treating Sleep Disorder Eases Heartburn,
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
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
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
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
The Price of Fat
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
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.
Here's where you can learn more about obesity.
Bowel Disease More Common After
By Merritt McKinney
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
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.
Baby Brush Strokes
(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
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.
European Team Launches Hunt for
By Michael Leidig
REGENSBURG (Reuters Health) - Researchers hope to find genes
responsible for Alzheimer's disease (news
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,"
Kluenemann said that the project would take several years to
(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.
Arthritis Drug Helps in Heart Disease,
By Maggie Fox
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
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
All three improved while the patients were on COX-2 inhibitors,
the researchers report in this week's issue of the journal
"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
"Inflammation and infection may be two different stories.
Inflammation may be caused by non-infectious agents,"
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.
Depression Linked to Early Onset
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
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
Source: Archives of General Psychiatry 2003;60:29-36.
JANUARY 12, 2003
When a Bump on the Head Is Serious
SUNDAY, Jan. 12 (HealthScoutNews) -- As many as one third of
all children will have a concussion before they finish
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
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
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.
To read more, visit the American
Academy of Family Physicians.
Layer Up, It's Cold Outside
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
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.
Learn more about hypothermia in winter from World
Book Medical Encyclopedia.
JANUARY 11, 2003
Epilepsy Drug Succeeds Where Others
By Jennifer Thomas
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
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
"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,
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,"
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,
"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
"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."
For more information about epilepsy and treatments, visit the
Foundation or the National
Institute of Neurological Disorders and Stroke.
GERD Yourself Against Heartburn
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
The National Heartburn Alliance has more food
for thought on what to eat to avoid heartburn.
Winter Full of Risks for Seniors
SATURDAY, Jan. 11 (HealthScoutNews) -- Now that winter has
rolled into town, senior citizens should be on their
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,"
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,"
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
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.
The Illinois Department of Aging has these tips
for seniors during the dangerous winter months.