The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
March 31, 2003




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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of January 25 - 31

  1. Ingrown Toenails
  2. Skimping on Sleep Raises Heart Risk for Women



Premature Births on the Rise

By Janice Billingsley
HealthScoutNews Reporter


Thursday, January 30, 2003

THURSDAY, Jan. 30 (HealthScoutNews) -- Too many babies are being born too soon, say doctors and health officials who report a jump of 27 percent in premature births over the last 20 years.

"The problem is huge. One in eight babies is born prematurely, and these babies are at increased risk for neurological, hearing, behavioral and IQ problems," says Dr. Nancy S. Green, a New York City pediatrician and medical director of the March of Dimes. "But prematurity is not a high-priority health issue like other issues in maternal health."

The March of Dimes hopes to change that, today announcing a $75 million, five-year national program to increase awareness of premature births and decrease the number of babies born before 37 weeks of gestation.

The rate of premature births jumped from 9.4 percent of live births in 1981 to 11.9 percent in 2001, Green says, and the March of Dimes would like to see the rate lowered to no more than 10.1 percent of live births.

"This would mean 70,000 to 80,000 fewer preterm babies annually," she says.

Some of the increase in premature births can be blamed on an increase in known risk factors for premature births, including a rise in the number of older women giving birth and the explosion of obesity in the country, Green says.

Older women, for instance, are more likely to have twins, half of whom are born prematurely, Green says, "and reproductive technology has also contributed to the births of more twins and triplets. Almost 90 percent of triplets are born prematurely."

However, about half of premature births have no known cause, and Green says further research is needed to understand those causes.

The public is largely misinformed about what causes premature delivery, two March of Dimes surveys found. One survey of 600 pregnant women and a second of 2,000 men and women found that two-thirds of both groups felt that premature births were due to a mother not taking care of herself -- smoking, abusing drugs or not getting prenatal care.

That's because doctors thought so, too, says Dr. Ian Holzman, chief of newborn medicine at New York City's Mount Sinai School of Medicine.

"It has been medicine's perception that if we can just get everybody into prenatal care, we'll stamp out prematurity, but it isn't that simple," he says. "Premature deliveries continue to be a major health issue, and what is disturbing is that the rates haven't come down even though other areas of health care have improved. This campaign is important."

The results of the two March of Dimes surveys appear, respectively, in the January Contemporary OB/GYN and the February American Journal of Preventive Medicine.

The March of Dimes campaign, Green says, will also work to alert parents to how seriously premature births can affect children's long-term development. Only one-third of the respondents of both surveys reported that prematurity was a very serious problem, and many are unaware the condition can affect a child's health when they are older.

"Among babies who are premature and have some early breathing problems, there is a definite increase in the amount of asthma and more severe problems with colds," Holzman says.

Premature births are births that take place before 37 weeks, or about nine months, of gestation. Most premature births take place between 32 and 37 weeks, but about 2 percent of premature births take place between 28 and 32 weeks, at six-and-a-half months, Green says.

While the health risks of the early births are considerable, including those of infection from being hospitalized, being able to prolong gestation for even a week during this time can considerably improve odds for the baby, Green says.

"Once labor starts it can be slowed, stopped or, more often, delayed if a woman gets medication, and a few days can make a big difference in the outcome for the baby," she says.

More information

A story about how one child has coped with a premature birth can be found at the March of Dimes. For some of the risks of preterm delivery go to the National Institutes of Health.


Sugar risk: It can make you hungry

From Herald Staff and Wire Reports
The Miami Herald
Thursday, January 30, 2003

Just in time for the crunch -- and munch -- of Girl Scout cookie sales, a new study is linking sugar consumption with how much Americans eat.

Pause a minute before you gobble up that Thin Mint or chocolate smothered All About. You'll eat one, but you won't stop there. Before you know it, maybe the entire pack has disappeared into your mouth.

Well, researchers say there's a good reason for that -- and we're not just talking about a lack of willpower. We're talking about the paradoxical nature of sugar -- and of that whole delicious family of simple and readily digested carbohydrates that make up a hefty proportion of American diets.

You eat them; they make you hungry. Hungrier, some scientists contend, than you were before you wolfed down those Thin Mints. Or that candy bar. Or those crackers made of refined white flour. Or that 16-ounce bottle of soda. Or those slices of white bread. Or potatoes. Yes, we're even talking baked russet potatoes here.

So what do you do? You reach for more, of course.

These are known as high-glycemic foods. When eaten without much else, they tend to cause spikes in our blood sugar. And that, some scientists say, triggers a chain of events that cause us to cycle between intense hunger and trips to the snack machine.

Americans are chowing down on larger and larger amounts of high-glycemic foods, not just around Girl Scout cookie sale times, but throughout the year.

A New York Times best seller, Sugar Busters! (Ballentine Books, $24.95), and the recent release of the latest edition of The New Glucose Revolution (Marlowe, $15.95) are among several books promoting diets with low glycemic levels -- although nutritionists have said not enough studies have been done to prove the diets' validity.

David Ludwig, an assistant professor of pediatrics at the Harvard Medical School and director of the obesity program at Boston Children's Hospital, has been assessing the impact of high-glycemic foods on hunger and eating patterns. A couple of years ago, he recruited 12 obese teenage boys and divided them into three groups. He fed them breakfast and lunch.

One group he fed low-glycemic meals. Their breakfast , was a vegetable omelet and some fruit. Another group had meals with moderate glycemic levels. Their breakfast was centered on a bowl of steel-cut oats. The last group was fed high-glycemic meals, mainly instant oatmeal.

At each meal, the caloric content was identical among the three groups.

Then, for five hours after lunch, Ludwig and his team monitored the subjects' blood sugar and their insulin and glucagon, hormones that control blood-sugar levels. They also tracked the boys' reports of hunger and the food they ate.

Unequal Calories

The boys who ate the moderately glycemic meals ate 53 percent more calories than the boys on the low-glycemic meals. The boys on the high-glycemic regimen ate 81 percent more calories than the low-glycemic meal group.

Ludwig's conclusion: All calories are not created equal.

''We think foods that rapidly raise blood sugar lead to a sequence of metabolic events that cause blood sugar to fall below fasting levels a few hours later, and that can trigger excessive hunger and overeating in susceptible people,'' he said.

Ludwig's study isn't the first to demonstrate that high-glycemic foods do not satisfy for long. Of 16 other studies asking a similar question, Ludwig found that 15 concluded that high-glycemic foods cause people to feel hungry sooner and/or to eat more soon afterward.

But a University of Miami nutritionist cautioned that studies have not shown a conclusive link between weight loss and low glycemic diets.

''There are many factors that can affect how a food is absorbed,'' said Gwen Enfield, who is also a certified diabetes educator. She said a great deal depends on portion size. If you eat large portions of foods with low glycemic index, the net result for weight loss may be the same, she noted.

''For weight loss, there have been contradictory studies and there haven't been long-term prospective studies done,'' Enfield said.

She said there are benefits to the emphasis on glycemic levels: ``As a nutritionist, when you have people starting to pay attention to what they're eating, it's a good thing.''

Eating Patterns

Robert Murray, who directs the Center for Nutrition and Wellness at the Children's Hospital in Columbus, Ohio, has investigated the effect of glycemic levels on hunger and eating patterns.

''I think Americans have been shown to eat way, way more sugar than they should be taking in,'' he said. Teenage boys, for example, on average derive 9 percent of their daily calories from soda, he said. For girls the figure is 8 percent.

``I think it does fuel this cycle of hunger, carbohydrate and hunger again two hours later. We do that rather than eat solid meals that keep us for hours. Obesity has to do with a sense of satiety. I think simple sugars are a big driver for a sense of hunger within two hours.''

There's little doubt that Americans are eating increasing amounts of sugar and the whole gamut of high-glycemic foods. The U.S. Department of Agriculture reported in 1998 that Americans on average were consuming about 20 teaspoons of added sweeteners daily, at least 50 percent more than they consumed two decades earlier. Added sugar doesn't occur naturally, as it does in fruits and milk.

It's estimated that added sweeteners account for 16 percent of the average American's caloric intake and 20 percent of the average teen's intake.

Frank Hu, an associate professor of nutrition and epidemiology at the Harvard School of Public Health, evaluated the data from the Nurses Health Study and concluded that their consumption of high-glycemic foods has increased.

The glycemic index is still the subject of much debate among dietitians and nutrition and medical researchers. It apparently is more widely embraced in Canada and Australia than it is here.

One Yardstick

It's important to bear in mind that the glycemic index is just one yardstick to use in evaluating a food, said Wahida Karmally, the director of nutrition at Columbia University's Irving Center for Clinical Research. It would be a mistake to rely on it exclusively.

White and whole-wheat bread differ by only a couple of points, for example. But whole-wheat flour provides fiber and a wide range of nutrients not found in white flour, making the glycemic rating ''of no value there,'' Karmally said.

It's fine in theory to measure a single food's ability to affect blood sugar, said Susan Bowerman, assistant director of the UCLA Center for Human Nutrition. ``But people don't eat foods in isolation.''

Or not routinely, anyway. And when a highly glycemic slice of white bread is smeared with peanut butter, she said, it is broken down and released into the bloodstream much more slowly than it would be on its own.

Herald medical writer Connie Prater contributed to this report.


Preventing Suicide

Thursday, January 30, 2003

THURSDAY, Jan. 30 (HealthScoutNews) -- The drug Clozaril reduces the risk of recurrent suicidal behavior and suicide attempts in people with schizophrenia or schizoaffective disorder by 26 percent.

So says a study in a recent issue of the Archives of General Psychiatry.

The two-year study included 1,000 people at 60 health centers in the Middle East, Europe and the Americas. It's the first study to prospectively demonstrate the efficacy of a medication to affect suicidal behavior in any patient group.

In December 2002, the U.S. Food and Drug Administration (news - web sites) approved Clozaril for treatment of recurrent suicidal behavior in people with schizophrenia or schizoaffective disorder.

Between 30 percent and 40 percent of people with schizophrenia and schizoaffective disorder will attempt suicide during their lifetime, and 10 percent of them will die from suicide.

Suicide risk is especially high in males during their first decade of illness. That risk can be increased by substance abuse, which is present in about half the people with schizophrenia in the United States.

More information

Here's where you can learn more about schizophrenia.


Caution With Crutches


Thursday, January 30, 2003

(HealthScoutNews) -- If a broken leg or some other injury has you hobbling around on crutches, other parts of your body may be taking more strain and need added attention.

According to the Sports Medicine Institute in Buffalo, NY, while using crutches you should:

  • Use body lotion or talcum powder to prevent chafing, since the crutches may rub against the skin between your arm and chest.
  • Put extra padding on the crutch grips to prevent your hands from growing tired or sore.
  • Avoid leaning on the crutches. This puts pressure on your armpits. If you feel pressure and you're using the crutches in the correct manner, they are too long and need to be shortened.


Fast food 'as addictive as heroin'


Thursday, January 30, 2003 

Hamburgers and French fries could be as addictive as heroin, scientists have claimed.

Researchers in the United States have found evidence to suggest people can become overly dependent on the sugar and fat in fast food.

The controversial findings add weight to claims that over-eating is simply down to a lack of self-control.

“Some animals - and by extension some people - can become overly dependent on sweet food”

Dr John Hoebel, Princeton University

It may also explain soaring rates of obesity in the western world.

Dr John Hoebel and colleagues at Princeton University in New Jersey based their theory on a study of rats.

'Cold turkey'

They found that rats fed a diet containing 25% sugar are thrown into a state of anxiety when the sugar is removed.

Their symptoms included chattering teeth and the shakes - similar to those seen in people withdrawing from nicotine or morphine, according to researchers.

Dr Hoebel said he believed high-fat foods stimulate opioids or 'pleasure chemicals' in the brain.

"The implication is that some animals - and by extension some people - can become overly dependent on sweet food," he said.

Further studies published in New Scientist magazine back up this theory.

Ann Kelley, a neuroscientist at the University of Wisconsin Medical School, the behaviour of rats after the were given sweet, salty and fatty foods.

She found a link between the brain's pleasure chemicals and a craving for this type of food.

She stimulated the rats' brains with a synthetic version of the natural opioid enkephalin. This caused rats to eat up to six times their normal intake of fat.

In addition, Dr Kelley identified long-lasting changes in rats' brain chemistry - similar to those caused by extended use of morphine or heroin.

Dr Kelley said: "This says that mere exposure to pleasurable tasty foods is enough to change gene expression and that suggests that you could be addicted to food."

However, other experts expressed doubts over whether people can become addicted to food.

Michael Jacobson, executive director of the Center for Science in the Public Interest, a nutrition lobby group in Washington DC, said there was a lack of evidence.

"I think the burden is on advocates of the addiction argument to provide evidence of addiction," he said.

Dr Jeane Randolph, from the University of Toronto, dismissed the theory. She said fast food causes blood sugar to peak and then plunge, creating a natural desire for another snack.

"It's a set-up for a late-afternoon binge rather than addiction," she said.


Ingrown Toenails

HealthScoutNews Reporter
Thursday, January 30, 2003

 (HealthScoutNews) -- Ingrown toenails -- when a section of the nail curves into the flesh of the toe -- are often caused by poorly fitting shoes and improperly trimmed toenails.

The McKinley Health Center at the University of Illinois suggests you prevent ingrown toenails by:

  • Cutting your toenails straight across without tapering the corners.
  • Not wearing shoes and socks that are too tight.

If you develop an ingrown toenail, prevent it from becoming infected by keeping your feet clean.


Folic Acid Is Fine

By Serena Gordon
HealthScoutNews Reporter
Thursday, January 30, 2003

THURSDAY, Jan. 30 (HealthScoutNews) -- Folic acid has been widely touted for its ability to reduce birth defects, such as spina bifida, in growing fetuses when taken before conception and during pregnancy.

However, several small studies have suggested the nutrient might increase the incidence of twins.

Not so, say researchers from the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC) and the Peking University Health Sciences Center in China. Their study appears in this week's issue of The Lancet.

"This is good news for women around the world," says study co-author Dr. Robert Berry, a medical epidemiologist with the CDC. "The consumption of folic acid does not increase a woman's chance of having twins."

Since public health officials began recommending consumption of folic acid before pregnancy in 1992, the rate of spina bifida has dropped 32 percent, according to the CDC.

However, because multiple pregnancies are often more complicated than single pregnancies, health-care professionals were concerned that recommending folic acid to reduce spina bifida and other neural tube defects could inadvertently increase the rate of twins. Twins and other multiple pregnancies are more likely to be born prematurely and have growth problems, according to the American College of Obstetricians and Gynecologists.

Berry and his colleagues reexamined data that had been collected for a study on the effectiveness of folic acid. The study included almost 250,000 young Chinese women with an average age of 24. About half of the women took 400 micrograms of folic acid daily before and during their pregnancies. The women didn't take any other vitamin supplements.

Nearly 1,500 women from the whole group had twins. The rate of multiple births was 0.59 percent for women who took folic acid and 0.65 percent for women who didn't. That difference is not statistically significant, according to the study.

Berry says researchers aren't sure why past studies linked folic acid to an increase in the rate of twins, but he suspects it may have something to do with the participants in the other studies. For example, one of the studies was done on older women, who naturally have a higher rate of multiple pregnancies.

Dr. Elizabeth Ginsburg, a reproductive endocrinologist at Exeter Hospital in New Hampshire, agrees that some other factor, such as maternal age, was probably the reason for the higher twin rates seen in previous studies.

One weakness of the new study, she says, is the researchers didn't ask the women about their diets. She says it would have been useful to know how much folic acid the women were getting in the foods they ate.

More information

To learn more about the benefits of folic acid, visit the March of Dimes. For more information on multiple pregnancy, read this from the American College of Obstetricians and Gynecologists.


Babies' Mental Delay Tied to Moms' Vegan Diet 

By Alison McCook

Reuters Health
Thursday, January 30, 2003

NEW YORK (Reuters Health) - The breast-fed infants of two mothers who did not eat any animal products, including milk and eggs, developed brain abnormalities as a result of a vitamin-B12 deficiency, the US Centers for Disease Control and Prevention (news - web sites) (CDC) reported Thursday.

The primary sources of vitamin B12, which is essential for brain development, are animal products like meat, dairy products and eggs. Since the mothers ate little or no animal products, too little vitamin B12 was transmitted to their children through breast milk, according to the CDC's Dr. Maria Elena Jefferds.

Jefferds added that these cases serve as a reminder to parents and pediatricians to ensure that both pregnant women and mothers who breast-feed their infants consume enough B12, either through diet or B12-containing supplements.

"You have to make sure you're getting it," she said, in reference to vitamin B12.

And don't abandon breast-feeding altogether, Jefferds cautioned. Breast-feeding has many advantages, and mothers who choose to not eat animal products should still continue to breast-feed their infants.

"Vegetarians should absolutely breast-feed, there's no question about that," she said.

In the January 31st issue of the Morbidity and Mortality Weekly Report, Jefferds and her colleagues describe the cases of two babies who showed signs of brain abnormalities as a result of a deficiency in vitamin B12.

In one case, doctors examined and diagnosed the deficiency in a 15-month-old child with slow growth and mental development. Her mother said she had avoided consuming all animal products for many years, and had breast-fed the baby for 8 months after birth.

After receiving supplements of vitamin B12, the child began to improve, but was still below her age group in speech and language at 32 months of age.

Jefferds explained in an interview that many children fully recover from vitamin-B12 deficiencies but that, in some cases, a prolonged period of low consumption of vitamin B12 can cause irreversible damage.

"I think it really depends on how severe the deficiency was, and how long it was taking place for," she said.

She added that while both children described in the report showed lingering symptoms of low vitamin B12, over time, those impairments may disappear.

The initial symptoms of low vitamin B12 in infants are often vague and not obvious, Jefferds noted. She recommended that doctors keep the possibility of a deficiency "on their radar screen," and ask mothers if they eat animal products or take supplements that contain enough vitamin B12, also known as cobalamin.

Vegans eat only plant-based foods, using grains, legumes, fruits and vegetables to fill all their dietary needs. Vegetarians, on the other hand, typically avoid meat, but may eat some animal products, such as milk, eggs and possibly fish.

Source: Morbidity and Mortality Weekly Report 2003;52:61-64.


Study Ties Birth Size to Early Breast Cancer

By Ed Edelson
HealthScoutNews Reporter

Thursday, January 30, 2003

THURSDAY, Jan. 30 (HealthScoutNews) -- The length and head size of a baby girl when she is born can affect the risk that she will have breast cancer (news - web sites) decades later, a European study indicates.

Looking through the many years of data about the more than 5,000 women born at the Uppsala Academic Hospital in Sweden between 1915 and 1929, British researchers say breast cancer was at least three times more likely to occur in longer babies with bigger heads, especially if their time in the womb was short.

Girl babies weighing more than 4,000 grams (8.8 pounds) were 3.5 times more likely to have breast cancer than those weighing less than 3,000 grams at birth, says a report in this week's issue of the British Medical Journal by researchers at the London School of Hygiene and Tropical Medicine. However, the increased risk was concentrated in the longest babies with the largest heads, the report says.

And gestation time also predicted risk, the researchers say. Babies born after less than 39 weeks in the womb were three times more likely to have breast cancer in their adult years as babies of the same size who spent more than 41 weeks in the womb. "Fetal growth rate, rather than size at birth alone, may be the etiological (causal) factor," they write.

The increased risk was found only in women who had breast cancer before menopause, they say.

How could size and length of pregnancy time affect breast cancer risk after may years? One theory is based on the knowledge that the mammary gland starts to develop before birth, they say. Exposure to high concentrations of growth factor might result in development of cells that are likely to turn cancerous over the years, they say. And the fast growth of babies who are ready for the outside world after a relatively short pregnancy might also affect risk, they say.

Whatever the reason, "if the findings are real, large birth size would be responsible for only a small proportion of the total number of cases of breast cancer in any population, as the incidence in premenopausal years is low," they say. And the breast cancer risk is balanced by the known fact that heavier babies are less likely to develop heart disease as adults, they say.

The study is interesting but necessarily flawed, says Dr. Julia A. Smith, a clinical assistant professor of medicine at New York University Medical Center.

"This is not the first time this has been postulated and looked at, but it is the first time researchers have looked at this size population," she says.

And while Sweden has the best population records of any country, the database did not include many of the important risk factors for breast cancer, such as family history and genetics, Smith says.

While it is true that the mammary gland does begin to develop before birth, it is unclear what role the mother's circulating estrogens play in that development, and the study does not address that point, she says.

More information

You can get comprehensive information about breast cancer from the National Cancer Institute. Meanwhile, the March of Dimes has tips on making your pregnancy a successful one.


Federal Advisers Mull Testosterone for Aging Men 

By Alicia Ault

Reuters Health

Thursday, January 30, 2003

WASHINGTON (Reuters Health) - Federal advisers began the first of several meetings Thursday that will result in recommendations later this year on how to best determine if testosterone replacement therapy is good or bad for aging men.

An unknown, but significant number of older men have begun using patches, gels or other forms of testosterone in the hopes of reversing the aging process and a flagging sex drive, but there is no scientific evidence that hormone supplements can help.

And, there may even be some dangerous side effects, including an increased risk of prostate cancer (news - web sites).

"The chasms of our ignorance here are vast," Marc Blackman, an endocrinologist with the National Institutes of Health (news - web sites), told a 17-member Institute of Medicine (news - web sites) (IOM) advisory committee.

The panel has been asked to make recommendations on how to answer questions on the pros and cons of testosterone replacement, and its mechanism of action.

They are also weighing how to properly inform potential study participants when the benefits and the risks of therapy are very unclear.

Over the last few decades, studies on relatively young men with testosterone deficiencies have shown that replacement can counter increased body fat and cholesterol levels, decreased skeletal strength and decline in immune function associated with lower testosterone levels, said Blackman.

Four to five million relatively young American men have below-normal testosterone levels, and 5% are receiving replacement therapy, he said.

The few studies in older men with naturally declining testosterone levels has shown that replacement therapy decreases fat and increases lean muscle mass. But only one, a small 15-person study in very frail elderly men, has shown any improvement in muscle strength or function. So it is unclear if increased muscle mass leads to better physical functioning, Blackman said.

