The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
April 28, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 February 7-14

  1. Women Less Likely Than Men to Have a Second Stroke
  2. Protein Blocks Obesity in Mice: Study
  3. Playground Equipment May Pose Cancer Risk
  4. Nurse Your Nose in the Cold
  5. Smallpox Info on Internet

FRIDAY, FEBRUARY 14, 2003 

Outlook for People With HIV Is Improving 

By Daniel Q. Haney

AP Medical Editor

The Associated Press
Friday, February 14, 2003

BOSTON - Seven years into the modern era of AIDS (news - web sites) treatment, the outlook for people with HIV (news - web sites) infections continues to improve.

Encouraging new European data released Friday show that the risk of developing full-blown AIDS or dying of the disease is still falling.

In 1996, treatments became widely available that abruptly changed the prospects for people with HIV. These people once faced almost certain death, but the combinations of drugs have made HIV a treatable and largely survivable infection.

Still, many have wondered how long these benefits would last. Currently, 16 AIDS drugs are on the market, and many more are in development. Yet some patients have resistant forms of the virus that flourish despite shifting combinations of pills. Others have worrisome side effects, such as rising cholesterol levels.

However, figures presented Friday at the 10th Conference on Retroviruses show that despite all the drawbacks, the drugs continue to work well, and their benefits have not been exhausted.

Dr. Amanda Mocroft of Royal Free and University College Medical School in London outlined the outcomes of 9,803 people diagnosed with HIV in Europe between 1994 and 2002. Between 1994 and 1998, their risk of AIDS or death fell by 80 percent.

Since then, improvements have continued. Between September 1998 and 2002, the risk of AIDS or death has fallen 8 percent each six months.

"Even though therapy is not perfect, it's working," Mocroft said.

The continuing decline in death and AIDS is a surprise, she said. "An awful lot of people expected the curve to bottom out or even rise again, but it's still going down," she said, "which is very encouraging."

The outlook is worst when people have high levels of virus and few of the blood cells that HIV attacks. Mocroft's team found that survival has significantly improved in recent years among people who start treatment with low blood counts but not among those with higher levels.

"It's quite remarkable. You have to wonder what the end of the story will be," said Dr. Kevin DeCock, head of the U.S. Centers for Disease Control and Prevention (news - web sites)'s program in Kenya.

In the United States, the CDC has followed 1,769 Americans diagnosed with HIV since 1994, and "we have data that corroborates what the Europeans are saying," said Dr. Scott Holmberg, a senior epidemiologist.

The first goal of treatment is to drive down the virus so it falls below the ability of detection on standard tests, which can find 25 copies of HIV in a milliliter of blood. In the mid-1990s, many worried that virus levels would begin to rise again as resistant forms of HIV evolved, but Holmberg said the opposite has happened.

"We are seeing more people who are able to suppress to undetectable viral loads," he said. "HAART continues to do better and better."

HAART — highly active anti-retroviral therapy — is what doctors call the combinations of pills that have revolutionized the treatment of AIDS.

Holmberg said that while deaths from all causes among people with HIV have stabilized in the United States in recent times, deaths from AIDS itself have continued to fall. Instead, they are dying from heart disease, liver problems, cancer and other ills unrelated to their HIV infections.

Another analysis from Dr. Jonathan Sterne of the University of Bristol in England found that how people do in their first six months of treatment is more important in the long run than their initial blood counts and virus levels.

"It matters where you are, not where you came from," he said.

Those who have respond the best after six months have only a 2 percent risk of death over the next three years, compared with an 83 percent risk among those doing the worst after six months.

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

On the Net:

Conference: http://www.retroconference.org/2003/

Back to the Top

Baby, Coated Aspirin May Not Prevent Stroke-Study 

By Maggie Fox

Reuters
Friday, February 14, 2003

WASHINGTON (Reuters) - People who take baby aspirin or coated aspirin to try to prevent heart attacks or strokes may not be getting the benefits they expect, US researchers said on Friday.

A study of more than 250 people showed that most of those who took low-dose or coated aspirin in fact saw no reduced blood clotting, the researchers told a meeting of the American Stroke Association in Phoenix.

Full-sized, uncoated aspirin seemed more effective, according to a measurement of the blood's stickiness called platelet function, said Dr. Mark Alberts, director of the Stroke Program at Northwestern Memorial Hospital in Chicago.

"More than 50% of patients who got coated or low dose aspirin seemed to have normal platelet function," Alberts said in a telephone interview. "This is remarkable."

He said his study would help explain why aspirin does not seem to work for many people. "About half the patients who have a heart attack or stroke are taking aspirin at the time they have a heart attack or stroke," he said.

Several studies have shown that aspirin can reduce blood clotting, lowering the risk of heart attack and stroke. Stroke is the third leading cause of death in the United States, affecting 750,000 people a year and killing 165,000.

But aspirin can be dangerous. It and related drugs are blamed for thousands of deaths every year, so doctors want patients to take the lowest-possible dose that is effective.

Alberts and colleagues tested 126 patients prescribed aspirin after having strokes or clogged arteries to the brain.

Low-Dose Aspirin Work In Fewer Than Half

The patients were taking various doses and formulations of aspirin. Alberts found that 56% of those taking 81 milligram "baby" aspirin had no changes in blood clotting.

But 72% of patients taking 325 mg aspirin pills had measurable effects.

He found 65% of patients taking coated aspirin--no matter what the strength--had no reduced clotting, while 75% of patients taking uncoated aspirin did have reduced clotting.

Alberts stressed that no one should be taking aspirin to prevent heart disease or stroke without first visiting a doctor. But he said his study suggests that doctors may want to take the time to check to see whether aspirin is working in a patient, perhaps using the platelet test.

The findings have implications for more than patients.

Bayer this week asked the US Food and Drug Administration (news - web sites) to allow it to market aspirin to prevent a first heart attack or stroke, and it has launched a specially packaged 81 mg coated aspirin product.

In 2002 Bayer sued rival Johnson & Johnson over Johnson's advertising for its St. Joseph brand of aspirin, which comes in a "baby" dose. Bayer argued that larger doses of aspirin were more effective than the lower doses.

Dr. Allen Heller, vice president and head of global research and development for Bayer, said he would have to study the findings further but also stressed that no one take aspirin for preventing heart disease without a doctor's advice. But he said Bayer had little guidance for doctors.

"We don't tell doctors what dose to prescribe," he said.

Aspirin is not approved for children or babies because it can cause a fatal brain condition called Reye syndrome.

Back to the Top

Light Sleeper, Heavy Gainer

HealthScoutNews
Friday, February 14, 2003

(HealthScoutNews) -- If you're trying to lose weight, don't burn the midnight oil. According to the Cincinnati Sleep Management Institute, too few ZZZs can mean you'll pack on the pounds.

Here's why:

  • Sleep loss can result in high blood levels of glucose, which causes your body to overproduce insulin and makes it easier to gain weight.
  • Sleep deprivation can increase production of cortisol, a stress hormone that stimulates the appetite.
  • Lack of sleep can lead to a growth hormone deficiency, which can cause you to put on fat, rather than muscle.

Back to the Top

U.S. Clears New Test to Help Rule Out Heart Attacks
 

Reuters
Friday, February 14, 2003
 

WASHINGTON (Reuters) - US health officials on Friday approved a new blood test that can help doctors rule out a heart attack in patients with severe chest pain.

An estimated 3 million to 5 million Americans show up at emergency rooms each year with heart attack symptoms, but only about 22% of