It's also not known if testosterone replacement reduces the risk of disability, falls, or fractures, or otherwise improves health outcomes. And it's unclear if supplementation would have similar effects in healthy older men and physically impaired older men.

A big concern is whether testosterone supplementation will increase the risk of prostate cancer. Increased levels of male hormones can enlarge the gland, and most researchers believe that increased prostate volume eventually leads to cancer.

Scientists at Baylor College of Medicine have drawn up plans to carry out a large, long-term study of testosterone replacement therapy in older men. The trial has been put on hold while the IOM panel considers its merits.

Lead investigator Glenn Cunningham said the study aims to enroll 6,000 men over age 65. They would be in the study for four years, and then followed for five years more. The main goal is to see if testosterone replacement reduces fractures, since men, just like women, are at risk for osteoporosis as they age, primarily due to declining hormone levels.

Researchers will also measure testosterone replacement's ability to reduce heart attacks and strokes, and to improve mood, energy levels, cognition and sexual function.

Finally, they will assess whether replacement therapy increases the incidence of prostate cancer or leads to more procedures to reduce prostate size.

IOM committee member Paul Lombardo of the University of Virginia asked why any man would participate in the study, given the potential risks and sketchy benefits, and the easy availability of the drug outside of study.

"That's a good question," said Cunningham, who added that he thought men would take part to get osteoporosis treatment and prostate screening and to contribute to medical science.

National Institute on Aging chief Richard Hodes noted that women who took part in the Women's Health Initiative study of estrogen and progestin replacement therapy had to make the same kinds of calculations and most decided to participate.

That study was halted earlier this year when it was found that the risks of the treatment outweighed the benefits.


Preventing Common Eye Infection Proves Costly

By Nancy Deutsch
HealthScoutNews Reporter


Thursday, January 30, 2003

TUESDAY, Jan. 28 (HealthScoutNews) -- The cost of treatment to prevent the flare-up of a common eye condition -- a seemingly smart medical move -- actually comes with a hefty price tag, a new study says.

Researchers in Texas looked at the cost of preventing flare-ups of Herpes Simplex Virus (HSV) Eye Disease, a condition that affects more than 400,000 Americans. While treating the virus once it occurs is approximately $290, averting a flare-up by treating the patient with the drug acyclovir digs much deeper into the pocketbook.

One year of treatment with the antiviral costs $8,532, the researchers report in the January issue of the Archives of Ophthalmology.

"The drug was effective, but not cost-effective," says study co-author Charles Begley, a professor in the School of Public Health at the University of Texas Health Science Center.

Ocular HSV is one of the leading causes of blindness, and mainly affects the cornea, which is the clear layer of the eye. While researchers aren't sure how the virus is transmitted, most people have the virus in a latent form until something triggers an outbreak, Begley says. The affected eye becomes red, and blurred vision may occur. There are estimated to be 59,000 new and recurrent episodes of ocular HSV each year in the United States.

The researchers analyzed data of a clinical trial of 703 people with ocular HSV. Half of participants were treated with a placebo and half were given twice daily doses of 400 milligrams of oral acyclovir for a year. Using this data, the scientists used an economic "decision-tree" model to determine the costs of treating people to prevent flare-ups.

"It's a common analysis that economists use that allows specific consequences of decisions," Begley says.

The researchers included the average price around the country to treat a flare-up, including medication and physician services. They factored in savings from fewer infections and surgeries that were avoided.

They also considered that taking acyclovir daily could not guarantee a person would not experience a flare-up. Of the people on acyclovir in the trial, 19 percent had a flare-up in the year of follow-up. In the placebo group, 32 percent did.

Finally, the researchers looked at whether the treatment would be cost-effective for a specific group of people, those with stromal keratitis, a type of ocular HSV that often leads to more serious vision problems, including blindness. "The cost of drugs was (still) too high," Begley says.

Begley says he's fairly sure that most individuals and insurers would balk at paying more than $8,000 annually to avert recurring problems. "We don't know, but we think it's just common sense. Would you be willing to pay $8,500 for a 50 percent reduction for the average person?" he asks.

There are limited health-care dollars and many places to spend them, notes Dr. Mark Fendrick, an associate professor at the University of Michigan's School of Public Health.

"There's tremendous growth to show whether medical interventions provide benefits or not," he says. "We have to make decisions as to what to invest our resources in. We can't give everything to everybody."

More people might think the price worth it if the researchers were "trying to prevent a rare, rapidly progressing mortal disease," Fendrick adds.

If drugs became more efficient at treating or curing ocular HSV, the cost might not seem so high, he says. On the other hand, if it were determined that wearing sunglasses could reduce the risk of recurrence, then the cost to use acyclovir would seem even higher than it does, Fendrick says.

At this time, the study "shows us that it seems somewhat expensive to prevent this disease," he says.

Fendrick says it's important to do these types of studies to show what is cost-effective, and to help officials decide where to spend their health-care dollars. However, "I'm glad I'm not the one making those decisions," he says.

More information

To read the new study, visit this American Medical Association site. For more on ocular HSV, visit Emory University.


Study Questions Acetaminophen for Knee Arthritis 

By Merritt McKinney

Reuters Health

Thursday, January 30, 2003

NEW YORK (Reuters Health) - A small study suggests it may be time to reconsider guidelines that recommend acetaminophen as the first pain reliever of choice for knee arthritis.

Acetaminophen is the active ingredient in Tylenol and some other over-the-counter pain and fever relievers. The company that makes Tylenol says the new findings are in conflict with existing evidence that acetaminophen does fight knee arthritis.

The study of 82 people with osteoarthritis of the knee found that an anti-inflammatory medication called diclofenac sodium, but not acetaminophen, improved symptoms.

In fact, people taking acetaminophen experienced no more improvement in their aching knees than people who were taking a placebo, according to findings published in the January 27th issue of the Archives of Internal Medicine (news - web sites).

"Reliance by physicians or patients on acetaminophen in the treatment of knee osteoarthritis, and probably other types of osteoarthritis, appears to be doing patients a disservice, as other, significantly more effective drugs are available," Dr. John P. Case, the study's lead author, told Reuters Health.

"If clinicians and investigators find the results convincing, I expect that the recommendation to use acetaminophen as first-line therapy in osteoarthritis will change," said Case, who is at Rush-Presbyterian-St. Luke's Medical Center and Cook County Hospital in Chicago, Illinois.

According to the Chicago researcher, physicians may instead start opting for medications called nonsteroidal anti-inflammatory drugs, or NSAIDs. This class of drugs includes over-the-counter pain relievers such as ibuprofen, aspirin and naproxen, as well as the newer prescription drugs celecoxib (Celebrex) and rofecoxib (Vioxx).

"At the very least," Case said, "it will no longer be possible to regard acetaminophen as an effective pain reliever in osteoarthritis of the knee."

But Tylenol maker McNeil Consumer and Specialty Pharmaceuticals disputed the idea that acetaminophen should no longer be the first choice for treating arthritis.

The study "conflicts with a large body of well-controlled clinical trials establishing the efficacy of acetaminophen in treating osteoarthritis of the knee," the company said in a statement.

The company also asserted that guidelines from the American College of Rheumatology, which were updated in 2000, recommend a daily dose of up to 4,000 milligrams of acetaminophen as the preferred initial therapy for people with osteoarthritis of the knee.

"Used as directed, acetaminophen is a safe and effective treatment for osteoarthritis pain," the statement concluded.

Diclofenac sodium, the comparison drug used in the study, is a type of NSAID. Although acetaminophen relieves pain and fever, unlike NSAIDs, it does not have a strong anti-inflammatory effect.

Largely based on a study in the early 1990s in which acetaminophen seemed to provide the same arthritis relief as the NSAID ibuprofen did, acetaminophen is widely considered the best first-line treatment for arthritis of the knee and hip.

But although acetaminophen is often the first choice of physicians, research suggests that people with osteoarthritis prefer NSAIDs, Case and his colleagues note in their report.

An advantage of acetaminophen is that the pain reliever, because it attacks pain in a different way than many NSAIDs do, is less likely to irritate the stomach.

But since newer NSAIDs may cause less gastrointestinal irritation than older drugs, the stomach-sparing effect of acetaminophen may not be as important, according to Case's team.

What's more, experts believe inflammation, which acetaminophen does not attack, plays an important role in osteoarthritis.

In their study, Case and his colleagues randomly assigned 82 people, ages 40 to 75, to take acetaminophen, diclofenac or a placebo each day for 12 weeks.

Only people taking diclofenac experienced any significant improvement in their arthritis symptoms, according to the researchers.

Changes in symptoms in the acetaminophen group were small and "indistinguishable" from changes in the placebo group, they report.

Source: Archives of Internal Medicine 2003;163:169-178.


A Better Way To Measure Heart Damage


Thursday, January 30, 2003

THURSDAY, Jan. 30 (HealthScoutNews) -- Cardiac magnetic resonance imaging (MRI) technology can find small areas of heart muscle death that can't be detected by a commonly used nuclear imaging technique.

An American study in the Feb. 1 issue of The Lancet says the ability to detect those small areas of muscle cell death, known as infarcts, may help prevent more severe heart problems down the road.

The study was done by researchers at Duke University Medical Center and Northwestern University Medical School. It included 91 people with known or suspected coronary artery disease.

They were examined using cardiac MRI and the traditional nuclear imaging technique called single photon emission computed tomography (SPECT).

The study found that SPECT was able to detect only 53 percent of the microinfarcts identified by cardiac MRI. It also found that 13 percent of the people with microinfarcts were shown to have none when SPECT alone was used to examine them.

More information

Here's where you can learn more about coronary disease.


Molecules Show Early Promise for Brain Diseases 

By Merritt McKinney


Thursday, January 30, 2003

NEW YORK (Reuters Health) - Molecules that keep proteins from "misfolding" represent a promising approach for preventing a variety of diseases that involve abnormal protein formation, including Alzheimer's disease (news - web sites), Parkinson's disease (news - web sites) and the human form of "mad cow" disease, new research suggests.

For a protein to perform its normal function, chains of amino acids must be looped around each other, or folded, in a particular way.

But in some diseases, including Alzheimer's, this protein folding goes awry. This can lead to the build-up of abnormal proteins. In Alzheimer's, for instance, abnormal proteins cluster to form brain deposits called amyloid plaques, which are a hallmark of the disease.

Dr. Jeffery W. Kelly, who led the new research, told Reuters Health that recent research in diseases involving protein misfolding reveals that the early stages of misfolding are the most damaging to the brain.

So blocking protein misfolding in its earliest stages is "highly desirable," according to Kelly, of the Scripps Research Institute in La Jolla, California.

That is exactly what Kelly's team has done, at least in the lab. In experimental models of the inherited form of a disease called amyloidosis, which involves misfolding of a liver protein called transthyretin, several small molecules blocked the formation of amyloids.

The molecules prevent misfolding in the same manner as a particular transthyretin mutation that is already known to prevent hereditary amyloidosis in humans.

So, Kelly said, "there is reason to believe that the small molecules will work" to prevent disease, too.

The findings are published in the January 31st issue of the journal Science.

"The next step," Kelly said, "is to test some of these compounds in humans with disease and others in animal models of these diseases."

Kelly and his colleagues have already completed two human trials involving small molecules, and they have started a third study, but the results have not been announced yet.

Although Kelly said that the results of the current study are "promising," he cautioned that future studies will be needed before these molecules can be made into drugs.

Source: Science 2003;299:713-716.


Campaign Devotes Millions to Fight Premature Birth 

By Todd Zwillich

Reuters Health

Thursday, January 30, 2003

WASHINGTON (Reuters Health) - The March of Dimes announced Thursday that it will spend $75 million over the next five years in an attempt to garner more research into premature birth and to educate the public.

Experts from the group, which works to promote healthy pregnancy and infancy, said that premature births have now reached near-epidemic proportions in the US. More than 475,000 infants were born prematurely in 2001, up 27% from two decades before.

Nearly 12% of all births are now premature, occurring before 37 weeks of pregnancy. Premature births are also the leading cause of mortality among US infants, causing more than 4,000 deaths each year, according to figures from the National Center for Health Statistics.

Experts blame some of the rise in premature birth rates on the growing use of reproductive technologies such as ovulation-stimulating drugs. The practice has lead to an increase in multiple births, which is a major risk factor for a premature delivery.

"There's been an epidemic of multi-fetal pregnancies," said Dr. Charles J. Lockwood, chair of obstetrics and gynecology at the Yale University School of Medicine.

Infections during pregnancy are also a major cause of premature delivery. Smoking, obesity and stress are also thought to be risk factors, though scientists still understand little about why some women with risk factors deliver prematurely and others do not.

In all, half of all premature births occur with no known cause, Lockwood said.

"A woman can do everything right and still have a premature baby," said Dr. Louis Wade Sullivan, the honorary chair of the March of Dimes Campaign and a former Secretary of Health and Human Services (news - web sites) under President George H.W. Bush.

"My doctors couldn't explain why it happened to me," said Susan Henderson, an Oklahoma City woman whose daughter Emma was born weighing only 1 pound.

March of Dimes officials said that they will spend their money lobbying Congress for more federal research dollars targeted at finding causes of premature birth and at prevention strategies.

The organization wants to reduce the number of premature births by 15% by 2007, said March of Dimes president Dr. Jennifer Howse.

The group also wants to convince Congress to improve insurance coverage for women of child-bearing age.

Experts were critical of assisted reproduction techniques that result in too many embryos being implanted in a woman's uterus. The techniques maximize the chances of pregnancy, but have helped lead to a rise in multiple births, according to Dr. Ralph Hale, executive director of the American College of Obstetricians and Gynecology.

Hale said an interview that better insurance coverage would help women undergoing assisted reproduction avoid fertility clinics that, in the hopes of boosting the odds of pregnancy, do not limit the number of embryos they implant.

"It means they would not have to try to succeed (at getting pregnant) all in one go, because it is so expensive" to pay for without health insurance, he said.


Magnet Therapy May Quiet 'Voices' in Schizophrenia 

By Alison McCook

Reuters Health

Thursday, January 30, 2003

NEW YORK (Reuters Health) - Schizophrenics who hear imaginary voices that are not quieted by medication could find some relief in an experimental procedure that directs magnetic waves toward certain brain regions, a small study suggests.

Among 12 patients who received up to 16 minutes of magnetic stimulation for 9 days, nine said their hallucinations had improved after treatment. People reported that they were hearing voices less often and were less disturbed by such hallucinations when they did appear.

In contrast, similar improvements were reported by only two of the 12 participants who had "sham" treatment that involved a similar procedure, but not magnetic stimulation.

"Patients find (magnetic therapy) to be a significant relief from these often debilitating symptoms," study author Dr. Ralph E. Hoffman of Yale University in New Haven, Connecticut, told Reuters Health.

Hoffman cautioned, however, that magnetic stimulation remains experimental, and so is not yet available to most patients in the US.

"This is still at the level of research, as opposed to something patients can call up and get," he said.

Hoffman and his colleagues report the findings in the January issue of the Archives of General Psychiatry.

Up to 70% of people with schizophrenia say they have auditory hallucinations, which generally involve hearing imaginary "voices." These hallucinations are often disturbing and, for some, can contribute to violent or suicidal behavior.

While many are helped with medication, around one quarter of schizophrenics who hear auditory hallucinations only partially improve with drugs, according to Hoffman and his colleagues.

All of the patients in their study were having auditory hallucinations up to five times each day before magnetic therapy, despite having tried numerous medications.

The researchers targeted magnetic therapy to brain regions that previous studies have indicated play a role in auditory hallucinations.

In earlier research, Hoffman and his colleagues had some success in quieting auditory hallucinations in schizophrenics who received a shorter course of magnetic therapy, lasting only 4 days.

However, all the patients who improved after 4 days of treatment had a resurgence of symptoms anywhere from 4 days to 2 months after treatment.

In the current study, more than half of patients maintained their improvements for at least 15 weeks.

A comparison of the findings from both studies suggests that the longer the treatment, the better for patients, Hoffman said in an interview. However, in both groups, it may be necessary to repeat the procedure, he noted.

Hoffman said that magnetic therapy may work by calming the nerves that, under other circumstances, would become excited and lead people to hallucinate. Magnetic therapy "is actually reducing excitability of neurons that are involved in the production of these hallucinations," he explained.

Patients did not report many side effects from the treatment, Hoffman's team notes in the report. Some experienced headaches that disappeared on their own or were easy to treat, and patients reported feeling lightheaded for a few minutes after the procedure.

Importantly, none of the patients seemed to experience any changes in mental functioning as a result of the treatment, Hoffman said.

The researcher said that he and his colleagues continue to investigate magnetic therapy, testing the procedure in a larger group of patients and trying to discover which brain regions, when targeted by magnetic therapy, result in the biggest improvements in auditory hallucinations.

Source: Archives of General Psychiatry 2003;60:49-56.


Ultrasound Cancer Treatment Kills Tumors in Mice 


Thursday, January 30, 2003

LONDON (Reuters) - Scientists at a Northern Ireland biotech company have developed a new non-invasive technique that can destroy cancer cells in mice.

Instead of surgery, drugs or radiation treatment, researchers at Gendel used an electric field and ultrasound to kill cancerous cells in the laboratory, as well as in the tumors of 50 mice, a science magazine said Wednesday.

Although it is in early stages of development, the company believes the technique could one day be used to treat head and neck tumors and hopes to begin human trials in two years.

"The technique relies on the application of an electric field to a tumor to make it susceptible to a follow-up blast of ultrasound," according to New Scientist.

"The combination appears to cause tumor cells to self-destruct."

The new procedure is based on a drug delivery technique that Gendel hopes to test in human trials later this year. It involves transporting drugs to hard-to-reach areas of the body by using the patient's own red blood cells.

The blood cells are sensitized outside the body with the electric field, which makes them permeable, and then filled with a drug and put back into the patient.

Ultrasound is directed to the tumor site and the cells with the drug burst open, putting the drug exactly where it is needed.

Gendel scientists are still perfecting the double whammy cancer treatment and admitted they do not know why the cells rupture when hit by ultrasound.

The ultrasound fields used in the cancer treatment are stronger than those used to monitor the growth of babies in the womb and are similar to the strength applied to muscles in sports medicine.

But other cancer treatments that have worked in animals have not been successful in humans. Cancer experts said more information about the new technique is needed.


UK Warns of Ectopic Risk with 'Morning-After' Pill 

By Richard Woodman


Thursday, January 30, 2003

LONDON (Reuters Health) - Britain's Chief Medical Officer has warned that women who delay taking the so-called "morning-after" pill to prevent pregnancy could increase their chances of having an ectopic, or tubal, pregnancy.

In a letter to all doctors, Sir Liam Donaldson said 12 cases of ectopic pregnancy out of a total of 201 unintended pregnancies had been reported to the Committee on Safety of Medicines following failure of Schering's emergency contraceptive pill Levonelle (levonorgestrel 0.75mg).

Although widely known as the "morning-after" pill, the progestogen-only drug is actually licensed for use up to three days after unprotected sex. However, the letter makes clear that the longer women delay taking it, the less effective it becomes.

Whereas the pills prevented 95% of pregnancies when taken within the first 24 hours, this fell to 85% on the second day and as low as 58% on the third day.

The letter notes that pregnancies that occur in women taking progestogen-only pills are more likely to be ectopic--a potentially dangerous form of pregnancy in which the embryo implants in a fallopian tube rather than the womb. As the fetus grows, it can cause the tube to rupture, which can be potentially life-threatening if not treated.

The Committee on Safety of Medicines has now advised that women seek treatment as early as possible after unprotected sex and that doctors inform women that the treatment can fail.

"Women who do not experience a normal period after using Levonelle should be followed up so that pregnancy can be excluded.

"The possibility of an ectopic pregnancy should be considered, particularly in women with a previous ectopic pregnancy, fallopian tube surgery or pelvic inflammatory disease," the letter says.

A spokeswoman for Schering's UK arm said patient information leaflets already referred to the small risk of ectopic pregnancy, but the company was discussing changes with the Medicines Control Agency to make this even clearer.



Pink Eye 

Wednesday, January 28, 2003


(HealthScoutNews) -- Pink, watery and itchy eyes and crusty eyelids are common signs of conjunctivitis, also called pink eye. The condition is an inflammation of the eye's thin tissue and can be caused by allergies, preservatives in some contact lenses, chemical irritants or chlorine from swimming pools.

The University of Wisconsin Medical center recommends these tips if you have the condition:

  • Avoid rubbing your eyes.
  • Wash your hands often to prevent spreading the infection to your other eye.
  • Use a warm, wet washcloth to gently soak off any crusting.  


Newer Bypass Surgery Stacks Up Against Older Method

Reuters Health

Wednesday, January 28, 2003

NEW YORK (Reuters Health) - A type of bypass surgery that eliminates the need to stop a patient's heart from beating is comparable to traditional surgery for those with relatively mild heart disease, researchers reported Wednesday. What's more, the technique appears to be slightly cheaper.

After one year, patients who had so-called "off-pump" bypass surgery, during which only a portion of the heart is immobilized, had virtually the same rates of survival, stroke, heart attack or additional treatments as those who had standard bypass surgery.

During conventional bypass surgery, a person's heart is stopped and a heart-lung machine is used to circulate blood during the operation.

The current findings may not apply to people with more extensive heart disease, such as blockages in three or more places in heart arteries, according to the findings published in the January 30th issue of The New England Journal of Medicine (news - web sites). Many patients undergoing bypass surgery have blockages in three or more arteries and only 1% have a blockage in a single artery.

In the study, Dr. Hendrik M. Nathoe of University Medical Center Utrecht in The Netherlands and colleagues followed two groups of patients with blockages in one or two heart arteries.

In all, 139 patients underwent traditional, or "on-pump" surgery, while 142 had off pump surgery.

A year later, about 90% of patients in both groups were alive and had not had a stroke, heart attack or further artery-clearing procedure. Overall, the researchers estimate that on-pump surgery had direct medical costs that were $1,839 more than off-pump surgery ($14,908 vs. $13,069).

"The findings ... document a significant, 14% cost savings with off-pump as compared with on pump surgery, representing a potentially important societal benefit," writes Dr. Eric A. Rose of Columbia University College of Physicians and Surgeons in New York City in an accompanying editorial.

Overall, the findings show "the potential clinical value of the off-pump surgical approach in low-risk patients yet fail to establish its material superiority over conventional surgery," adds Rose.

The off-pump surgery was conducted during the study using a device invented at the University Medical Center Utrecht and some of the researchers are entitled to compensation from sales of the device.

Source: The New England Journal of Medicine 2003;348:379-380,394-402.


Bypass Surgery Can Bypass Heart-Lung Pump

By Amanda Gardner
HealthScoutNews Reporter


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- Coronary bypass surgery without a heart-lung machine is as successful as surgery with the machine, and it may be less expensive to boot.

That's what Dutch researchers claim in a report that appears in the Jan. 30 issue of the New England Journal of Medicine (news - web sites).

Coronary artery bypass graft surgery (CABG), performed when a person has a blocked artery, involves using a blood vessel from another part of the body to reroute blood around the blocked vessel.

Traditionally, CABG is performed on a stopped heart, while a heart-lung machine keeps the patient alive. "The advantages of using the machine are that the surgeon can operate in a clean, dry field with great precision and at a steady pace without feeling like he's got an ax above his head," explains Dr. Joseph Cunningham, chairman of surgery and director of cardiothoracic surgery at Maimonides Medical Center in Brooklyn, N.Y.

There are, however, some drawbacks to using a heart-lung machine. Some evidence shows the machine might cause inflammation of the lungs, heart, or other organs, Cunningham says. And other studies suggest the machine results in cognitive disorders years down the line.

Finally, some experts believe that patients would have fewer complications and, therefore, a shorter and less expensive hospital stay if no machine was used. In fact, there is some evidence to support this. According to one statistic cited in the study, only 64.5 percent of patients who had been hooked up to the heart-lung machine did not have complications. Longer hospital stays and recovery periods were also noted.

Thus was born a movement to find alternatives to the heart-lung machine. Performing the surgery without a machine rose in New York from 3 percent in 1997 to 27 percent in 2000, notes an accompanying commentary.

This study set out to quantify the differences between the two types of bypass surgery. It looked at 139 patients who had surgery with the machine and 142 who went without it. All the patients were relatively young -- about 61 or 62 years old -- and had only one or two blocked vessels.

After one year, the survival rate and freedom from complications was roughly equivalent: 90.6 percent for the group that had not used a heart-lung machine and 88 percent for the group that had.

To top it off, surgery employing a heart-lung machine was more expensive: $1,839 in additional direct costs per patient, a difference of 14.1 percent.

There are a few caveats. For one thing, the study involved only low-risk patients. "This is a subset of patients who, by all criteria, should be winners to begin with," Cunningham says. "I would expect good results in this particular group of patients."

And although off pump procedure is cheaper, that's "a weak reason to choose one modality over another," Cunningham says. (The cost savings may actually be an illusion. When Cunningham did a cost comparison at his own center, he found the two procedures were identical when it came to cost, possibly indicating price differences between the United States and the Netherlands.)

So, should the pump be on or off?

"The downside of doing something off-pump is that in many situations if you're not selective about the patients you're operating on and the type of artery you decide to bypass, you may end up doing a bypass with less precision," Cunningham says.

"This approach [without a heart-lung machine] is not for everybody," Cunningham says. "There are six ways to skin a cat, and this is just one of them. You have to learn when to use this technology and take advantage of its positive aspects and when to say no."

More information

Check out the American Heart Association (news - web sites) for more on bypass surgery and on the history of the heart-lung machine.


Antibiotic Overload


Wednesday, January 28, 2003

(HealthScoutNews) -- Bacteria have shown a remarkable ability to mutate and gain immunity to drugs designed to kill them.

According to the U.S. Centers for Disease Control and Prevention (news - web sites), antibiotic overuse is a big part of the problem.

Here's how you can prevent antibiotic-resistant infections:

  • When prescribed an antibiotic, ask your doctor whether it's likely to help your illness, and ask what else you can do to feel better sooner.
  • Don't take an antibiotic for a viral infection like a cold or the flu. Antibiotics don't affect viruses.
  • Don't save some of your antibiotic for the next time you get sick. Always take all of the antibiotic you're prescribed, even if you feel better.
  • Take an antibiotic exactly as your doctor tells you.
  • Don't take an antibiotic that's prescribed for someone else.


Women Unhappy With Care for Heart Disease 

By Ross Grant
HealthScoutNews Reporter


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- More than half of American women with heart disease are dissatisfied with the care they received, and 57 percent said they suffered mental illness because of the disease, says the first-ever national survey of its kind.

Although many of them don't know it, women with heart disease make up the largest health risk group in the United States. Heart disease is by far the biggest killer in America, and women are 15 percent more likely to die of it than men, according to the American Heart Association (news - web sites).

Because of advances in treatment and diagnosis for men, the number of them dying from heart disease annually has dropped from 510,000 two decades ago to 440,000 today. But in that same period, the number of women dying each year from the disease has risen from 490,000 to 510,000, the association says.

This survey, published in the current edition of Women's Health Issues, puts a human face on that disparity in care, says study co-author Dr. Sharonne Hayes, director of the women's heart clinic at the Mayo Clinic in Rochester, N.Y.

"We wanted to know how heart disease changed these women's lives," she says. "As a physician, I see how it affects them, but this lets us hear in their own voices that it often changes every aspect of their lives."

The survey questioned 204 women heart patients from around the country. It is unique because it asked open-ended questions and focused on how the disease influenced the quality of life for afflicted women. It was funded by a group called WomenHeart: The National Coalition for Women With Heart Disease.

"By having open-ended questions, it obviously make this survey more work, but it also gave us the breadth of their experience," Hayes says. "We allowed women to really tell things as they were."

The findings include:

·         52 percent of the respondents were dissatisfied with some aspect of their care;

  • 58 percent of them attributed the problem to physician attitudes and communication styles;
  • 57 percent said they suffered some mental illness from the disease, ranging from anxiety (17 percent) to clinical depression (38 percent), or both (21 percent);
  • 27 percent said relationships with their families deteriorated as a result of the illness;
  • just 35 percent of patients said they recognized their heart disease symptoms early on, while 45 percent felt the disease "came out of the blue";
  • and 42 percent of women said they had to change their work schedule or leave job as a result of the illness.

"This should be a wake-up call for those of us who care for women with heart disease," Hayes says. "We still identify heart disease with middle-age men. But we need to make the right diagnosis for women early on. We need to think 'heart' in doctors' offices and emergency rooms."

The study cites a 1999 Gallup poll, in which only 55 percent of primary-care physicians correctly identified heart disease as the greatest risk to women over 50.

In the general population, women are three times more likely to be depressed than men. But when depression occurs among heart patients, it increases the risk they will die early because they are less likely to take care of themselves, says Dr. Nieca Goldberg, chief of the women's heart program at Lenox Hill Hospital in New York City and author of Women are Not Small Men: Lifesaving Strategies for Preventing and Healing Heart Disease in Women.

"The connection between mind and body can't be written off," she says. "We have some pretty good statistics that show that the blood-clotting cells have increased clumping activity during depression. That could lead to more heart attacks."

Goldberg adds, "We're so good at whipping people into the hospital and doing these high-tech treatments, but sometimes we need to look past that and make sure we improve the quality of life for these people as well. It's a long-term process."

More information

For facts about heart disease and women, visit WomenHeart: The National Coalition for Women With Heart Disease. Or for information about preventing heart disease, try the U.S. Centers for Disease Control and Prevention.


Key to Diabetes Treatment: Stay Ambitious 

By Alison McCook

Reuters Health

Wednesday, January 28, 2003

NEW YORK (Reuters Health) - Ambition helps when reaching for life goals, and new research released Wednesday shows that the same holds true for diabetics (news - web sites).

According to a report in The New England Journal of Medicine (news - web sites), diabetics who are given more ambitious goals for lowering their blood pressure, cholesterol, and blood sugar are less likely to suffer from cardiovascular problems than patients whose doctors set less ambitious treatment goals.

All patients had type 2 diabetes, the most common form of the disease, which is often linked to obesity.

When the study began, doctors did not routinely try to help diabetics meet the ambitious treatment goals offered in the study. But times have changed--according to Dr. Caren G. Solomon of the New England Journal of Medicine, current treatment recommendations from the American Diabetes Association (ADA) closely resemble those set for the ambitious group.

"If you do what the ADA said to do, you're kind of doing this intensive arm," Solomon told Reuters Health.

"It's a really nice validation," added Solomon, who wrote an accompanying editorial.

During the current study, patients offered intensive treatment were followed by a "team," consisting of a doctor, nurse and dietician, all focused on helping patients keep up with their medications and stay healthy, such as with diet and exercise.

In contrast, patients with less ambitious goals to reduce risk factors for health problems only visited a doctor during each consultation, although both groups received approximately the same number of consultations.

All of the patients in the current study were considered to have a high risk of cardiovascular problems because they all had microalbuminuria, meaning they excreted small amounts of the protein albumin in their urine. This condition is a sign they have a defect in their blood vessels, which can put them at risk of cardiovascular problems.

Patients given intensive treatment all received blood pressure-lowering drugs like ACE inhibitors, regardless of whether or not they had high blood pressure. Those with high blood pressure were offered other drugs as well, and patients with high cholesterol received cholesterol-lowering drugs.

Study author Dr. Oluf Pedersen of the Steno Diabetes Center in Denmark, explained that patients given less ambitious treatment goals initially only received ACE inhibitors if they had high blood pressure. Other drugs to lower blood pressure and cholesterol drugs were offered, he said, but often less frequently and at lower doses than for patients in the intensive treatment group.

"When you put forward more ambitious targets, you have to give more drugs and more behavior modifications," he told Reuters Health.

Indeed, after following 160 patients for an average of eight years, Pedersen and his colleagues noted that the 80 patients who received the intensive treatment were about 50% less likely to experience a cardiovascular problem than patients offered less ambitious goals for diabetes treatment.

Solomon explained in an interview that the intensive treatment offers certain barriers to some diabetics, notably those who lack insurance to cover the costs of prescription drugs. "If you're not covered for drugs, this is really expensive," she said.

However, Solomon noted that a treatment program that cuts the risk of future health problems also significantly cuts long-term costs from these problems, and that benefit might outweigh the expense of buying more drugs.

"Despite the inconveniences" of the more intensive program, "the benefit is really great," Solomon said.

Source:  The New England Journal of Medicine 2003;348:383-393,457-459.


Managing Type II Diabetes Sharply Cuts Heart Risk

By Ed Edelson
HealthScoutNews Reporter


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- The measures that experts recommend for preventing cardiovascular disease in people with Type II diabetes really do work, a carefully controlled Danish study finds.

Those who lowered their blood pressure and "bad" LDL cholesterol, raised their "good" HDL cholesterol, exercised regularly, avoided smoking and took the proper medications had almost half the risk of a heart attack, stroke or other cardiovascular problems as those who had less intensive medical care, the study says. It appears in the Jan. 30 issue of The New England Journal of Medicine (news - web sites).

Since all these measures are known to reduce risk, why do such a study?

"This study was started 10 years ago, and at that time there was no evidence that people with Type II diabetes would benefit from treatment at all," says study leader Dr. Oluf Pedersen, director of the Steno Diabetes Center in Copenhagen. "Diabetes treaters were indifferent and uncertain about the outcome."

In addition, Pedersen says, while there have been many studies evaluating the effect of individual risk-reducing measures -- lowering blood pressure or cholesterol, promoting exercise, abstaining from smoking -- "nobody has previously evaluated the total impact of integrated treatment of Type II diabetes."

Type II diabetes happens when the body cannot produce enough insulin or uses it improperly. It was once called adult-onset diabetes, but doctors are finding it in children more and more. It is by far the most common form of diabetes.

The eight-year study assigned 80 patients with Type II diabetes to conventional care and another 80 to intensive care designed to meet specific goals for a number of risk factors -- for example, keeping blood pressure below 130/80 and keeping LDL cholesterol below 100 milligrams per deciliter. People in the intensive care group were also advised to take a dietary supplement that included vitamins E and C and folic acid, and they were given an ACE inhibitor drug to prevent kidney disease. After nearly eight years, 24 percent of those in the intensive care group had a major cardiovascular event (heart attack, stroke or the like), compared to 44 percent of those getting conventional treatment, the report says.

"We were not hoping for so great an impact," Pedersen says, based on the results of studies of individual risk factors. "It is important to have this kind of evaluation. Most national health experts recommend this kind of treatment, but its effects have never been evaluated."

The study results are "reaffirming the things we pretty much do," says Dr. Eugene J. Barrett, a professor of medicine at the University of Virginia and president-elect of the American Diabetes Association. "There's nothing startling here. It says that if you pay attention to each of the cardiovascular risk factors, you will have a major effect on the clinical outcome."

However, what is possible in a small study is not always achievable in everyday practice, Barrett acknowledges. "The issue with any set of practice guidelines is what people recognize as optimum and what can be done in the real world (news - Y! TV)."

Both physicians and patients must work to put the recommended preventive measures into action, Barrett says.

More information

Learn how to prevent heart complications from the Joslin Diabetes Center or the National Institute of Diabetes and Digestive and Kidney Diseases.


Death of Autopsies Reported

By Robert Preidt
HealthScoutNews Reporter


Wednesday, January 28, 2003

TUESDAY, Jan. 28 (HealthScoutNews) -- The dead have many things to tell us, but we're not tuning into their messages.

This failure to communicate has nothing to do with seances. The problem is with autopsies -- or lack of them.

A new report says there's been a dramatic decline over the past few decades in the number of autopsies done in the United States. That means the loss of valuable medical information that could improve health care for the living.

The report is based on an analysis of more than 50 studies on autopsies over 40 years. It found the autopsy rate for all non-forensic deaths (those that don't involve the law) in the United States fell below 6 percent in 1994 (the last year for which national data exist), compared to 50 percent in the 1960s.

Using information from their analysis, the researchers estimated that in American hospitals in the year 2000, the lack of autopsies meant the correct cause of death eluded clinical detection in 8 percent to 23 percent of deceased patients, with as many as 4 percent to 8 per cent of all dead patients having a missed diagnosis that may have harmed them.

The report also found that as many as 5 percent of autopsies revealed clinically unsuspected complications caused by medical care.

It was prepared for the U.S. federal Agency for Healthcare Research and Quality (AHRQ) by the University of California at San Francisco (UCSF)-Stanford University Evidence-based Practice Center.

The report examined the benefits of the autopsy as a method of health care performance measurement and improvement and explored the potential negative effects of the trend towards fewer autopsies.

It didn't focus on using autopsies to point fingers at doctors and other health-care professionals about mistakes. The authors approached this as a public health concern -- that facts gleaned from dead patients can provide precious knowledge that will improve overall health care.

"The bottom line is that the autopsy is still much more important than we thought," says lead author Dr. Kaveh Shojania, assistant clinical professor in UCSF's department of medicine.

He says that in the 1950s and 1960s, autopsies were done on a third to a half of all patients who died in American hospitals. Now, many American hospitals do few or no autopsies.

"Why it's happened is actually a complicated story. It's not a single answer," Shojania says.

Many health-care professionals don't see the need for autopsies, he adds. They feel that modern medical technology accurately reveals the cause of death in the majority of patients.

"Even though that's widely believed ... there's hundreds of studies out there ... showing that there's substantially high rates of what you might called diagnostic surprises or errors," Shojania says.

Those studies show that autopsies sometimes reveal the cause of death to be quite different than conclusions based on information from medical technology.

There are other factors. Hospitals don't get paid for doing autopsies, so there's no financial incentive to do them, he notes.

Many pathologists view autopsies as consuming valuable time that can be used doing tests that benefit the living. And many pathologists are more interested in the high-technology, laboratory-based aspect of pathology, rather than, "mucking around in a dead person's colon," Shojania says.

"I guess the major message is that the report indicates that the autopsy, which has fallen out of fashion, is still a very valuable resource for several reasons," says Dr. Paul Raslavicus, president of the College of American Pathologists, which requested the AHRQ to produce the report.

Raslavicus agrees that autopsies can play an important role in improving public health. That's because autopsies help track the true incidence of disease and the accuracy of death certificates.

Also, doctors, nurses and other health professionals can benefit from autopsy findings, which may provide them with new insights and knowledge to help them provide better treatment and care for their patients.

"There's an old saying that the dead teach the living," Raslavicus says.

He agrees that a major factor in the decline of autopsies is the belief that current medical technology can detect all the important medical information about a person, including the cause of death.

There's also increasing demand from many different areas of medicine for dwindling health-care dollars.

"Something has to go. And the autopsy seems to be sort of the orphan child," Raslavicus says.

He says many morgues are in poor shape and require improvement and modernization. However, that is just not seen as high a priority compared to, for example, equipping or building a new operating room.

More information

You can learn more about autopsies here or from this BBC article.


Cold Water Ups Risk of Lung Problem in Swimmers 

Reuters Health

Wednesday, January 28, 2003

NEW YORK (Reuters Health) - Strenuous swimming in cold water may cause a life-threatening build-up of fluid in the lungs, the recent cases of three US sailors show.

Navy researchers report that the three men, all in their 20s, accumulated fluid in their lungs during a 2-mile ocean swim in water that was 67 degrees Fahrenheit.

During their swims, the men--all undergoing training as Navy SEALs--developed symptoms that included dizziness, rapid breathing, confusion and coughing up blood.

The swimmers recovered with treatment, but if they had been left untreated, the fluid in their lungs--the mark of a condition called pulmonary edema--would have cut off their access to oxygen, causing them to suffocate.

These cases of pulmonary edema, reported this week in the February issue of the Annals of Emergency Medicine, occurred even though the patients had worn wet suits. They also said they had not put their heads underwater or inhaled water during their swims.

The report's authors, led by Dr. Keri L. Lund of the Naval Medical Center in San Diego, California, say that they treat around 20 people each year who develop pulmonary edema while swimming.

Once patients have recovered, the doctors advise them on how to swim without overexerting themselves, and suggest other ways to reduce their risk of future episodes.

Pulmonary edema can occur in a number of situations, the authors note, and it has been documented in marathon runners, bicyclists and rugby players.

In swimmers, cold water causes an increase in blood flow to the lungs, while exercise ups the amount of blood pumped from the heart. As a consequence, tiny blood vessels feeding the lungs may begin to leak, causing the lungs to fill with fluid.

In one of the current cases, a 21-year-old man complained of shortness of breath, confusion and coughing after only 10 minutes of swimming. He got out of the water, and was taken to the emergency department, where doctors diagnosed him with pulmonary edema and gave him supplemental oxygen and a drug to open up his lungs.

Another 25-year-old man developed pulmonary edema after swimming for 30 minutes, when he began to feel confused and weak, and started swimming off course. He was pulled from the water, and began wheezing and breathing rapidly. He also received oxygen and the lung-opening drug.

None of the patients said they drank alcohol or smoked cigarettes.

Source: Annals of Emergency Medicine 2003;41:251-256.


Breath of Fresh Air for Hard-to-Heal Wounds

By Robert Preidt
HealthScoutNews Reporter


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- A simple, economical way to treat chronic and other hard-to-heal wounds may be in the bag.

Ohio State University surgical scientists say they've had success using a specially designed bag called a "topical hyperbaric oxygen chamber." The researchers found that using the chamber to treat wounds with pure oxygen for brief intervals helped problem wounds to heal better and faster.

The researchers' study, in the current issue of the journal Pathophysiology, examined results from 30 people with 56 wounds, including post-surgical wounds, acute trauma injuries, diabetic ulcers, and bedsores.

The people in the study included some whose wounds didn't heal with standard treatments such as wound-care creams or stitches.

The topical oxygen chamber -- an inflatable, clear plastic bag -- was positioned around the wound area or around a limb with a wound. The bag was secured using medical-grade adhesive. Pure oxygen was pumped into the bag for 90 minutes a day for four days. That was followed by a three-day rest period, the researchers say.

The length of treatment varied for different patients, ranging from 24 days to eight months. The topical oxygen therapy was done in a hospital, extended care facilities, and the study subjects' homes.

The study found that about three-quarters of the wounds healed after topical oxygen therapy.

"What we reported is that we are seeing roughly a 75 percent success rate in these very difficult wounds," says study lead author Chandan Sen, associate director of the Davis Heart and Lung Research Institute at Ohio State University.

The best healing rates were in acute trauma (75 percent) and postsurgical (100 percent) wounds on the trunk, arms, and hands. Half of all acute wounds on the hands and feet healed, the study says.

Chronic wounds that had good healing rates included venous stasis ulcers on the leg (92 percent) and diabetic hand ulcers (91 percent).

Some wounds didn't respond as well. For example, bedsores had a 44 percent healing rate when treated with topical oxygen therapy.

Sen says topical oxygen therapy may not be sufficient to fully heal bedsores and wounds on the lower extremities. But he says it may be helpful in such cases when used with other kinds of standard wound care.

He says oxygen is an important factor in wound healing, but the very nature of a major acute or chronic wound can limit the amount of oxygen available to help healing.

"One of the basic characteristic features of a wound is disruption of blood vessels. They get torn," Sen says.

"So what happens is the area that is injured does not get enough blood supply. This means it does not get enough oxygen supply. So hypoxia [low oxygen] is a characteristic feature and a major limiting factor in wound healing," Sen says.

He notes that he's referring to serious, difficult-to-heal wounds, not your everyday nicks and cuts.

Large hyperbaric chambers are often used to improve oxygen supply to difficult and dangerous wounds. These are the same chambers used to treat divers who suffer decompression sickness, also called "the bends."

But these large chambers have a number of drawbacks, Sen says. They're not available everywhere, they can help only a few people at a time, they're expensive, and they require specialized staff.

The topical oxygen chambers are much less expensive, easy to use, and highly portable. For example, they can be used at home and could be used to treat soldiers on the battlefield or to treat disaster-related casualties, Sen says.

Topical oxygen chambers have U.S. Food and Drug Administration (news - web sites) approval and are sold by a number of manufacturers. For this study, Sen and his colleagues had a topical chamber manufactured to their specifications.

Dr. Stan Nahman, a professor of internal medicine at Ohio State who was not involved in the study, says the topical chambers are a "clever way of administering local, high-dose oxygen to tissue that needs it."

He agrees that topical oxygen therapy has a number of advantages over the large, hyperbaric chambers.

"You could see this becoming a fairly common ancillary care kind of tool. They can be developed and used fairly cheaply," Nahman says.

More information

Here's where you can learn more about how wounds heal. And check this story from the Herald-Leader of Lexington, Ky., on hyperbaric chambers.


Leg-Artery Disease May Impair Women More Than Men 

By Jacqueline Stenson

Reuters Health

Wednesday, January 28, 2003

NEW YORK (Reuters Health) - Women with peripheral arterial disease, a condition marked by reduced blood flow to the legs, are more likely to have trouble walking than their male counterparts, new study findings suggest.

"Women had poorer function," said study author Dr. Mary McGrae McDermott, an associate professor of medicine at Northwestern University in Chicago, Illinois.

Peripheral arterial disease (PAD) occurs when the arteries in the legs become narrowed by a buildup of fatty plaque. Because blood flow to the legs is impaired, people with PAD may experience painful leg cramps while walking. Some also have pain at rest, while others have no symptoms at all.

The risk factors for PAD are similar to those for heart-artery disease, which include high cholesterol, diabetes and smoking.

In the study of 187 female and 273 male PAD patients age 55 and older, tests of physical functioning showed that women as a whole were not able to walk as far or as fast as men, even though both groups had similar degrees of disease severity.

At least part of the explanation for the differences is that the men had more leg strength than the women, McDermott and colleagues report in the February issue of the Journal of the American Geriatrics Society.

When the researchers took leg strength into account, they found it was responsible for some of the differences in physical functioning.

"Leg strength is an important determinant of walking speed and endurance," McDermott told Reuters Health.

The study also found that men tended to walk more in their leisure time, whereas women got a significant amount of their physical activity from housework. Previous research has suggested that the more people with PAD walk, the better their functioning, McDermott noted.

Her advice to both women and men with PAD: "Go out and walk."

While many patients may be reluctant to exercise since exertion can trigger leg pain, studies have found that walking regularly results in less pain over the long-term by helping to prolong the amount of time a patient can walk pain-free, McDermott said.

As another incentive to walk, the researchers added, maintaining mobility may be a key factor that prevents elderly people with PAD from requiring nursing-home care.

Source: Journal of the American Geriatrics Society 2003;51.


AIDS-Related Eye Disease on Wane

By Randy Dotinga
HealthScoutNews Reporter


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- In almost all of us, a destructive virus known as CMV lies in wait, hoping our immune systems will one day fall apart. That day came for thousands of AIDS (news - web sites) patients who could do nothing as the virus stole their sight.

However, these ravages are mostly in the past now, and researchers say their decline coincides exactly with the rise of powerful drugs over the past decade.

Some AIDS patients are developing resistance to the drugs that keep them alive, but the rates of CMV-related eye disease remain low. "They're down and staying down. We have all feared a swing back toward higher numbers, but it has not happened," says Dr. Elaine L. Chuang, an associate professor of ophthalmology at the University of Washington School of Medicine.

CMV -- cytomegalovirus -- is present in as many as 85 percent of Americans by the age of 40, according to the U.S. Centers for Disease Control and Prevention (news - web sites). The virus usually settles in before the age of 20 during minor bouts of the flu, Chuang explains.

In almost all cases, the virus lies dormant, although researchers have linked its presence to heart disease and stroke. However, it can awaken in people with severely weakened immune systems and attack various parts of the body, including the gastrointestinal system, the brain and the eyes.

Attacks on the eyes are especially horrific because a disease known as CMV retinitis can destroy the retina, Chuang says. Other CMV-related illnesses, such as a type of pneumonia, can kill.

AIDS patients become especially vulnerable in the last stages of their disease when their immune systems have virtually disintegrated. In the early days of the AIDS epidemic, patients often became infected with CMV retinitis just before they died.

A group of researchers wanted to determine when the eye disease started to wane in AIDS patients, and they turned to studies completed between 1990 and 1996. The results of their investigation, which looked at the records of 681 patients with eye disease and AIDS, appear in the January issue of the Archives of Ophthalmology.

The researchers found the severity of the eye disease cases began to drop in the early 1990s and fell even further in the middle of the decade, says study co-author Janet T. Holbrook, an assistant research professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. The study reports that the severity of eye disease cases dropped by 30 percent thanks to new AIDS drugs that began to appear in the mid-1990s.

The AIDS drugs -- known variously as the "cocktail," "combination therapy" or HAART (highly active anti-retroviral therapy) -- bolster the immune systems of HIV (news - web sites)-positive people. For many patients, the drugs have turned AIDS from a fatal disease into a treatable chronic condition.

The early 1990s also brought better powerful drugs to treat CMV retinitis itself, Chuang says. Doctors continue to use those drugs, which remain the standard treatment for the disease.

Now, the number of cases among AIDS patients Chuang sees has dropped so much that it is almost equal to that among another vulnerable group -- people who have had organ transplants. They're at risk because they must take drugs that weaken their immune systems to keep their bodies from rejecting new organs.

However, AIDS patients are far from immune to CMV retinitis, Chuang says. Some don't take their AIDS drugs regularly, especially those who aren't gay men, such as IV drug users. The disease can then take advantage of their weakened immune systems.

The rates of CMV retinitis may remain low, however, as long as people get tested for HIV, the virus that causes AIDS, and seek treatment if needed, she says.

More information

To learn more about CMV, check out the U.S. Centers for Disease Control and Prevention., sponsored by a group of eye doctors, offers this helpful information sheet on CMV retinitis.


Airlines Accused of Hindering Key Blood Clot Study 

By F. Brinley Bruton


Wednesday, January 28, 2003

LONDON (Reuters) - Airlines are dragging their feet in co-operating with a study on whether so-called "economy class syndrome," which causes potentially deadly blood clots, is linked to flying, a leading researcher told Reuters on Wednesday.

One of the scientists in charge of the investigation conducted by the World Health Organization (news - web sites) (WHO) said that the carriers' slowness had hindered his team's research.

"The airlines' defensive reaction is counterproductive," the scientist, Frits Rosendaal, said.

An international airline lobby group denied the accusation.

The investigation seeks to prove whether the potentially deadly syndrome, known as deep vein thrombosis (DVT), is related to long-distance flying, and it is crucial to airlines and plaintiffs battling each other in courts around the world.

"The airlines are not really used to this kind of research. That combined with a defensive position--being scared of publicity, lawsuits or losing travelers--have helped cause delays," he said.

As a result, Rosendaal said the issuing of questionnaires crucial to a pilot study had been delayed by about five months.

Rosendaal did not say which carriers have been slowing down the study, which needs airlines' co-operation to analyze hundreds of thousands of fliers over the next few years.

The International Air Transport Association (IATA), which represents the majority of the world's international carriers, defended the industry and said carriers were doing everything in their power to help with the study.

"The fact is that we are co-operating to the best of our ability and don't feel that it is fair to accuse the airlines of dragging their feet," said an association spokeswoman.

"The airlines are ready to go on their part of the study," she said, adding that two airlines were participating in the pilot study, but declined to say which carriers were involved.

Sources close to the airlines told Reuters that the two airlines participating in the study are British Airways and Brazil's flagship airline VARIG.

BA said it would let IATA speak for it on the subject, and VARIG could not initially be reached.

DVT A Flying Disease?

A link between DVT--which can cause blood clots in the legs that break away and invade the lungs and heart--and flying would give claimants around the world powerful ammunition to pursue airlines and demand millions of pounds in damages.

Cases in England, Canada, the United States and Australia pit DVT sufferers and their families against the world's leading airlines--including Europe's largest, British Airways Plc, and the world's biggest, American Airlines.

Ruth Christophersen, whose 28-year-old daughter Emma died after a flight from Australia to Britain, said the airlines' actions appear to show that airlines are not interested in finding out if there is a link between flying and the ailment.

"I wonder, do the airlines not want an answer? I would have thought that the airlines would have sought to get the study done and not put obstacles in the way," she said.

DVT patients and their families suffered a stinging defeat in December when a London judge blocked claimants' attempts to sue 27 airlines, including BA and American Airlines, whose parent is AMR Corp., over claims that cramped seating on long flights caused the potentially deadly blood clots.

Claimants say the airlines knew about the risks of DVT for years but did not inform passengers, while the airlines maintain DVT is not a flying disease.

The airlines argue that DVT is not an "accident" under a key 1929 international agreement governing air travel, and therefore they cannot be held responsible.

The London decision ran counter to a ruling made earlier on the same day in Australia involving Qantas and British Airways over a blood clot suffered by a passenger on a long-haul flight.

Lawyers for the airlines have said they would appeal against the decision in Australia, and claimants have said they would appeal in the case in London.

The WHO study is also being looked at carefully by DVT victims and their lawyers in Canada and the United States, where several cases are winding their way through the legal systems.

In the United States, the law firm of O'Reilly, Collins and Danko, in California, has a number of DVT-related clients and recently obtained a settlement from American Airlines, a move that surprised lawyers in the London case because it ran counter to the airlines' policy of not settling DVT cases.

But lawyers, DVT sufferers and airlines will have to wait for years to find out if DVT is linked definitively to flying, since the study's results will likely not be released until 2007, at the earliest, according to Rosendaal.


Minor Oxygen Deprivation at Birth Can Dull Mental Skills

By Jennifer Thomas
HealthScoutNews Reporter


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- Premature babies who experience even minor oxygen deprivation during or shortly after birth have lower IQs and poorer language skills, a new study says.

Researchers did a battery of tests to measure the intellectual abilities and language skills of 52 children, aged 5 to 6. All of the children had been born prematurely, defined as 36 weeks or less.

Half of the children were at slight to moderate risk of perinatal hypoxia, or oxygen deprivation, within two hours of birth. To measure this, the researchers used data on the babies' blood acidity. High acidity is a biochemical sign of reduced blood oxygen levels. Half of the newborns had no signs of oxygen deprivation.

Despite relatively minor differences in blood acidity, the two groups of babies showed significant differences in their language and intellectual skills as children, say the authors.

The pre-term group with mild to moderate levels of blood acidity scored 10 to 11 points lower on verbal and visuospatial tests than the low-risk pre-term group, a large discrepancy.

The study appears in the January issue of Neuropsychology. The researchers were from Wayne State University in Michigan, the University of Memphis, and Baptist Memorial Hospital in Memphis.

The study shows the threshold for problems associated with oxygen deprivation might be lower than thought, says Kathy Katz, a child psychologist and associate professor of pediatrics at Georgetown University.

"The study does suggest findings that are contrary to what has previously been believed," Katz says. "Previously, we believed it took a fairly substantial degree of hypoxia [oxygen deprivation] in order for there to be a later impact on cognitive function. This study suggests more mild hypoxia can have an impact."

Still, Katz adds, the study sample was small and more research is needed to confirm the findings.

"The findings are sort of surprising," she says. "Most studies have found newborns have a fair amount of resilience when deprived of oxygen."

The dangers to babies born prematurely is of increasing significance because so many more children are being born pre-term, according to the study.

In 2001, 12 percent of babies were born prematurely. That was the highest level in 20 years and was due in part to more multiple births, induced labor and older mothers, who are at higher risk of delivering prematurely.

"We need to be thinking about the fact that those babies may be at even higher risk than we thought," Katz says.

Previous research by the study authors found that full-term infants faced a similar risk.

In a 1999 study, the authors looked at 48 children who had mild to moderate hypoxia. Half of those children were born prematurely, while half were born full-term. The authors found the babies had poorer intellectual and verbal skills at age 6, regardless of whether they were born full term or prematurely.

The research was not able to show precisely what portion of the brain was damaged by the oxygen deprivation. One reason for this, the authors surmise, is that ultrasound, the typical way of looking at a baby's brain, is not powerful enough to detect subtle lesions.

More information

Here's a primer on premature babies from KidsHealth. Or check out this list of links to support groups, books and other resources for parents of premature babies.


SUV Rollovers Play Rising Role in Traffic Deaths 

Reuters Health

Wednesday, January 28, 2003

NEW YORK (Reuters Health) - Although deaths due to car crashes have remained stable in the last decade, light trucks--pickup trucks, vans and SUVs in particular---are an increasing component of all fatal rollover crashes, according to a Georgia researcher.

"From 1991 to 2000, passenger car occupant rollover deaths decreased by 15%, whereas occupant deaths in light truck rollover crashes increased by 35%," notes Lee M. Morris of the Medical College of Georgia, in Augusta, in the February issue of the Annals of Emergency Medicine released this week.

According to recent data from a National Highway Traffic Safety Administration (news - web sites) (NHTSA) report, rollover crashes of cars and light trucks killed 9,873 people in the year 2000--or nearly one third of all people who died in passenger vehicles that year.

"A rollover crash is particularly violent in nature," Morris writes. "Unrestrained occupants in such crashes are subjected to a variety of forces and impacts that can result in severe injuries or death."

During that same year, 6% of SUVs involved in crashes rolled over, compared with 4% of pickup trucks and 2% of vans. And in fatal crashes, 36% of SUVs rolled over, as did 24% of pickup trucks and 19% of vans.

Overall, 47% of deaths among passengers of light trucks, including pickup trucks, SUVs and vans, were attributable to rollovers. That compares with 22% of car deaths.

And while car-rollover deaths declined 15% between 1991 and 2000, this was offset by a 35% increase for light trucks, according to the report.

Whether an occupant is ejected from the vehicle "can mean the difference between living and dying," Morris points out. And seat belt use has been found to be 80% effective in reducing rollover fatalities in light trucks.

In 2000, more than half of all people killed in a motor vehicle were not buckled up, according to the report.

Without concerted consumer safety education, the overwhelming popularity of SUVs and other light trucks may cause the US to find itself in a "rollover epidemic," Dr. Federico Vaca of the University of California in Irvine writes in an accompanying editorial.

"This report," he concludes, "stresses the urgency for further consumer education by vehicle manufacturers, safety promotion program implementation and greater advocacy on the part of emergency physicians."

The NHTSA's report is available at

Source: Annals of Emergency Medicine 2003;41:271-272.


Testing a New HIV Vaccine


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- A clinical trial of a new AIDS (news - web sites) vaccine begins this month at three locations in the United States.

The Phase I clinical trial will include 30 people at the University of Alabama at Birmingham, the University of Washington in Seattle, and the San Francisco Department of Public Health (news - web sites).

This vaccine strategy includes two different components -- two inoculations of a DNA vaccine that primes the immune system to recognize HIV (news - web sites), followed by a booster vaccine based on a recombinant poxvirus.

Neither of these components incorporates the actual HIV virus (news - web sites). Instead, the vaccine produces the three major proteins expressed by HIV. That primes the body's immune system to respond to the distinguishing features of HIV so it is ready to battle the virus if it enters the body, the researchers say.

The trial will last one year. It will focus on assessing the safety of the primer DNA vaccine among people who are HIV-negative. They'll be randomly assigned to receive either a high-dose vaccine, low-dose vaccine or a placebo.

A separate trial will examine the safety of the booster vaccine, and a third trial will test the safety of the combined regimen.

The vaccine was developed at the Yerkes Primate Research Center of Emory University, the Emory Vaccine Center, and the Laboratory of Viral Diseases at the U.S. National Institute of Allergy and Infectious Diseases (news - web sites).

More information

Here's where you can learn more about HIV vaccines.


Drug-Resistant Staph Bacteria Found in Los Angeles 

By Deena Beasley


Wednesday, January 28, 2003

LOS ANGELES (Reuters) - A bacterial skin infection that does not respond to standard antibiotics is showing up for the first time in gay men, raising concerns that it could spread further, a Los Angeles health official said on Tuesday.

The virulent strain of drug-resistant Staphylococcus aureus, or staph, has caused symptoms like abscesses and boils in a still undetermined number of gay men, as well as other people, said Dr. Elizabeth Bancroft, a medical epidemiologist with the Los Angeles County Health Department who is leading an investigation.

"We don't yet have a sense of the magnitude of the problem," she said.

Due to the overuse and frequent misuse of antibiotics--like using them to treat colds, flu and other viral illnesses--many bacteria have learned to outsmart the drugs and have consequently become much more difficult to treat.

The infection showing up in Los Angeles does not respond to oral antibiotics like penicillin or even Cipro, and some patients have had to be hospitalized and given powerful intravenous antibiotics, according to the health department.

The staph infection usually needs skin to skin contact to spread, but records show that it can be contracted in damp, warm environments like steam rooms, Bancroft said.

"The number of reports has been rising since the end of the summer...but doctors don't expect to see (staph) in healthy individuals, they expect to see it in elderly patients who are in and out of nursing homes," Bancroft said.

She said the health department only recently determined that the infections were the same strain of bacteria.

Past outbreaks of the antibiotic-resistant skin infection have been seen in groups such as athletes and intravenous drug users who live in close quarters and share things like gym equipment and towels.

An infection within the gay community is of concern because these men might have more skin-to-skin contact that could make it easier for the staph infection to spread, Bancroft said.

To find out, the Los Angeles health department is launching one study to assess the risk of transmission in the gay community and another to determine the prevalence of the disease.

For now, Los Angeles area doctors are being alerted to the infection trend and encouraged to do cultures of suspected cases.

Bancroft said the county does not yet have the data to instruct doctors to change their initial antibiotic treatment regimen.


Getting at the Guts of Your Gut


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- A protein that appears to kill certain kinds of bacteria in the intestines has been identified by researchers at Washington University School of Medicine in St. Louis.

The findings were published Jan. 27 in the online version of Nature Immunology.

The protein is called angiogenin 4 (Ang4). It belongs to a class of proteins originally believed to be involved in the formation of blood vessels that supply nutrients to tumors.

This study found that Ang4 is released by Paneth cells, which are located in the intestinal lining. These Paneth cells assist the body's immune system by defending against infection. The researchers tested how Ang4 interacts with a variety of microbes.

They found that Ang4 killed certain kinds of gut microbes. Because of that, the researchers concluded Ang4 may be one of the microbial proteins manufactured by Paneth cells to keep gut bacteria from getting too close to the intestinal lining, where they could cause damage.

The study also found that Ang4 production is controlled by a bacterium that lives in the intestine. The microbe is called Bacteroides thetaiotaomicron. This makes Ang4 the first example of a protein antibiotic whose expression is controlled by friendly intestinal bacteria.

More information

Here's more about gut bacteria and Paneth cells.


Scientists: You Really Are Only as Old as You Feel 

By Pat Hagan

Reuters Health

Wednesday, January 28, 2003

LONDON (Reuters Health) - Expressions like "You're only as old as you feel" may be cliches, but according to a new study they can have a positive effect on a person's mental and physical wellbeing.

Researchers from Eastern Illinois University in Charleston found that so-called "memorable messages" about aging can persuade people to change their lifestyle as they grow older.

Dr. Sherry J. Holladay and colleagues wanted to test if pearls of wisdom about the benefits and drawbacks of growing old actually have any impact on the way younger people live their lives as they get older.

To find out, they asked 104 people ages 18 to 77 to fill out a questionnaire detailing one specific memorable message they recalled and how it had influenced them. The results were published recently in the Journal of Communication.

The responses were split into different groups, according to how each message interpreted the aging process. Messages to do with enjoying life included "You're only young once, enjoy it while you can," and those to do with age being a state of mind included "Getting old and being old are two different things."

Most messages the volunteers remembered put a positive spin on the aging process. Thirty-four percent said they had either changed their lives or changed their relationships with others as a result. About 11% had resolved to enjoy life more, and 7% had taken up exercise and were eating healthily.

Describing the impact of memorable messages, one volunteer wrote: "The message had a tremendous effect on my thoughts of old age. I now see it as an award for leading a decent life."

Another wrote: "It has shown me that aging is not a bad thing. It will be a time where I can relax and watch my family grow."

Holladay said it is most likely that people remember phrases or messages that are important to them, either because of the timing or their own beliefs.

Source: Journal of Communication 2002;52:681-69.


Bypass Surgery Can Bypass Heart-Lung Pump

By Amanda Gardner
HealthScoutNews Reporter


Wednesday, January 28, 2003

WEDNESDAY, Jan. 29 (HealthScoutNews) -- Coronary bypass surgery without a heart-lung machine is as successful as surgery with the machine, and it may be less expensive to boot.

That's what Dutch researchers claim in a report that appears in the Jan. 30 issue of the New England Journal of Medicine (news - web sites).

Coronary artery bypass graft surgery (CABG), performed when a person has a blocked artery, involves using a blood vessel from another part of the body to reroute blood around the blocked vessel.

Traditionally, CABG is performed on a stopped heart, while a heart-lung machine keeps the patient alive. "The advantages of using the machine are that the surgeon can operate in a clean, dry field with great precision and at a steady pace without feeling like he's got an ax above his head," explains Dr. Joseph Cunningham, chairman of surgery and director of cardiothoracic surgery at Maimonides Medical Center in Brooklyn, N.Y.

There are, however, some drawbacks to using a heart-lung machine. Some evidence shows the machine might cause inflammation of the lungs, heart, or other organs, Cunningham says. And other studies suggest the machine results in cognitive disorders years down the line.

Finally, some experts believe that patients would have fewer complications and, therefore, a shorter and less expensive hospital stay if no machine was used. In fact, there is some evidence to support this. According to one statistic cited in the study, only 64.5 percent of patients who had been hooked up to the heart-lung machine did not have complications. Longer hospital stays and recovery periods were also noted.

Thus was born a movement to find alternatives to the heart-lung machine. Performing the surgery without a machine rose in New York from 3 percent in 1997 to 27 percent in 2000, notes an accompanying commentary.

This study set out to quantify the differences between the two types of bypass surgery. It looked at 139 patients who had surgery with the machine and 142 who went without it. All the patients were relatively young -- about 61 or 62 years old -- and had only one or two blocked vessels.

After one year, the survival rate and freedom from complications was roughly equivalent: 90.6 percent for the group that had not used a heart-lung machine and 88 percent for the group that had.

To top it off, surgery employing a heart-lung machine was more expensive: $1,839 in additional direct costs per patient, a difference of 14.1 percent.

There are a few caveats. For one thing, the study involved only low-risk patients. "This is a subset of patients who, by all criteria, should be winners to begin with," Cunningham says. "I would expect good results in this particular group of patients."

And although off pump procedure is cheaper, that's "a weak reason to choose one modality over another," Cunningham says. (The cost savings may actually be an illusion. When Cunningham did a cost comparison at his own center, he found the two procedures were identical when it came to cost, possibly indicating price differences between the United States and the Netherlands.)

So, should the pump be on or off?

"The downside of doing something off-pump is that in many situations if you're not selective about the patients you're operating on and the type of artery you decide to bypass, you may end up doing a bypass with less precision," Cunningham says.

"This approach [without a heart-lung machine] is not for everybody," Cunningham says. "There are six ways to skin a cat, and this is just one of them. You have to learn when to use this technology and take advantage of its positive aspects and when to say no."

More information

Check out the American Heart Association (news - web sites) for more on bypass surgery and on the history of the heart-lung machine.



Curing Kidney Tumors Without Surgery

By Jennifer Thomas
HealthScoutNews Reporter


Tuesday, January 28, 2003

TUESDAY, Jan. 28 (HealthScoutNews) -- Kidney tumors just got a little easier to cure.

A treatment called radiofrequency ablation zaps kidney cancers with electrical currents, causing the tumors to disintegrate without the need for surgery, a new study says.

"It's very promising for small tumors and tumors growing outside of the kidney," says Dr. Debra Gervais, director of Interventional Radiology at Massachusetts General Hospital in Boston. "It's a little more problematic if the tumors are larger or close to a vital structure or organ."

Gervais and her colleagues tried the technique on 42 relatively small, cancerous tumors in 34 patients. The tumors, which ranged in size from 1 centimeter to 9 centimeters, had not metastasized -- or spread -- to other organs.

The researchers were able to eliminate 36 of the tumors completely, including all those, regardless of size, located on the surface of the kidney.

Larger tumors (3 centimeters or bigger) deep inside the kidney were more difficult to treat. The researchers were able to eliminate about half of them.

Two of the 11 larger, centrally located tumors were eliminated in a single session. Three others were eliminated with only one additional visit.

The study, the most extensive to date on radiofrequency ablation and kidney cancer, appears in the February issue of Radiology.

After three and a half years, no one in the study had a recurrence of kidney cancer.

"It's a very promising application of this technology," says Dr. Bradford Wood, an interventional radiologist at the National Institutes of Health (news - web sites) who was involved with some of the earliest studies on radiofrequency ablation and cancer.

The American Cancer Society (news - web sites) estimates there will be approximately 31,900 new cases of kidney cancer in the United States in 2003. The five-year survival rate for people diagnosed with renal cell carcinoma is approximately 60 percent.

The current standard treatment is surgical removal of the kidney, Gervais says.

In radiofrequency ablation, an insulated needle is inserted into the tumor mass, using a CT scan, ultrasound or other imaging technique to guide it.

An electrical current from the needle heats up and burns the cancer tumor, turning it into a mass of dead scar tissue, says Gervais, lead author of the study and an assistant professor of radiology at Harvard Medical School (news - web sites).

For that reason, radiofrequency ablation can't be used to treat all cancers, Gervais says. Doctors have to be very careful not to damage surrounding organs or tissues.

The insulating fat surrounding the kidney allows high temperature ablation on tumors protruding from the kidney. Tumors deep inside the kidney are more difficult to eliminate because ablation temperatures must be controlled to avoid damaging the rest of the kidney, she says.

For now, Gervais limits radiofrequency ablation to patients who aren't good candidates for surgery because of kidney disease, or because they only have one functioning kidney.

Doctors are experimenting with radiofrequency ablation on other types of cancers.

The procedure was first used in the 1980s on benign, painful bone tumors, Gervais says.

The technique is also used on some liver cancers, lung cancer and to treat a type of heart arrhythmia.

Wood says he has used radiofrequency ablation on tumors from "the neck to the thigh."

One newer use of the technique is to relieve pain in people who are dying from cancer, Wood says. Cancerous tumors, as they grow, can push on other structures of the body, causing pain.

In some cases, he can use radiofrequency ablation to reduce the size of the tumor, easing the discomfort.

For example, he and his colleagues used the technique in a woman who had a large tumor in the wall of her pelvis that was causing her extreme pain and forcing her to urinate every hour.

"She only lived another nine months, but reducing the size of the tumor allowed her to get off much of her pain medication and enjoy the last months with her family," Wood says.

More information

Read more about radiofrequency ablation and its uses at the National Institutes of Health. The American Cancer Society has information about kidney cancer.


Experts Warn Against Sleep-Deprived Kids 

By Siobhan McDonough

Associated Press Writer

The Associated Press

Tuesday, January 28, 2003

WASHINGTON - To wake parents up to the importance of snoozing, sleep experts warned Tuesday that seemingly energetic children who dodge bedtime for other activities are more prone to injury, poor school performance and crankiness.

"A tired child is an accident waiting to happen," said Dr. Carl Hunt, director of the National Center on Sleep Disorders Research at the National Institutes of Health (news - web sites).

Many children with chronic sleep deprivation may not seem tired and may even appear to be overactive.

Hunt said injuries on bicycles and on playground equipment are more likely to occur when a child is sleep-deprived, and if poor sleeping habits continue as kids grow older, "the stakes get higher."

"It turns into the teenager who is drowsy and driving a car," he said.

Research shows that bad sleep habits for children can carry over into poor health for adults — causing heart ailments, respiratory problems and obesity, said Dr. Claude Lenfant, director of NIH's National Heart, Lung and Blood Institute.

Children ages 7 to 11 require at least nine hours of sleep each night on a regular basis to do their best in school and extracurricular activities, NIH said.

Inadequate sleep results in difficulties with focused attention, irritability, easy frustration and difficulty controlling emotions.

NIH estimates that more than 70 million Americans of every age are sleep-deprived.

"Unfortunately in this 24-7 society we're living in these days, it creates many distractions and obstacles to getting a good night's sleep," said Hunt. "We're living in a society that doesn't value sleep enough."

Besides increased extracurricular activities and homework, things that are getting in the way of a good night's sleep for a child are television, the Internet, cell phones and e-mail — with many of those distractions located in children's bedrooms.

"These give children lots of opportunity to do other things besides sleep," Hunt said.

To address health problems associated with sleep deprivation, NIH launched its Star Sleeper educational campaign to raise family awareness to the problem.

On Tuesday, it announced three winners of its "How I Get a Heap of Sleep" contest in which children described their tactics for getting nine hours of sleep each night. One winner was Danielle Wodka, 7, of Lemont, Ill. Her sleep strategies included taking a warm bath and saying her prayers.

Other winners — including Amanda Davol of Somerset, Mass., and Qian Wang of Fort Thomas, Ky. — said they listened to soothing music or read a book to lull them into sleep.

Getting children in the mood for bedtime is half the battle, says Danielle's mother, Chris Wodka, of Lemont, Ill.

"It's a struggle with Game Boy and the TV shows," said Wodka.

On the Net:

National Institutes of Health Star Sleeper educational campaign:


Skiers at Risk for Skin Cancer, Experts Say

By Stephanie Riesenman

Reuters Health

Tuesday, January 28, 2003 

NEW YORK (Reuters Health) - Skiers beware: you may be soaking up as much sun on some slopes as you would at a midsummer beach, according to a new study by New York dermatologists.

"People don't think of sun protection in the winter, that's what this study shows. Especially when you're skiing, remember to protect yourself from the sun," said Dr. Darrell S. Rigel, a professor of dermatology at the New York University School of Medicine.

According to a report in the January issue of the Archives of Dermatology (news - web sites), Rigel and colleagues measured ultraviolet radiation (UV) rays at a popular ski resort in Vail, Colorado by having 10 professional ski instructors wear UV sensors on their arms. Data for hourly exposure to UV-B was collected for 84 days, and UV-A data was collected for 66 days.

The researchers found that the sun's intensity at the base of the mountain in Vail in December was equivalent to a summer day in Florida or a June day at the beach in New York.

The researchers say UV exposure increases as elevation increases, so for skiers, the risk for skin cancer may be just as great on a snowy mountain as it is on a sandy beach in the summer. Vail is located at 2,500 to 3,500 meters (8,200 to 11,400 feet) above sea level.

Rigel told Reuters Health most people don't think about getting a sunburn in the wintertime because it's so cold. But temperature doesn't measure the amount of radiation hitting the skin.

The risk of melanoma--the most rare but dangerous type of skin cancer--is strongly correlated with sun exposure and sunburn, especially when the exposure occurs before the age of 18. Similar to smoking, the younger you start, the greater the risk for cancer, said Rigel.

Prior to the current study, no one had quantitatively measured radiation exposure in alpine skiers, he said.

About two thirds of the skiers received an average daily UV exposure about twice that necessary to burn fair or light skin, he said. "So basically they got more than twice of what it takes to sunburn, and if they didn't wear sunscreen they were guaranteed to burn that day," he said.

Protection is as easy as changing a few behaviors. Rigel and his colleagues suggest wearing clothing and eye gear that shields from the sun's rays. If you're going to ski in a T-shirt, make sure to put on some sunscreen. Peak sun exposure occurs from 10 AM to 2 PM, prime skiing hours, so Rigel says nothing less than SPF 30 should be slathered on skin that's exposed.

Those who rarely burn, or have olive or brown complexions should also wear sunscreen. People with dark complexions may not get red from the sun, but the exposure can still cause damage that leads to premature aging or skin cancer later in life, according to Rigel.

"There are more skin cancers than all other cancers combined in the United States each year," said Rigel. "The fact is, skin cancer is one of the few cancers where we know what the cause of almost all of them are, and a simple behavioral change can dramatically lower your risk."

Source: Archives of Dermatology 2003;139:60-62.


Test May Help in Heart Disease Prevention

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Tuesday, January 28, 2003

A check for hidden, painless inflammation is likely to become part of a standard checkup for millions of Americans at moderate risk of heart disease.

New guidelines published Tuesday suggest doing a blood test for C-reactive protein, or CRP, when doctors are unsure whether their patients need aggressive treatment and lifestyle changes to protect their hearts. Studies in recent years have shown that people with high levels of this inflammatory protein, necessary for fighting injury and infection, face double the usual risk of heart attacks and strokes.

"These recommendations are exceptionally conservative but very important," said Dr. Paul Ridker of Boston's Brigham and Women's Hospital, who pioneered the field.

The new recommendations, drawn up by the American Heart Association (news - web sites) and the Centers for Disease Control and Prevention (news - web sites), are the first to propose an important role for inflammation testing in heart disease.

They suggest limiting the testing to those already judged to be at 10 percent to 20 percent risk of heart disease over the next 10 years, based on such factors as age, high cholesterol and high blood pressure. This category is large, encompassing an estimated 40 percent of U.S. adults.

However, even in these patients, the test is considered optional and should be used only if it will help doctors decide whether they need treatment, which typically includes cholesterol-lowering drugs, better diets and losing weight.

The guidelines urge against testing people at very low risk, since those patients would probably not be put on treatment even if inflammation were found, as well as those already diagnosed with heart disease, since they should already be getting all standard treatments.

"The guidelines are very much oriented toward coming up with numbers that would alter your or your patients' behavior," said Dr. Thomas Pearson of the University of Rochester, co-chairman of the committee that wrote the statement.

The inflammation comes from many sources — including possibly even gum disease and lingering urinary infections — and triggers heart attacks by weakening the walls of blood vessels and making fatty buildups burst. It can be measured with a test that checks for C-reactive protein, a chemical necessary for fighting injury and infection. The tests cost a few dollars to perform, and labs and hospitals charge between $10 and $120.

The cautiously worded statement is being published in the journal Circulation. Pearson said it struck a balance between those who argue every adult should get a CRP test and those who reject any use, in part because they fear it will draw attention away from cholesterol lowering.

Dr. Eric Topol, cardiology chief at the Cleveland Clinic, called the guidelines "a dramatic advance" but wished they recommended testing for everyone at intermediate or high risk.

"In medicine, advances and changes in practice come slowly, unfortunately, so this set of recommendations is typical of a burgeoning field where the evidence overrides the ability of a group of experts to come to consensus," Topol said.

One of Ridker's latest studies, conducted in women, found that half of all heart attacks and strokes occur in people with seemingly safe cholesterol levels, and that those with high CRP have double the risk of women with low levels.

He said CRP is the first new blood test to be accepted for checking heart disease risk since cholesterol screening became standard about 30 years ago.

CRP can be lowered by the same strategies that bring down cholesterol — exercising, losing weight, giving up smoking and taking statin drugs.

For now, Pearson said the field lacks gold standard studies showing that measuring and treating elevated CRP helps people live longer. However, such experiments are under way.

One, directed by Ridker and financed by AstraZeneca, will test the statin rosuvastatin, which is not yet approved for routine prescription in the United States. It will involve about 15,000 men and women with no history of heart trouble, cholesterol in the safe range and CRP above two milligrams per deciliter of blood.

The average CRP reading in the United States is 1.5. Ridker's studies show the risk is dramatically higher when levels hit 3.

Editor’s Note: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.

On the Net:



Covering Bedding Cuts Kids' Need for Asthma Drugs 

Reuters Health

Tuesday, January 28, 2003

NEW YORK (Reuters Health) - Encasing mattresses and pillows in special covers may help asthmatic children cut down on their use of powerful anti-inflammatory drugs, new study findings from Denmark suggest.

After 1 year, about 73% of youngsters given the polyurethane covers cut their dose of inhaled steroids by at least half, compared with 24% of children given cotton covers, according to the report published in the January issue of the Journal of Allergy and Clinical Immunology.

Such polyurethane covers have long been recommended as a way to cut down dust-mite allergen, the most common cause of allergic asthma, although how effective they are has been unclear. The proteins associated with dust mites, the ubiquitous microscopic creatures that live in and on many household surfaces, can collect in pillows and mattresses.

In the current study, Dr. Susanne Halken of the Sonderborg Hospital and colleagues had 26 asthmatic children aged 5 to 15 use pillows and mattresses completely encased in semi-permeable polyurethane. A second group of 21 children were given mattress and pillow covers made of good quality cotton.

All of the children has asthma, were allergic to dust mites and had never used such covers before. Youngsters allergic to cats or pollen were excluded from the study.

Before and during the study, the researchers tapered the children's inhaled steroids to the lowest effective dose. Corticosteroids are medications used to treat inflammatory conditions such as asthma and chronic lung disease. They are usually used in combination with bronchodilators, which are drugs that widen the airways and make it easier to breathe.

"We found a significant effect of the coated polyurethane mattress and pillow encasings on the need for inhaled steroids," the researchers report.

They found that the dose of inhaled steroids was cut by about 50% in those children without causing their symptoms to get worse or requiring an increase in other medications.

Asthma is the most common chronic disease in children, and for reasons that are unknown, the number of asthma cases has been on the rise in the US and other developed countries.

Source: Journal of Allergy and Clinical Immunology 2003;111:169-176.


Stopping a Cold in its Tracks


Tuesday, January 28, 2003

TUESDAY, Jan. 28 (HealthScoutNews) -- Zincum gluconicum nasal gel reduces the severity and duration of cold symptoms, even when treatment starts on the second day of the cold.

New research, which appears in the January issue of QJM: An International Journal of Medicine, is the first to look at the effectiveness of zincum gluconium nasal gel when it's used after the first 24 hours of illness.

The study found people with a cold who were treated with the nasal gel had a 50 percent reduction in the length of time it took to be free of cold symptoms, compared to people in a placebo group.

The researchers suggest this study provides more proof that the nasal gel is effective in reducing nasal drainage, nasal congestion, sore throat and other cold symptoms.

The study included 78 people between the ages of 18 and 55. They all had cold symptoms but were otherwise in good health. The study participants were enrolled within 24 to 48 hours after they had the onset of three or more of these symptoms: nasal drainage, sore throat, nasal congestion, sneezing, scratchy throat, hoarseness, cough, headache, fever, and muscle aches.

Forty of the people were treated with the nasal gel and 38 received a placebo. The study subjects were not allowed to use any other cold remedies during the study period.

The study was funded by Matrixx Initiatives Inc., which makes the nasal gel.

More information

Here's where you can learn more about the common cold.


Aspirin Users Show Lower Esophageal Cancer Risk 

By Amy Norton

Reuters Health

Tuesday, January 28, 2003

NEW YORK (Reuters Health) - New research suggests that aspirin and related painkillers may help protect against cancer of the esophagus, a relatively rare but often fatal disease.

The study found only an association between lower esophageal cancer risk and the use of non-steroidal anti-inflammatory drugs (NSAIDs)--and not a cause-and-effect relationship.

Still, researchers say their findings warrant studies into whether NSAIDs can help prevent the cancer in certain people at heightened risk.

For example, a small percentage of people with a condition called Barrett's esophagus will develop esophageal cancer. Barrett's esophagus develops in some people with acid reflux disease due to cumulative damage to the esophageal lining.

At first glance, an association between NSAID use and lower esophageal cancer risk might seem odd: One of the medications' well-known side effects is irritation of the gastrointestinal tract, including ulcers and bleeding.

The American Cancer Society (news - web sites)'s Dr. Michael J. Thun told Reuters Health that several years ago, he would have doubted the association found in the new study.

However, he said, lab research in recent years has given a "strong biological basis" to the idea that NSAID use might lower the risk of some cancers, including those of the colon and prostate.

The reason has to do with the drugs' ability to fight inflammation, which is thought to play an important role in the complex cancer process.

Specifically, NSAIDs block the activity of an enzyme called COX-2, which is suspected of aiding cancer-cell growth. Studies show that COX-2 activity is induced early in the development of some tumors, including those of the esophagus.

Now the new research--a review of nine earlier studies--shows that people who reported any use of aspirin or other NSAIDs had a roughly 40% lower annual risk of esophageal cancer.

And more frequent use was associated with greater protection than "intermittent" use was, Dr. Douglas A. Corley, of the University of California, San Francisco, and his colleagues found.

Broken down by medication type, aspirin showed the strongest protective effect, while other NSAIDs were "borderline protective," according to findings published in the January issue of Gastroenterology.

However, aspirin and other older-generation NSAIDs, such as ibuprofen and naproxen, also block the COX-1 enzyme--a feature that means they can irritate the gastrointestinal tract.

So, the current findings could, in part, reflect the fact that people with acid reflux or other GI problems often avoid NSAIDs. If this is true, it would create the false impression that NSAIDs were helping to prevent cancer.

Such "reverse causation" is a possibility, Thun notes in an accompanying editorial.

"What's missing," he explained in an interview, "is the final proof" that NSAID use directly lowers esophageal cancer risk.

Because regular NSAID use can cause GI problems, Thun said, doctors need a "high degree of certainty" that the drugs can safely lower cancer risk before they recommend them for that purpose.

Among the "major questions" that future studies must answer, he noted, are what NSAID dose and what duration of use might do the job.

So far, three trials of NSAIDs for esophageal cancer prevention have gotten underway.

Source: Gastroenterology 2003;124:47-56,246-248.


Counting Calories Can Protect Your Brain


Tuesday, January 28, 2003

TUESDAY, Jan. 28 (HealthScoutNews) -- Counting calories does more than keep your waistline trim: It may also help you protect your brain against the ravages of aging.

A University of Florida study is the first to look at the effects of lifelong calorie-restricted diets on brain cells. It found that certain proteins linked to cell death that naturally increase with age were greatly reduced in the brains of rats with limited calorie intake.

The study also found that levels of a beneficial protein that provides protection against brain cell death were twice as high in older rats whose calorie intake was restricted by 40 percent.

The findings could be important in finding ways to limit memory loss and other mental declines that are a normal part of aging, and also for combating disorders such as Parkinson's and Alzheimer's diseases.

The study was published in the online edition of the journal of the Federation of American Societies for Experimental Biology.

More information

Here's where you can learn more about the aging brain.


Athletes Prone to Joint, Bone Problems 

By Patricia Reaney


Tuesday, January 28, 2003

LONDON (Reuters) - Athletes may be in top shape but the grueling physical activity and competition to which they subject themselves increases their risk of suffering bone and joint problems, researchers said on Monday.

British soccer players are 10 times more likely to develop osteoarthritis in their hip than other men and long-distance runners are more prone to low bone mineral density, which can lead to fractures and the brittle-bone disease osteoporosis.

"We suspect it is just the nature of the sport. It is almost analogous to an industrial injury," said Gordon Shepard, an orthopedic surgeon at the Royal Bolton Hospital in Lancashire, northern England.

Shepard and his colleagues studied the rate of osteoarthritis in 68 football managers who had been former players and 136 men who had never played football. Their research is reported in The British Journal of Sports Medicine.

They discovered that nine of the former players suffered from osteoarthritis, even if they have not had a serious hip injury, and six of them had had a total of eight hip replacements between them. But there were only two cases of the illness in the non-footballers.

"There was about a 10-fold difference between the ex-professional players and non-professionals," Shepard added in an interview.

There were not only more cases of the illness among former footballers, they also had hip replacements in their late 30s and early 40s, which is uncommon at such a young age in a small group of people.

Shepard believes that footballers probably sustained minor groin and other injuries which increased the risk of osteoarthritis, an illness in which the joints wear out.

In a separate study in the journal, Dr. Melanie Burrows and researchers at the University of East London found that instead of increasing bone mineral density in female athletes, long distance running lowered it.

By measuring the bone density of 52 women who ran between 5 and 70 km (3 and 43 miles) a week, they discovered a link between lower bone density in the spine and hip and running greater distances, even after taking account of differences such as diet, size and age.

But they found that the heavier women in the study, who had more muscle than fat, had a higher bone density, similar to athletes who do weightlifting, gymnastics and volleyball.

"It may not be the exercise mode alone that affects bone mineral density but the force applied to the limbs during such exercise and the resulting effects on body composition," Burrows said in the journal.


Airplane Exercise


Tuesday, January 28, 2003

(HealthScoutNews) -- With airlines reigning in their budgets, more leg room for travelers is unlikely to be on a company's agenda soon, despite all the talk about economy class syndrome.

 So to keep your blood flowing, especially during long airplane flights, the American Physical Therapy Association recommends you:

  • Take a walk down the aisle every hour or so.
  • Do in-seat exercises every half-hour, such as heel lifts, toe lifts and ankle rotations. Repeat each movement 10 times.


Inhaled Steroids May Not Reduce Women's Bone Mass 

Reuters Health

Tuesday, January 28, 2003

NEW YORK (Reuters Health) - Postmenopausal women who use inhaled steroids to control their asthma may not be increasing their risk of osteoporosis and bone fracture over the long term, new study findings suggest.

Inhaled steroids, which are among the safest and most effective treatments for persistent asthma, reduce inflammation in the airways. While steroids taken orally are known to reduce bone mass, it is unclear whether steroids taken through an inhaler, at currently recommended doses, have the same effect.

The new study found that inhaled corticosteroids were not associated with a loss of bone density in the forearms of women who were long-term users.

Dr. Solve Elmstahl, of Lund University in Malmo, Sweden, and colleagues measured bone density in the forearms of 106 postmenopausal women who had a history of using only inhaled steroids. They were compared with 674 women who had never been exposed to corticosteroids and 49 women with a history of using oral, injected and inhaled steroids.

On average, study participants had used inhaled steroids for about 8 years, according to the report in the January issue of the Journal of Allergy and Clinical Immunology.

The researchers found no difference in bone density between the inhaled-steroid group and the group with no steroid use. Women who had used oral steroids, as expected, had the lowest bone density measurements.

"Moderate doses of inhaled corticosteroids seem to carry less risk than traditional oral corticosteroid therapy provided that the dose is kept at the lowest daily dose sufficient to maintain optimum control of the disease," the authors write.

Nonetheless, Elmstahl's team notes that the number of women in the their study was small, and additional research will need to confirm or refute their findings.

According to experts, women on steroid medications can help preserve their bone mass by engaging in weight-bearing exercise and getting enough calcium and vitamin D.

Source: Journal of Allergy and Clinical Immunology 2003;111:91-96.


Resolute Resolutions


Tuesday, January 28, 2003

(HealthScoutNews) -- We're less than a month into the new year, and already some of your resolutions may be on thin ice.

Stay on track with these tips from the Texas Medical Association:

  • Seek support from friends who will cheer you on or who share similar goals.
  • Make a list of the benefits of making a change and stick the list on the fridge or somewhere where you'll see it every day.
  • Instead of thinking "I'll never make it," praise yourself for each day's progress.
  • Get plenty of sleep. You're more likely to give in to impulses if you're tired.
  • Have a contingency plan for when you're tempted. For instance, if you want to smoke, go for a walk instead, or call a friend.
  • Reward yourself for your progress.


Glucosamine Supplement May Ease Knee Pain

NEW YORK (Reuters Health) - Glucosamine supplements may provide some degree of relief to chronic knee-pain sufferers, a small Australian study suggests.



"Glucosamine seems to provide benefits to people who (have) knee pain that is likely due to cartilage damage, and these benefits are most noticed in daily activities, such as walking," lead author Dr. Rebecca Braham of Monash University told Reuters Health.

Among the 46 volunteers her team studied, 88% of those who took glucosamine supplements for 12 weeks reported "some degree of improvement" in their knee pain.

The findings appear in the January issue of the British Journal of Sports Medicine.

Glucosamine is a natural substance found in the body, made from the combination of glucose and glutamine, explained Braham. It is found mostly in the cartilage and plays an important role in that tissue's health and resilience.

"Many researchers believe that joint cartilage is alive and constantly rebuilding itself in such a way that as old or damaged cartilage degenerates, it is replaced by new healthy cartilage," Braham said.

Previous research has suggested that glucosamine-containing supplements may reduce cartilage breakdown and cushion the joints. Such over-the-counter supplements are frequently marketed to people with osteoarthritis, which is marked by the breakdown of cartilage, resulting in joint inflammation, pain and stiffness.

In the current study, 24 men and women between the ages of 20 and 70 who were "suffering from regular knee pain of unspecified origin" took daily glucosamine supplements. Twenty-two other knee-pain sufferers took a placebo.

After 12 weeks, 88% of the glucosamine group reported improvements in knee pain, compared with only 17% of the placebo group.

However, in tests of knee function, such as stair climbing, there were no clear differences between the groups.

Braham pointed out that, at the dose used in the study--2,000 milligrams per day--there were "no major side effects."

"Some patients," she added, "experienced mild side effects, but these were experienced by patients in each group--not just the glucosamine group--and no side effects were severe enough to warrant withdrawal from the study."

These side effects included headache, stomach upset and dry mouth.

The study was conducted and funded by the Department of Human Movement and Exercise Science at the University of Western Australia. The glucosamine supplement was supplied by Musashi, an Australian company that makes sports supplements.

Source:British Journal of Sports Medicine 2003;37:45-49.


New Guidelines for Cervical Cancer Screening


Tuesday, January 28, 2003

TUESDAY, Jan. 28 (HealthScoutNews) -- While regular screening for cervical cancer is strongly recommended for women between the ages of 21 and 65, some women can safely discontinue regular screening or be screened less often, says the U.S. Preventive Services Task Force.

The task force says the harm of continued routine screening, such as false positive tests and invasive procedures, outweighs the benefits of regular screening for women aged 65 and over who have had regular normal Pap smears.

And there is no evidence that annual screening achieves better outcomes than screening every three years in young women who have had at least two normal annual screenings, the task force says.

Pap testing followed by appropriate treatment can effectively prevent invasive cervical cancer by detecting pre-cancerous lesions before they grow and spread, the task force says.

Here are some other recommendations from the task force, the nation's leading independent panel of private-sector experts in prevention and primary care:

·         Screening should start for women three years after they begin sexual activity or at age 21, whichever comes first.

  • Screening is not recommended for women who have had a total hysterectomy for a non-cancerous condition.
  • There is insufficient evidence to recommend for or against new technologies such as liquid-based cytology instead of conventional Pap smears to screen for cervical cancer.
  • There also is insufficient evidence to recommend for or against the use of human papillomavirus testing as a primary screening tool for cervical cancer.

More information

Here's where you can learn more about cervical cancer.


Study Doubts Acrylamide in Food Causes Cancer

By Patricia Reaney


Tuesday, January 28, 2003

LONDON (Reuters) - Fried foods such as potato chips and French fries may contain a substance that can cause cancer in animals, but the levels do not appear high enough to increase the risk of the disease in humans, researchers said on Tuesday.



Swedish scientists sparked a worldwide food scare last year when they found high levels of acrylamide, a suspected human carcinogen, in high-carbohydrate foods including crackers, certain cereals and cooked potatoes.

But new research by scientists at the Harvard School of Public Health in Boston, Massachusetts, and the Karolinska Institute in Sweden--the first to look at acrylamide in terms of human diet and cancer risk--suggests it may not be as dangerous as people have been led to believe.

"There was a lot of concern in the public that was raised from the initial findings of acrylamide in food," said Dr. Lorelei Mucci of Harvard.

"This study provides some evidence that the amount of acrylamide people are taking in is probably not sufficient to increase the risk of cancer," she told Reuters.

Although conclusions about the health risks of acrylamide cannot be drawn from one study, Mucci said the research is a starting point that could help to address some of the concerns raised by Sweden's National Food Administration, a government food safety agency.

Animal Studies

Acrylamide, a colorless compound used in manufacturing processes, in laboratories and in water purification, is labelled as a probable carcinogen based on data from animal research.

But Mucci said doses given in animal studies were several times higher than what humans would be exposed to through diet or other sources.

"These data suggest the doses of acrylamide people are taking in can be effectively detoxified," she said, referring to her research, which is published in the British Journal of Cancer.

The American and Swedish researchers studied the diets of 987 patients with either cancer of the colon, bladder, rectum or kidney, as well as more than 500 healthy people, to determine whether levels of acrylamide could be a factor in the development of the disease.

They calculated participants' dietary acrylamide intake by asking them how often they ate a range of different foods, including items--such as fried potatoes, bread and biscuits--that have been found to have medium or high levels of acrylamide.

The researchers found no link between the compound in food and the risk of bladder or kidney cancer, and high amounts of acrylamide were associated with a reduced risk of bowel cancer.

However, the scientists said the lower bowel-cancer risk could be due to other factors, such as the high fibre content in the foods.

"This study provides preliminary evidence that there's less to worry about than was thought," Mucci said.

Scientists believe acrylamide is formed during the cooking process, when starchy foods like potatoes, rice and cereals are fried or baked at high temperatures.

"We know that acrylamide can be carcinogenic to animals, but this study suggests that either the levels in food are too low to affect cancer risk, or that the body is able to deactivate the chemical in some way," Sir Paul Nurse, chief executive of the charity Cancer Research UK, said in a statement.

Source: British Journal of Cancer 2003;88.


With Exercise, More Isn't Always Better 

By Serena Gordon
HealthScoutNews Reporter


Tuesday, January 28, 2003

TUESDAY, Jan. 28 (HealthScoutNews) -- If some exercise is good for you, then more must be better, right?

Not so, say two studies appearing in the February issue of the British Journal of Sports Medicine.

One study found that professional soccer players have an increased risk of osteoarthritis in the hip, while researchers in the second study discovered that women who run long distances are at risk for lower bone density, which can lead to osteoporosis.

For the first study, researchers in the United Kingdom compared 68 professional soccer players to 136 comparably aged "controls" who hadn't played professional sports. The soccer players answered questionnaires about their health, while information about members of the control group was obtained from X-rays used in a previous study.

"The study showed that the footballers (soccer players) had a tenfold higher prevalence of osteoarthritis of the hip than the general public," says one of the study's authors, Dr. Gordon Shepard, a consultant orthopedic surgeon at Royal Bolton Hospital in Lancashire.

Dr. Charles Ruotolo, director of Sports Medicine at Nassau University Medical Center in New York, says he's not surprised by the findings.

"It's not an uncommon thing to hear about professional athletes after 20 or 30 years of competition developing osteoarthritis," he says.

He did, however, say the study would have been more useful if the researchers had compared hip X-rays of the soccer players to the X-rays of the control group, rather than relying on questionnaires for the soccer players.

For the second study, researchers from the University of East London looked at 52 premenopausal women, between the ages of 18 and 44, who ran between five and 70 kilometers a week. That's about the equivalent of three to 43 miles.

The study volunteers kept food diaries so the researchers could track intake of vital nutrients, such as calcium, magnesium and zinc. The scientists also included information on menstrual cycles and contraceptive use in their analysis.

They found that the more a woman ran, the greater her chance of low bone density. The researchers noted a 2 percent drop in bone density for every 10 kilometers (6 miles) run a week.

Diet didn't seem to play a large role in the bone density of the spine in this study. However, higher intake of magnesium coupled with lower zinc intake was associated with higher bone density in the thigh.

"Load-bearing exercise is assumed to increase bone density," says Ruotolo, "but for women, if you do too much, it can actually decrease bone mineral density."

Does all this mean you should hang up your gym shoes? Not at all.

Shepard points out his study was on professional athletes, and says he doubts that people who play soccer recreationally would get arthritis from it.

Ruotolo suggests that women who like to run long distances should talk with their doctors about their diets, to be sure they're getting enough nutrients to keep their bones healthy.

And, while there's no "magic number" of miles that women should run each week, Ruotolo says if you find you're not getting your menstrual period as regularly as you used to, that's often a sign that you're running too much.

More information

Here's some more information, from the Arthritis Foundation, on how moderate exercise can help people with arthritis. And this article from The Physician and Sportsmedicine discusses what exercises are helpful for preventing osteoporosis.


Workers' Comp May Cover Smallpox-Vaccine Injury 

By Alicia Ault

Reuters Health

Tuesday, January 28, 2003

NEW YORK (Reuters Health) - Kentucky received word last week that its workers' compensation program will cover smallpox vaccine-related injuries, and several other states, including New Jersey and New York, have gotten similar preliminary advisories, health officials said Tuesday.

Health workers' unions, nursing organizations and some hospitals have urged against starting the federal government's ambitious plan to vaccinate up to 500,000 volunteers until states and the federal government determined whether workers' comp would compensate any injured recipients.

Vaccination began January 24, largely because liability protection for hospitals and vaccine manufacturers kicked in under the Homeland Security Act. But there has been no statement that vaccine volunteers--or family members or others who might be infected by the vaccine's live vaccinia virus--would be protected.

The House and Senate will hold hearings Wednesday and Thursday on the smallpox plan, and several senators, including Massachusetts Democrat Ted Kennedy, have said they would consider introducing a bill to offer federal compensation.

But in the meantime, some states are moving ahead.

The Kentucky Department of Workers' Claims issued a written opinion January 24 that smallpox vaccinations "have a direct benefit to the healthcare employer" and are being encouraged by the federal government, and so "would be covered for purposes of workers' compensation benefits."

The claim would still ultimately be decided by an administrative law judge, according to the advisory.

The ruling was applauded by Cheryl Peterson, senior policy analyst for the American Nurses Association (ANA).

Still, she told Reuters Health, "it's not going to solve the whole issue."

The ANA is concerned that absent a federal compensation law, there will be a patchwork of state solutions, some good and some bad.

And, noted Peterson, workers' comp does not address other concerns, including who will compensate those who might be secondarily infected by the vaccinia virus--a smallpox-related virus that confers protection against smallpox and generally poses no risk to healthy people.

However, vaccinated individuals can sometimes spread vaccinia to others, and the elderly, pregnant women, children, those with skin conditions like eczema, and the immunocompromised are especially at risk from vaccinia virus infection.

Peterson also said that some compensation programs were only offering oral opinions, not written ones, which she called "bothersome."

Kentucky aims to vaccinate 20 state health workers on Thursday, and after several weeks of monitoring for side effects, immunize up to 180 others, said Gwenda Bond, spokeswoman for the Kentucky Cabinet for Health Services.

She said there has been no reluctance among volunteers so far, but says the state won't be disappointed if it doesn't use all 200 doses.

"We're not concerned with hitting any certain number," said Bond. "This is totally voluntary, and if people have any concerns, they shouldn't be vaccinated."

New Jersey aims to vaccinate 100 workers on Friday, and has been approved to immunize up to 9,500, said spokeswoman Donna Leusner. The state has received a preliminary, but not final, opinion that workers' comp may cover vaccine-related injuries, Leusner said.

In Iowa, which aims to immunize 16 state health workers and 44 hospital volunteers next Tuesday, state employees have been advised that vaccine-related injuries will be covered by the state workers' comp fund, health department spokesman Kevin Teale told Reuters Health.

The state told hospital volunteers to check with their employers and health insurers on coverage, Teale said.

Iowa asked every one of its 140 hospitals to volunteer candidates for vaccination. Fourteen facilities agreed, and workers at those hospitals will start receiving shots later in February, Teale said.


Walking Helps Weakened Lungs

By Ed Edelson
HealthScoutNews Reporter


Tuesday, January 28, 2003

TUESDAY, Jan. 28 (HealthScoutNews) -- Exercise is good for people with the lung-destroying condition called chronic obstructive pulmonary disease (COPD), a Spanish study finds.

COPD patients who did the equivalent of one hour's walking every day had about half the risk of being hospitalized than physically inactive patients, says a report in the February issue of Thorax. The research was done by Judith Garcia-Aymerich and her colleagues at the Municipal Unit of Medical Investigation in Barcelona.

"Of course, we were surprised for such a finding," Garcia-Aymerich says. "In fact, we would have expected the inverse association."

COPD is a combination of lung diseases, mainly emphysema and chronic bronchitis, often caused by smoking, which obstructs airflow into the lungs. It gets progressively worse, with periodic flare-ups that require hospitalization. While it gets relatively little attention, it is the fourth leading cause of death in the United States.

In the study, the researchers monitored 304 men with COPD for just over one year -- a year in which 63 percent of them were hospitalized at least once and 29 percent of them died.

Checking out the various factors in medical treatment and lifestyle, the researchers found that the most important factor that reduced the chance of hospitalization was physical activity. One third of the patients reported daily physical activity that burned the calories exerted in at least one hour of walking, and their rate of hospitalization was 46 percent that of the more inactive patients.

"This is the first study to show a strong association between physical activity and risk of readmission to hospital with COPD, which is potentially relevant for rehabilitation and other therapeutic strategies," the journal report says.

COPD patients are routinely told to exercise but many of them don't because of the breathing problems and fatigue caused by the condition, Garcia-Aymerich says. The need to exercise "can be easily forgotten in the middle of the enormous need of health attention that COPD patients have," she says.

The study results are a bit surprising to Dr. William C. Bailey, a professor of medicine and head of the lung health center at the University of Alabama, but only because "that little exercise produced that much benefit."

"Otherwise, it is consistent with what we know, that pulmonary rehabilitation increases the quality of life," Bailey says. Pulmonary rehabilitation, he explains, is simply an exercise program under the supervision of nurses or other health personnel, and the study results "increase the stimulus to refer people to such a program."

One problem in giving the benefits of a rehabilitation program to COPD patients in the United States is money, Bailey says. Medical insurance generally will cover only one rehabilitation program, for a fixed period or until the patient has to stop because he or she goes into the hospital.

"One hospitalization and you lose all the benefits," he says.

More information

You can get an overview of COPD from the American Lung Association and some guidance on how to exercise from the American Association for Respiratory Care.



Study: Health Woes Linger in Trade Center Workers 

By Martin Downs

Reuters Health

Monday, January 27, 2003

NEW YORK (Reuters Health) - A new study shows that many workers and emergency responders who volunteered in New York after the September 11th terrorist attacks have had lingering health problems related to their rescue, recovery, and cleanup work.

In a press conference today, officials at the Mount Sinai Medical Center in New York announced early results of the ongoing study, which has provided free screening examinations and medical referrals to about 3,500 workers and emergency personnel to date. The data presented today came from exams of 250 people who worked at Ground Zero and the Staten Island landfill following the destruction of the World Trade Center, where they were exposed to hazardous particles in the dust and debris. This group was selected randomly from the first 500 people to participate in the study.

Ten months to one year after September 11, 2001, 73% had symptoms or abnormal findings in physical exams indicating ear, nose, and throat problems. Doctors also saw evidence of lung disease in 57% of them.

Fifty-two percent of those screened reported symptoms of mental health problems that required further evaluation, and about one quarter reported symptoms of post-traumatic stress disorder.

Approximately two thirds of those screened had not received any medical care for their conditions before participating in the study.

Robin Herbert, one of the Mount Sinai program directors, called the findings "alarming," and said the study "clearly demonstrates the need for immediate screening of WTC reponders."

"Even more important is to find the conditions that they will develop early enough so that treatment makes a difference," said Stephen Levin, medical director of the Mount Sinai-Irving J. Selikoff Center for Occupational and Environmental Medicine.

So far, Mount Sinai's program has received $12 million in federal funding-enough to screen 9,000 of an estimated 35,000 who took part in rescue and recovery efforts by July of this year, when the study is scheduled to wrap up. But politicians, doctors, and union representatives who spoke today said more people should be screened; those who are ill should be monitored longer, and that they should receive treatment in addition to screening.

Senator Hillary Clinton (news - web sites) (D, NY) said she would pressure the White House to release another $90 million in federal funds to continue efforts to screen workers and emergency personnel, and to provide treatment. She emphasized the national nature of the issue, given that many people came from outside New York to work at the site.

"This is some of the most important work being done anywhere in our country right now," Clinton said. "This is an American priority to take care of these brave men and women."

The National Institute for Occupational Safety and Health (NIOSH) a division the CDC, has helped support Mount Sinai's program.


Transplant Recipient Gets Nut Allergy

By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, January 27, 2003

CHICAGO - A man who received a liver transplant got a life-threatening nut allergy from the new organ, Australian doctors say.

The organ had come from a 15-year-old boy who died of an allergic reaction to peanuts, the doctors reported in Monday's Archives of Internal Medicine (news - web sites).

Dr. Tri Giang Phan, an immunology specialist at Sydney's Royal Prince Alfred Hospital who was involved in the case, said he knew of only one other report in medical literature of an allergy being passed on in an organ transplant. That incident, reported by French doctors in 1997, involved a man who developed a peanut allergy after a liver and kidney transplant.

While such cases may be rare, organ donors should be screened for allergies and transplant patients should be warned to take precautions, the Australian researchers said.

Nut allergies affect an estimated 3 million Americans. Such allergies generally would be noted during the organ procurement process, which involves obtaining information on the donor's health history, said Dr. Douglas Hanto of the United Network for Organ Sharing.

The 60-year-old Australian transplant patient and his doctors did not know about the boy's condition, which had not been formally diagnosed as a nut allergy, Phan said.

The man's own liver was sickened by chronic hepatitis B and a cancerous tumor. He underwent the transplant at the Sydney hospital in 1999. The day after being sent home, he ate some cashews. Within 15 minutes he developed anaphylaxis — a life-threatening allergic reaction causing tightness in the throat, severe vomiting, dizziness and blurred vision.

He recovered after hospitalization and drug treatment.

Tests showed that he had an allergy to cashews, peanuts and sesame seeds — all foods to which the boy had also been allergic. The reaction probably developed because the man's new liver contained allergy-inducing antibodies, Phan said.

About 11 months after his transplant, the man underwent more tests that suggested his allergy was waning, but he died two years after the operation from complications related to the liver tumor, Phan said.

On the Net:


UNOS: http://www.unos./org

American Society of Transplant Surgeons:


Scientists Discover Natural Antibiotic in Human Gut 

By Linda Carroll

Reuters Health

Monday, January 27, 2003

NEW YORK (Reuters Health) - Researchers have found a potent antibacterial protein that is made naturally by the human body.

The protein, dubbed Ang4, is created by cells in the intestines, according to a study published in the advance online version of the journal Nature Immunology.

It is likely that Ang4 normally plays a role in protecting the lining of the intestines, the study's lead author, Lora V. Hooper, explained in an interview with Reuters Health.

"We showed that Ang4 kills many different types of gut bacteria," said Hooper, a researcher at Washington University School of Medicine in St. Louis, Missouri. "We think that Ang4 is part of the arsenal that use to keep bacteria from getting too close to the intestinal lining and causing damage."

Hooper and her colleagues also found that Ang4 was a potent killer of a type of bacteria called listeria monocytogenes, which has been implicated in recent cases of severe food poisoning.

Interestingly, Hooper pointed out, bacteria that normally live in the gut control the release of Ang4.

There are numerous types of bacteria that live in the intestines in a kind of healthy, symbiotic relationship with their human hosts, explained study co-author Dr. Jeffrey I. Gordon, a professor and head of the department of molecular biology and pharmacology at the Washington University School of Medicine.

Without these bacteria, human beings would not be able to digest certain types of plant-derived nutrients, Gordon said. The breakdown of these nutrients is "assigned to our microbial partners," he added. "Their genes are the ones that have the encoding for the enzymes necessary for breaking down these important nutrients."

But even these "friendly" bacteria can do damage to the gut if they spread too deeply into the intestinal lining, Hooper explained. If they spread into the lining, the body will respond with inflammation, eventually killing off all the bacteria.

So, a system for protecting the intestinal lining has evolved over time, Hooper said. By signaling certain cells in the intestines to release Ang4, the bacteria keep their own numbers in check, creating a sort of "protective electric fence" around the intestinal lining.

"By controlling the expression of these types of antibiotic proteins, the bacteria are helping to shape their own neighborhood," Gordon said. "They groom the landscape in ways that are beneficial for both the host and the bug."

Ultimately, Gordon said, research into how Ang4 and other naturally occurring antibiotics work may lead to better medicines.

"Understanding the mechanism of how these proteins kill bacteria may lead to a better understanding of the chinks in the bacteria's armor," he added. "With the tremendous amount of resistant bacteria out there, it's important to push the envelope to find new classes of antibiotics-new tools to fight bacterial infections."

Source: Nature Immunology online edition 2003;10.1038/ni888.


Sleep Imbalance Linked to Heart Disease

By Geoffrey White

Associated Press Writer

The Associated Press

Monday, January 27, 2003


CHICAGO - Too little sleep — or too much — may raise the risk of developing heart disease, according to a study of nearly 72,000 nurses.

Women who averaged five hours or less of sleep a night were 39 percent more likely to develop heart disease than women who got eight hours. Those sleeping six hours a night had an 18 percent higher risk of developing blocked arteries than the eight-hour sleepers.

And nine or more hours of shuteye was associated with a 37 percent higher risk of heart disease. Researchers could not explain that finding, but suggested those women might have slept more because of underlying illnesses.

"People should start thinking of adequate sleep not as a luxury but more as a component of a healthy lifestyle," said Dr. Najib Ayas, a sleep disorders specialist who was at Harvard-affiliated Brigham and Women's Hospital in Boston when he led the study.

The researchers suggested that getting enough sleep may be nearly as important to heart health as eating right and exercising. And they pointed out a recent poll that found that about one in three Americans has long-term sleep deprivation.

The study was published in Monday's Archives of Internal Medicine (news - web sites).

The researchers could not say for certain whether the findings apply to men, too. But other research strongly suggests so.

Previous studies of men and women found short-term sleep deprivation can raise blood pressure and levels of the stress hormone cortisol, lower glucose tolerance and lead to variations in heart rate — all precursors of heart disease.

Phyllis Zee, director of the sleep disorders center at Northwestern Memorial Hospital, said the findings show that doctors should be asking their patients about sleep habits. And if those patients are losing sleep by choice, "they may want to rethink their priorities," Zee said.

Researchers examined 10 years of data on 71,617 participants in Harvard's Nurses' Health Study, which tracked female nurses for a variety of studies. The women were ages 45 to 65 and had no sign of heart disease at the outset in 1986. Over 10 years, 934 of the women had nonfatal heart attacks or died of heart disease.

The study relied on the nurses' recollection of their sleep patterns rather than directly measuring their sleep.

The researchers were also from the Harvard School of Public Health and Harvard Medical School (news - web sites), all in Boston.

On the Net:

Archives of Internal Medicine,


Study Links Sleep Imbalance to Heart Attacks


Monday, January 27, 2003

CHICAGO (Reuters) - Women who do not get enough sleep as well as those who sleep more than average may run a greater risk of getting heart disease compared with those who log 8 hours of sleep a day, study findings suggest.

Researchers are not sure why women who got less sleep were more likely to develop heart disease, but they point out that previous studies have linked sleep deprivation with high blood pressure. How too much sleep might lead to heart disease is unclear, according to the report.

More than 71,000 women in the study were asked in 1986 about their sleep habits. At the time they did not have heart disease. A decade later in 1996 the group had recorded a total of 934 heart attacks, including 271 fatal attacks.

After researchers took into account several factors, including snoring, smoking and body mass index--a measure of obesity that takes into account height and weight--women who reported sleeping 5 hours or less per day were 45% more likely to develop heart disease than women who slept 8 hours a night. For those who got 6 and 7 hours of sleep, the heart risk was 18% and 9% higher, respectively.

Compared to women who got 8 hours of z's per day, women who slept 9 or more hours a night were 38% more likely to develop heart disease.

Dr. Najib T. Ayas, of Brigham and Women's Hospital in Boston, Massachusetts, characterized the findings as a "modest, but significant" association between sleep duration and the risk of heart disease.

The results of the study are published in the January 27th issue of the journal Archives of Internal Medicine (news - web sites).

More studies are needed, the researchers state, to get a better idea of how sleep affects the risk of heart disease. One question that needs to be answered, according to Ayas' team, is whether the cause of sleep deprivation-insomnia or a harried lifestyle-affects the risk of heart disease.

Why women who slept 9 or more hours a day were at greater risk of heart disease is uncertain, according to the researchers.

Source: Archives of Internal Medicine 2003;163:205-209.


New Scan May Improve MS Treatment

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, January 27, 2003

WASHINGTON - It's one of the biggest frustrations in treating multiple sclerosis: Someone with debilitating symptoms can have an MRI scan of the brain that, inexplicably, shows only a tiny spot of damage.

A Duke University scientist calls that spot the tip of the iceberg, discovering that MS patients actually can have 2 1/2 times more damage there than the regular MRI detected — plus more hidden abnormalities lurking elsewhere.

A new scan that adds just 10 minutes to a standard MRI uncovered the trouble, tracking damage building deep in the brain by measuring how water flows through nerve fibers.

Testing of the new scans is in early stages, but the government-invented technology could lead to earlier diagnosis and better treatment of MS — as well as improvements in other brain diseases from schizophrenia to cancerous tumors.

In fact, Duke physicians consider the new scans so useful that the North Carolina hospital is believed the first to give this "tensor diffusion imaging" to every person prescribed a standard brain MRI regardless of the reason — resulting in a unique library of normal and abnormal brain anatomy.

Water may look still in a cup, but under a microscope its molecules move constantly, bumping into each other and then bouncing away. Put a drop of dye in that cup and it will spread out, or diffuse, in a spherical shape thanks to that molecular motion.

Water enmeshed in the celery stalk-like tracts that are the brain's nerve fibers diffuses not just outwardly but also in the direction in which those tiny tubes run.

Scientists at the National Institutes of Health (news - web sites) invented a way to measure the direction and speed of that diffusion, with software that modified regular MRI machines. So if something blocks part of a nerve fiber, the new "tensor diffusion imaging" detects the resulting water changes, signaling damage.

To Duke neuroradiology chief Dr. James Provenzale, those new scans promise to clear up some of the mystery surrounding multiple sclerosis.

The disease, which afflicts 350,000 Americans, occurs when the immune system attacks and destroys nerve fiber insulation, called myelin. Eventually, scar tissue builds up to prevent those nerves from working, causing muscle weakness or paralysis, fatigue, dim or blurred weakness, memory loss and other cognitive problems.

"Lots of people are called crazy and malingerers who really have MS" because it takes years for a regular MRI to spot the characteristic scarring, Provenzale explained. "My premise is a lot of areas that look normal on MRI really are abnormal."

In a series of small studies, Provenzale says diffusion scans detected areas of MS nerve damage in people that were 2 1/2 times bigger than regular MRI had detected — and uncovered similarly damaged areas in other spots the MRI missed altogether.

The MS Society cautions that diffusion scans still are experimental, and Provenzale's next step is to prove if the new scans accurately predict symptoms. If so, they one day could be used to determine when a patient is about to worsen and thus needs a treatment change.

Scientists at Washington University in St. Louis are awaiting funding for similar research, using the new scans to track how MS patients fare depending on whether their nerve fibers are damaged or completely destroyed.

But tensor diffusion imaging will play a role in many more diseases, says NIH inventor Peter Basser.

Most broadly, scientists are using the scans to compile crucial maps of nerve fibers — until now a slow process that required examining brains donated at death. Finally knowing where certain nerves run could help surgeons remove brain tumors while cutting in spots less likely to leave patients disabled, Basser says.

The scans can detect nerve degeneration in Lou Gehrig's disease (news - web sites), and help neurologists assess the damage from strokes. At Duke, genetics specialists use diffusion scans to track how babies born with the rare but deadly Krabbe's disease respond to experimental treatment. Provenzale also wants to scan children's brains to see if schizophrenia could be predicted.

The new scans may even shed much-needed light on routine brain development. NIH is collecting tensor diffusion scans of children from around the country, and Duke's unusual practice of giving everyone who gets a brain MRI the new scan as well is garnering lots of data on the healthy — such as kids who fall off bicycles but are found to be OK — that may prove invaluable.

Editor’s  Note — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.


Diabetics Need Better High Blood Pressure Control 

By Charnicia E. Huggins

Reuters Health

Monday, January 27, 2003

NEW YORK (Reuters Health) - Many people with diabetes do not meet national recommendations for keeping their blood pressure under control, and new research may help explain why. Doctors may not be aggressive enough in treating high blood pressure, or hypertension, in people with diabetes, the results of a new study suggest.

"Our findings emphasize how clinicians need to be more aggressive in their management of blood pressure in diabetic patients with hypertension," lead study author Dr. Dan R. Berlowitz, of Bedford VA Hospital in Massachusetts, told Reuters Health.

Building upon previous research showing the importance of blood pressure control among people with diabetes, Berlowitz and his team investigated whether diabetic patients are achieving that control and whether doctors are treating high blood pressure among diabetics (news - web sites) as intensely as they treat the condition among people without diabetes.

"While inadequate control of blood pressure is a national concern," the authors write, "it is particularly problematic among patients with diabetes."

The researchers analyzed medical records from 274 men with high blood pressure and diabetes and 526 men without diabetes. All of the men, who were military veterans, received regular medical care in New England between 1990 and 1995.

Overall, nearly three-quarters of the diabetics had blood pressure readings that were at least 140 millimeters of mercury (mm Hg) over 90 mm Hg or greater, the investigators report in the February issue of the journal Diabetes Care. Two-thirds of the non-diabetic patients had similarly high blood pressure.

Current national recommendations call for a target blood pressure that is below 130/85 mm Hg for people with high blood pressure and diabetes and below 140/90 mm Hg for people without diabetes.

Patients with diabetes also received much less intensive therapy for their high blood pressure than did those without diabetes, the report indicates. For example, diabetic patients were less likely than their peers to have been prescribed a new high blood pressure medication or an increased dosage in their existing medication, even when patients' age, race and other medical conditions were taken into consideration.

One reason for that less aggressive treatment, the researchers speculate, is that doctors were unfamiliar with the current guidelines. Another explanation may involve a phenomenon called "clinical inertia," which includes poorly trained doctors and doctors' overestimation of the intensity of care they provide.

Still, the results might be different today, since the current study's findings are based on data collected during the early to mid 1990s, the researchers note. Guidelines recommending a tighter level of blood pressure control for patients with a variety of risk factors for heart disease were not published until 1993, the report indicates.

Overall, however, "the message for patients is very clear," Berlowitz said. "They should be aware of their blood pressure, and if it is not at target--below 130/85--they should encourage their provider to provide additional care."

Source:  Diabetes Care 2003;26:355-359,534-535.


Fix the Health Care System, Win a Prize

By Rebecca Cook

Associated Press Writer

The Associated Press

Monday, January 27, 2003

SEATTLE - A $10,000 prize can be yours! All you have to do is fix America's ailing health care system.

A health care consultant in Seattle is sponsoring the contest to spark new ideas and start a debate about health care reform.

So far about 100 people and groups have entered, including doctors, lawyers, a Los Angeles venture capital firm and the daughter of a Navajo healer.

"We need to start talking about our health care system. It doesn't work," Kathleen O'Connor said.

Nationwide, 41 million people lack health insurance, according to 2001 Census Bureau (news - web sites) figures.

The deadline for completed plans is July 1; entry fees range from $10 for senior citizens and students to $500 for corporations. O'Connor has recruited eight judges from across the country and is looking for a ninth. All are from various professions with experience in health care.

"I'm not interested in ideological purity or elegant design," said contest judge Ed Howard, vice president of the Alliance for Health Reform. "I want something that works."

O'Connor said she will pay the winner with money from entry fees and, if necessary, from her own pocket.

The top three entries will be forwarded to the state's congressional delegation.

On the Net:


Cell Phones 'Blind' Drivers, Study Shows 

By Maggie Fox


Monday, January 27, 2003

WASHINGTON (Reuters) - Drivers who use a cellular telephone, even with a "hands-free" device, suffer from a kind of tunnel vision that endangers themselves and others, US researchers said on Monday.

Legislation that seeks to make mobile telephone use by drivers safer by mandating the use of a hands-free device may be providing a false sense of security, they warned.

New York is the only US state that requires the use of hands-free devices for mobile telephone conversations while driving, but 30 others have been considering similar laws, as has the Canadian province of Newfoundland.

"Sometimes you have to actually do the silly study that shows the obvious," David Strayer, an associate professor of psychology at the University of Utah, who led the study, said in a telephone interview.

Strayer, whose team has done a series of studies on cell phone use while driving, set up a driving simulator and put 20 volunteers in it. Sometimes they used a cell phone and sometimes they did not. Their reaction time, driving style and performance were monitored.

Writing in the March issue of the Journal of Experimental Psychology: Applied, Strayer's group said use of a cell phone clearly distracted the drivers.

The finding adds to a series of similar studies-most notably a 1997 New England Journal of Medicine (news - web sites) report that found talking on a phone while driving quadrupled the risk of an accident.

"People, when on a cell phone compared to when they weren't, overall their reactions were slower," Strayer said. "They got into more rear-end collisions. They just kind of had a sluggish style that was unresponsive to unpredictable events like a car breaking down in front of them, a light changing and things like that." There was no difference, Strayer said, between using a hands-free or a hand-held cell phone.

Impaired Either Way

"You were impaired in both cases," he said. "That suggests to us that whatever legislation may be put into place saying you can do one but not the other...might send the wrong message and give people a false sense of security."

Perhaps even more disturbing, Strayer said, was the finding that the volunteers did not realize they were driving badly. "We asked people afterward how they felt they performed and they usually felt they performed without impairment and, in some cases, thought they drove better when on the cell phones," Strayer said.

"It is like studies that show 90% of people think they are better-than-average drivers. Forty percent of them are wrong." Strayer wanted to know why talking on a cell phone had such a profound effect on drivers, so his team set up a second experiment.

"We used an eye tracker-a really precise device that allows us to see where someone is looking," he said. They found that while the drivers looked at objects, in this case billboards, if they had been talking on a cell phone at the time they could not remember having seen them.

"There is a kind of a tunnel vision-you aren't processing the peripheral information as well," Strayer said. "Even though your eyes are looking right at something, when you are on the cell phone, you are not as likely to see it."

This included road signs, other vehicles and traffic lights. "This is a variant of something called inattention blindness," Strayer said.

Tests showed this kind of inattention did not affect drivers who were listening to music, to audio books or talking with a passenger in the car.


Skimping on Sleep Raises Heart Risk for Women 

By Kathleen Doheny
HealthScoutNews Reporter


Monday, January 27, 2003

MONDAY, Jan. 27 (HealthScoutNews) -- Skimping on sleep is a popular survival strategy of women with too much to do.

But a new study suggests you're not doing your health any favors when you don't get enough shut-eye. You might be putting yourself at risk for a heart attack.

Researchers from Brigham and Women's Hospital in Boston found that women who sleep five or fewer hours have an 82 percent higher risk of heart attack than those who get the suggested eight hours, even after adjusting for age differences. Women who sleep six hours a night boost their heart attack risk by 30 percent.

But the researchers found that too much sleep isn't good, either. Those women who slept nine or more hours a night increased their heart disease risk by 57 percent.

The research, which evaluated some of the 121,700 women enrolled in the well-known Nurses' Health Study and followed them for 10 years, is published in the Jan. 27 issue of the Archives of Internal Medicine (news - web sites).

"I don't think the study is definitive per se, but suggestive," says Dr. Najib T. Ayas, an assistant professor of medicine at the University of British Columbia, who conducted the research while on faculty at Brigham and Women's Hospital.

So while Ayas cannot yet prove cause and effect, sleep deprivation and perhaps too much sleep should be considered unhealthy habits, he says.

Previous studies have found the same association between sleep deprivation and heart problems in men, Ayas says. What he and others think may be happening is that sleep deprivation can cause physiological changes -- such as boosting blood pressure -- that, in turn, up heart disease risk.

Only 37 percent of Americans get eight hours of sleep a night, and 31 percent get six or fewer, according to a recent poll from the National Sleep Foundation.

For the study, Ayas and his colleagues zeroed in on a subset group of the Nurses' Health Study -- 71,617 women ages 45 to 65 who did not have reported heart disease at the start of the study -- and followed them over 10 years to detect any association between sleep habits and heart attacks. Each had answered questions about sleep duration in 1986, 10 years after the study began.

When they adjusted not only for age but also for factors such as smoking and body mass index, the association was weaker but still present.

"I think this [study] is right on the money," says Dr. Virend Somers, a professor of medicine at the Mayo Clinic who is familiar with the study. "People are not sleeping enough and we are seeing the consequences."

What makes the study particularly impressive, he says, are the large numbers and the fact that the Nurses' Health Study is an established model that has yielded other important clues about cardiovascular risk, Somers says.

Even though no cause and effect is proven, Somers says women and men should take sleep deprivation seriously as a health risk.

"Eight hours [of sleep] would be optimal," Ayas says.

If you're really strapped for time? "Seven actually wasn't too bad. If you get seven hours, your relative risk of heart disease is about the same as [getting] eight hours," Ayas says.

More information

To take a sleep test, visit the National Sleep Foundation. Also, the American Heart Association has a section devoted to women and heart health.


Stronger Fish Mercury Warnings Sought

By Gary Gately
HealthScoutNews Reporter


Monday, January 27, 2003

MONDAY, Jan. 27 (HealthScoutNews) -- California activists say they hope a state lawsuit to force five supermarket chains to warn about mercury in fish will mark the beginning of a nationwide seafood safety campaign.

The activists, from two San Francisco-area organizations, filed court papers saying they planned to sue the five supermarket chains after tests revealed dangerously high levels of mercury in some species of fish the grocery stores sold.

The move prompted California Attorney General Bill Lockyer to file a lawsuit seeking to force Safeway Inc., The Kroger Co., Albertson's Inc., Trader Joe's Co. and Whole Foods Market Inc. to provide "clear and reasonable" warnings about the dangers of mercury in tuna, swordfish and shark.

"We hope this expands beyond California and really sends a message to state health agencies that they really need to step up their efforts to inform the public of the health hazards of mercury in fish," says Doug Israel, project director for the nonprofit Turtle Island Restoration Network, one of the two activist groups. The other is As You Sow, a nonprofit that focuses on the environment, health and safety.

"Contamination of seafood is a serious health threat," Israel says, "and it's the responsibility of retailers, as well as state health agencies and the federal government, to let the public know about the impact of the seafood they're eating."

Tests have also have revealed elevated mercury levels in swordfish and tuna samples from Andronico's Market and Costco Wholesale Corp. and in swordfish from a Red Lobster restaurant, Israel says. He says he expects the attorney general to add these two stores and the restaurant to the lawsuit.

Mercury occurs naturally in the environment and can be released into the air through industrial pollution that then accumulates in water. Waterborne bacteria transform the mercury into an organic form, methylmercury, which fish absorb when feeding. Thus, larger predatory fish accumulate higher methylmercury levels.

The Environmental Protection Agency (news - web sites) (EPA) warns that high-level exposure to methylmercury can impair central nervous system function; cause kidney, gastrointestinal, cardiovascular and immune system damage; and even lead to shock or death.

And the U.S. Food and Drug Administration (news - web sites) (FDA) urges pregnant women to avoid eating shark, swordfish, king mackerel and tilefish because high methylmercury content could damage an unborn child's nervous system. The FDA also advises nursing mothers and young children to avoid these fish.

The California lawsuit claims the five supermarket chains violated Proposition 65, a 1986 ballot initiative that requires businesses to provide "clear and reasonable" warnings before exposing people to known carcinogens and reproductive toxins. The EPA has classified methylmercury as a possible cause of cancer, but Proposition 65 lists it as a carcinogen.

In the lawsuit, the state seeks civil penalties that could total up to $2,500 a day for each supermarket chain's violations. And the suit alleges the stores have not complied with Proposition 65 since as far back as 1988.

However, Tom Dresslar, a spokesman for the attorney general, says the suit's main purpose is not seeking payment, but compliance, from the grocers.

"Our main objective is to get adequate warnings posted in the stores, and we're hopeful that we can reach a resolution to the situation," Dresslar says.

"We're not trying, by any stretch, to scare people away from eating fish," he says, but "to see that people are adequately warned" of the dangers of methylmercury.

Of the five supermarket chains named in the lawsuit, four would not comment.

In a statement, Whole Foods Market said it has provided handouts in stores and posted information on its Web site about methylmercury in some species of fish. Whole Foods said it believed such advisories exceeded Proposition 65 requirements.

Nonetheless, the company said it would cooperate with the attorney general's office in devising new methylmercury warnings.

Meanwhile, the two activist groups say they may test methylmercury levels in fish at other stores, markets and restaurants and work with organizations in other states to push for stronger warnings.

The Turtle Island group also says it is concerned about swordfishing killing endangered sea turtles. "People can protect their own health and our oceans by simply not eating swordfish," Israel says.

More information

For guidelines on fish consumption for pregnant women, nursing mothers and young children, visit the U.S. Food and Drug Administration. The Environmental Protection Agency offers more information on mercury contamination of fish.


Not All Kids Need Epilepsy Drugs After Seizure

Reuters Health

Monday, January 27, 2003

NEW YORK (Reuters Health) - When a child has just one seizure, he or she may not necessarily need powerful anti-seizure medication, according to new recommendations released Monday.

Many children who have such an unexplained seizure will not go on to have a second one, and the risks of the drugs may outweigh the benefits for some youngsters, according to the guidelines developed by the American Academy of Neurology (news - web sites) and the Child Neurology Society. The guidelines are published in the January 28th issue of the journal Neurology.

Each year, anywhere from 25,000 to 40,000 children in the US experience an unprovoked seizure, meaning a seizure that it is not caused by head trauma, an infection or other known cause.

"Antiepileptic drugs (AED) carry risks of side effects that are particularly important in children," writes Dr. Deborah Hirtz of the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland and colleagues. "The decision (to use such drugs) should be individualized and take into account both medical issues and family preference."

Hirtz's team based their recommendations on a review of research that was conducted between 1980 and 2001.

They found that side effects varied depending on the drug and dose, but could include rash, nausea and vomiting and weight gain, as well as irritability, a decline in mental ability and sleepiness. Other severe reactions can occur, such as liver or bone marrow damage.

In the past, it was thought that early treatment with medication prevented epilepsy or brain damage. Epilepsy is not a single disease, but a group of conditions that cause abnormal electrical activity in the brain and sometimes seizures.

However, two studies suggest that starting medication after a first or a second seizure makes little difference in terms of remission in the next few years.

"The majority of children who experience a first unprovoked seizure will have few or no recurrences," according to the report. "Only approximately 10% will go on to have many (10 or more) seizures regardless of therapy."

The authors caution that their guidelines are not "intended to include all proper methods of care for a particular neurologic problem." They note that treatment decisions should be made by the "patient and the physician caring for the patient, based on all the circumstances involved."

Source: Neurology 2003;60:166-175.


Health Groups Sour Over New Dairy Campaign

By Kathleen Doheny
HealthScoutNews Reporter


Monday, January 27, 2003

MONDAY, Jan. 27 (HealthScoutNews) -- Food fight! Just when the health-conscious public was getting familiar with the "5 A Day" campaign -- the one that urges us to stay healthy by eating five servings of fruits and vegetables daily -- along comes the "3-A-Day" plan.

It may sound like a quick-fix way to skimp, but it's not.

"3-A-Day" is a new campaign by the National Dairy Council, the folks who helped made milk mustaches chic. It urges us to eat enough dairy products, including milk, cheese and yogurt.

"5 A Day" was begun in California with a National Cancer Institute (news - web sites) grant and then taken nationwide in 1991; now it's a private-public partnership that includes government agencies and fruit and vegetable industry organizations.

The "5 A Day" folks don't seem to think imitation flatters. They have fired off a letter to the dairy council, asking it to dismantle the campaign. Representatives from the American Cancer Society (news - web sites), the American Heart Association (news - web sites) and other organizations signed the letter.

Their gripes? Besides the dairy council's obvious borrowing of a slogan that's gotten national recognition, the message to eat low-fat dairy products is not prominent enough, the "5-A-Day" proponents say. And the campaign urges three servings a day, while large portions of the population need only two. The public is likely to get confused, they explain.

"From a Cancer Society perspective, our biggest issue is probably that they have this campaign going that is not doing much to promote low-fat or fat-free dairy products," says Colleen Doyle, a registered dietitian who serves as nutrition and physical activity director for the American Cancer Society.

"The recipes on the [3-A-Day] Web site include low-fat and reduced-fat," she says. "We really don't have any issue with the fact that they are promoting dairy products, but we wish there had been a [stronger] low-fat message. With cancer and heart disease rates so high, it would have been desirable to see that message as a primary message of the campaign."

However, Ann Marie Krautheim, a registered dietitian who is vice president of nutrition and health promotion for the dairy council, can't understand why the fruit and veggie people can't work with the dairy people to improve America's eating habits.

"Our program is funded by dairy farmers who since 1915 have been committed to investing in nutrition education and research to improve the health of the American public," she says.

As to the concern about confusion, she disagrees. "We believe the opposite is true," she says. Studies have shown that consumers want to know not only what to eat, but how much, she says. "We developed a campaign that tells the consumer how much and how often [they should eat dairy products]. Three a day clearly brings the benefit of dairy to the forefront. The logo has pictures of milk, cheese and yogurt. People should not be confused."

The food guide pyramid recommends two to three servings of dairy a day, Krautheim says: "We have focused on the number three." Under the current food guide pyramid recommendations, children aged 9 to 18 and adults over the age of 50 need three servings and others need two.

Some health professional don't understand the fuss. The two programs, says Dr. Michael Fleming, president-elect of the American Academy of Family Physicians (news - web sites), "appear to be totally complementary. Both programs try to educate people about nutrition."

More information

Compare the 5 A Day and 3-A-Day campaigns for yourself.


No Mass Screening of Heart Disease Marker –Experts 

By Alison McCook

Reuters Health

Monday, January 27, 2003

NEW YORK (Reuters Health) - Despite recent evidence suggesting that blood levels of a protein linked to inflammation can predict heart disease risk, a panel of experts announced Monday that testing for the compound, known as C-reactive protein (CRP), should not be offered on a widespread basis.

How much CRP in the blood is too much remains uncertain, according to the panelists. Nor is it clear how levels of the protein might vary among different age and ethnic groups and between men and women, they note.

The actual CRP blood test is relatively inexpensive, panel co-chair Dr. Thomas A. Pearson told Reuters Health. Most of the extra costs arise when a person who is actually quite healthy undergoes unnecessary tests and procedures after a blood test detects high levels of CRP.

Given that much about CRP remains unknown, Pearson recommended that patients shift their focus from getting the CRP test to eating a healthy diet and getting regular exercise, which can drastically cut the risk of heart disease.

However, some people may still benefit from knowing their levels of CRP, Pearson and his colleagues note.

Looking at how many risk factors a patient has for heart disease, doctors can estimate the approximate future risk of the condition. In people with an "intermediate risk"--a 10% to 20% chance of developing heart disease in the next 10 years--knowing CRP levels may help doctors decide how aggressively to treat their conditions, Pearson explained.

Furthermore, patients whose risk is neither high nor low and who learn their blood contains high levels of CRP may realize they are less healthy than they believe. Consequently, they may become more motivated to improve their lifestyles, he said.

But for patients who are obviously at high risk of heart disease and clearly need aggressive treatment, measuring CRP levels will be unnecessary, added Pearson.

The current recommendations, appearing in the January 28 issue of Circulation: Journal of the American Heart Association (news - web sites), are based on a review of evidence on how well the protein predicts heart disease risk. The panel was convened by the American Heart Association and the Centers for Disease Control and Prevention (news - web sites).

Several studies have associated CRP, which is a marker for inflammation, with an increased risk of several conditions, including heart attack, stroke, sudden cardiac death and artery disease.

Another study in the same issue of the journal suggests that CRP levels may also help predict heart attack risk in women with metabolic syndrome, a condition linked to obesity, impaired metabolism of blood sugar, high blood pressure and high levels of blood fats.

People with metabolic syndrome are at risk of developing diabetes and cardiovascular disease, and a new study by Dr. Paul M. Ridker and colleagues shows that, among women with metabolic syndrome, those who have the highest levels of CRP were much more likely to have cardiovascular problems.

Ridker is based at Brigham and Women's Hospital in Boston, Massachusetts.

Source: Circulation: Journal of the American Heart Association 2003;107:499-511.


Stress Can Make You Clumsy


Monday, January 27, 2003

(HealthScoutNews) -- Are you a klutz who's constantly banging into tables, knocking over glasses or tripping over chair legs?

According to Toronto's Sunnybrook and Women's College Health Science Center, stress and a killer schedule may be to blame. If you're uptight, your muscles tense up and lead to clumsy movements.

Here's what you can do to loosen up:

  • Make a daily "to do" list. If it seems too full, cross off some items.
  • Practice deep breathing or yoga stretches to help slow you down.
  • Forget multitasking. Finish your snack, for example, before you drive or talk on your cell phone.


Early Career Success Linked to Early Grave 

By Alison McCook

Reuters Health

Monday, January 27, 2003

NEW YORK (Reuters Health) - US governors elected to their post at a relatively young age tend to have a shorter lifespan than those elected in their later years, new research shows.

The author of the research has noted a similar trend in early achievers who were US presidents, Canadian prime ministers and Nobel laureates.

"In fact, I have also found support among eminent psychologists," Dr. Stewart J. H. McCann of the University College of Cape Breton in Nova Scotia, told Reuters Health. "The age at which they received their PhD correlates with their length of life."

Just why early achievement is linked to an early grave is unclear, but McCann speculated that people who succeed when relatively young may have shorter lifespans because of the stress associated with early achievements.

"The strains, challenges, and obligations accompanying outstanding leadership and creative achievements may set in motion, or accelerate in some persons, physical--and perhaps mental--declines to which they eventually succumb," McCann said.

"Such stress-induced processes could lead to premature death among those having their ultimate success early in life," he added.

McCann noted that some early achievers may also share certain tendencies toward unhealthy behaviors that ultimately lead to their early demise. And in some cases, people who peak early in life may become less motivated to maintain their incentive to succeed and stay healthy, the researcher said.

"After what is likely to be the peak of achievement in a lifetime, perhaps there is a lessening of the drive to produce, to thrive and, ultimately, to survive, at least in some persons," McCann said.

But he cautioned that the findings of his current and previous investigations do not suggest that ambition is an unhealthy trait. "Ambition alone cannot kill," McCann said.

McCann based his current findings on 1,672 male governors who had served and died by 1978. On average, former governors reached their posts at age 49, but age at election ranged from 23 to 81 years. The average age of death was age 70, but ranged from 32 to 103.

Comparing age of election to age of death, McCann discovered that men elected governor at a relatively young age also tended to die at an earlier age.

The researcher published his findings in the February issue of the Personality and Social Psychology Bulletin.

McCann explained that his investigations of the so-called precocity-longevity hypothesis have mostly focused on men. However, he noted that a previous study of a small sample of women who have won an Academy Award for Best Supporting Actress suggested that early female achievers may also have a shorter lifespan.

Source: Personality and Social Psychology Bulletin 2003;29:164-169.


High-Fat Chow No Friend of Fido's

By Robert Preidt
HealthScoutNews Reporter

Monday, January 27, 2003

MONDAY, Jan. 27 (HealthScoutNews) -- Want more proof that dogs are our best friends?

New canine-based research may answer how a type of fat found in deep-fried foods commonly served at fast-food restaurants affects childhood development and the potential for diseases such as atherosclerosis.

The fats are called oxidized lipids. They're unsaturated fats that undergo change after prolonged exposure to heat and/or oxygen. Oxidized fats are found in oils that are used over and over for deep fat frying, according to the study, which was led by researchers at Purdue University.

Oxidized fats are believed to damage the lining of blood vessels, leading to an increased risk of atherosclerosis, a buildup of plaque in the arteries.

"We know that eating diets high in oxidized fat contributes to atherosclerosis and other diseases in people," John Turek, a cellular biologist at Purdue's School of Veterinary Medicine, said in a statement.

"But we don't know the long-term effects of foods high in oxidized lipids fed during the growth stage," he said. "Will organ and tissue growth be compromised? Will children develop geriatric diseases at an earlier point in their lives?"

To try to determine those long-term effects, the researchers fed coonhound puppies a highly oxidized lipid diet, and found the dogs had reduced growth, bone formation and immune function.

The same was true of puppies fed diets with moderate levels of the fats.

The study appears in the January issue of The Journal of Nutritional Biochemistry.

It's the first study in dogs to assess the impact of diets laced with oxidized lipids.

"In our society today we eat a lot of fried foods. For years, it has been felt that over-consumption of fried foods, which contain oxidized lipid products, could be detrimental to health," said Bruce Watkins, one of the study's authors and director of Purdue's Center for Enhancing Foods to Protect Health.

"What this study shows is that in a rapidly growing animal such as the dog, which parallels many of the ways in which we eat and our lifestyles as humans, there are some effects on immune function and bone growth, which could potentially be compromised with the eating of oxidized fat," Watkins said.

In their first few months of life, dogs grow rapidly, adding significant bone and lean body mass. In that way, they're comparable to children experiencing rapid growth spurts during puberty.

The 16-week study included 24 dogs, 2 months old at the start, who were divided into three groups. One group ate a diet of dog food with highly oxidized fat, one group ate dog food with moderately oxidized fat, and the third group ate dog food with low oxidized fat.

Other than the oxidation levels of fat, the dogs ate identical diets that provided all essential nutrients.

The dogs who ate highly oxidized fat gained less weight and had less body fat than the dogs in the other two groups. The dogs on the highly oxidized fat diet also had poorer immune function and a reduced rate of bone formation.

Their bodies also had less vitamin E, an antioxidant that counteracts the effects of free radicals, which damage protein, other lipids, DNA and cells, according to the study.

In terms of humans, this study reinforces what's been recommended for years -- limit the amount of fried foods you eat, Watkins said.

The level of oxidized fat in fast foods varies widely, depending on the restaurant, Watkins said. The amount of oxidized fat is also dictated by a number of factors, including how often the oil in a deep fat fryer is changed, how well the fryer is cleaned and how much water comes into contact with the frying fat, he said.

More information

Here's where you can learn more about the good and bad fats in your food. And here's where you can find the Center for Enhancing Foods to Protect Health.


Nicotine-Free Cigarettes Available in 7 U.S. States

Reuters Health

Monday, January 27, 2003

NEW YORK (Reuters Health) - Smokers who want the cigarette without the nicotine now have a product they can reach for on store shelves, according to a Monday announcement.

The company Vector Group Ltd. announced that it is now selling nicotine-reduced and nicotine-free cigarettes in stores in New York, New Jersey, Pennsylvania, Ohio, Indiana, Illinois and Michigan.

The cigarettes are marketed under the label Quest, and are available in three varieties. Quest 1 has only 0.6 milligrams of nicotine, Quest 2 halves that amount, and Quest 3 contains only trace amounts of the addictive substance.

Company representatives report that the Quest cigarettes taste and smoke like other cigarettes.

They caution that the product is designed to help smokers cut back on nicotine, and not to quit smoking altogether.

"For years experts have agreed that nicotine is the addictive element that keeps nearly 50 million US smokers hooked on cigarettes," Dr. Tony Albino of Vector Group said in a statement.

"We believe that reducing the levels of nicotine in cigarettes--and eliminating it altogether in Quest 3--is a significant achievement, which could ultimately provide a major contribution to public health," Albino added.


Teens Have Tricks for Cutting Back on Booze


Monday, January 27, 2003

MONDAY, Jan. 27 (HealthScoutNews) -- A new survey of the strategies teenagers use when they want to cut back on their drinking may provide ideas for improving programs to cut alcohol use among teens.

The survey of high school students revealed a number of ways they lessen their drinking. They may stop going to parties where alcohol is served, they may talk with a friend about drinking, or they may drink better-tasting non-alcoholic drinks.

They also listed participation in other activities, such as sports, and getting advice from counselor.

The findings appear in the January issue of Alcoholism: Clinical and Experimental Research.

The survey, conducted by a University of California, San Diego, researcher and her colleagues, included 1,069 high school students, aged 12 to 18. They were asked to list different strategies for drinking less or for giving up alcohol completely.

The students were also asked what strategies they might use to moderate their own drinking or that of a friend.

Most of the students surveyed were white. The researchers note that strategies to control drinking may vary among different ethnic and cultural groups.

More information

Here's where to learn more about alcohol and youth.


Some Teen Diabetics Show Signs of Heart Disease 

By Alison McCook

Reuters Health

Monday, January 27, 2003

NEW YORK (Reuters Health) - People with a form of diabetes that typically arises in childhood may show signs of heart disease as early as their teens, especially if they smoke or have high levels of a certain blood protein, US researchers report.

These findings serve as a reminder to monitor people with diabetes closely and to counsel them about risk factors for heart disease at an early age, study author Dr. Harold S. Starkman told Reuters Health.

Doctors should advise their diabetic patients not to smoke and to watch cholesterol levels "very, very early" in people with diabetes, he said.

In a sample of 101 diabetics (news - web sites) between 17 and 28 years old who had no history of heart disease, 11% had a buildup of calcium inside the walls of arteries that feed blood to the heart. These deposits are a marker for heart disease that appears long before a person develops noticeable symptoms.

The youngest person with this calcium buildup was only 17 years old.

All of the patients in this study had type 1 diabetes, a known risk factor for heart disease. This condition occurs when the immune system mistakenly destroys the insulin-producing cells of the pancreas. Insulin is a hormone that helps move sugar from the blood into cells to use as fuel.

This form of diabetes differs from the more common type 2 diabetes, which is often linked to obesity.

In the study, Starkman and his colleagues took blood samples, and screened patients for coronary artery calcification using electron beam tomography, a relatively new type of X-ray that takes photos between heartbeats to avoid the interference of body movement in the image.

The researchers found that young diabetics who said they smoked were five times as likely as non-smokers to have a buildup of calcium in the walls of their coronary arteries. People who had relatively high blood levels of a protein called lipoprotein(a) also appeared to have a slightly higher calcification risk.

In an interview with Reuters Health, Starkman, of Morristown Memorial Hospital in New Jersey, said that it would not be practical to routinely administer electron beam tomography to young diabetics as the test is not yet covered by insurance.

But physicians routinely take blood samples from people with diabetes, he noted. Screening these samples for high levels of lipoprotein(a) might help identify those most at risk of heart disease, Starkman said.

If a diabetic person has high blood levels of lipoprotein(a), the best way to reduce the risk of heart disease may simply involve getting diabetes under control, Starkman said.

Exercise, diet and other "heart healthy stuff" can help keep blood sugar and blood pressure at healthy levels, the researcher noted. For people with high levels of cholesterol that are not controlled through diet, it might be wise to offer them cholesterol-lowering drugs, according to Starkman. But doctors should make that decision carefully, Starkman said.

"You're really locking them into 35, 40 years of therapy," he noted.

Source:  Diabetes Care 2003;26:433-436.


Avoiding Medical Mistakes With Children


Monday, January 27, 2003

MONDAY, Jan. 27 (HealthScoutNews) -- A new effort to help prevent medical errors in children has been launched by the American Academy of Pediatrics (AAP) and the Agency for Healthcare Research and Quality (AHRQ).

The education campaign, aimed at pediatricians and parents, includes a fact sheet that offers 20 tips on how to prevent medical errors in children. The tip sheet provides evidence-based, practical tips on how to avoid medical errors related to prescription medicines, surgeries and hospital stays.

The fact sheet will be distributed to 57,000 pediatricians and to groups representing children and parents.

Studies have shown the rate for potential medication problems is three times higher for children than for adults. The rates for babies in hospitals are even higher.

Medicine-related medical errors can occur when a child is given the wrong medicine or is given the wrong dose of medicine for the child's weight.

The fact sheet tells doctors and parents to discuss medication dosages, potential side effects, and limits on food, drink or activities that might be necessary when a child is prescribed a particular medicine.

More information

You can get a copy of the tip sheet by calling 1-800-358-9295 or by sending an e-mail to Or you can find the fact sheet at the AHRQ Web site.


Study Looks at Benefits of Underwater Birth 

Reuters Health

Monday, January 27, 2003

BERLIN (Reuters Health) - Giving birth in water is safe for women with an uncomplicated delivery, and may shorten the first stage of labor, according to Italian scientists who studied more than 1,500 births.

However, some US-based experts caution that the jury is still out on the safety of such births.

Drs. Albin Thoni and Konrad Mussner, from the regional hospital in Sterzing in the South Tyrol region of northern Italy, compared data from 969 water births, 515 births in bed and 172 using a birthing stool.

After excluding complicated births that required vacuum extraction, other manual help or epidural anaesthetic, the results showed some advantages for water births, they report in the December issue of the German-language journal Geburtshilfe und Frauenheilkunde (Obstetrics and Gynaecology).

The average duration of first-stage labor, which finishes when the cervix is fully dilated, was 381 minutes for women in water compared with 473 minutes for those using other positions. There was no difference in the duration of the second stage of labor, when the baby moves through the birth canal.

"Our results suggest that water birth is associated with a significantly shorter first stage of labor, a lower episiotomy rate, fewer perineal lacerations and reduced analgesic requirements compared with other delivery positions. Water birth appears to be safe for the mother and the fetus-neonate if candidates are selected appropriately," they write.

Yet, the Italian team's views are not universally supported in the medical community. Other experts believe that underwater births need more study or are potentially dangerous. In August last year, New Zealand researchers described four instances within 18 months where infants inhaled water after underwater delivery.

In those cases, the four infants began to experience respiratory distress and a need for oxygen anywhere from five minutes to six hours after birth, study findings indicate. They were treated with antibiotics and/or oxygen, and all were discharged from the hospital a few days after birth.

Part of the problem is that there are not enough studies of the practice, said Dr. Bruce Shephard, affiliate associate professor of obstetrics and gynecology at the University of South Florida College of Medicine in Tampa, Florida, and author of the book, "The Complete Guide to Women's Health."

"There have been thousands of articles on all these things, but the problem is, it's the same thing we have with hormone replacement therapy," he said. "Most of the studies are observational studies that don't have statistically significant data from which general conclusions about clinical decision making can be made, they're just snap shots."

"Unless this was a large study, with randomized controls, it makes it hard to draw conclusions from it. Most of these studies have qualitative aspects as well as quantifiable aspects which are also hard to measure."

Most obstetricians would probably not recommend an underwater birth, said Dr. Bruce Flamm, an obstetrician-gynecologist at Kaiser Permanente Medical Center in Riverside, California.

He said there are several issues, including sanitation, as well as the fact that babies are not normally born underwater.

"It's an interesting theory that the baby kind of likes being in its water-filled world for the first few minutes after birth, and it will in some way be less traumatic, but there's no evidence to support that," he said.

Many midwives and some doctors believe that being in a tub in the early phase of labor is helpful, he said.

"That probably is reasonable, and I think many obstetricians will probably say that's quite reasonable, as long as it's a low risk patient, but the actual concept of giving birth underwater--that's a much more difficult question to answer, and I think most obstetricians would say it's not a good idea."

Source: Geburtshilfe und Frauenheilkunde 2002;62:977.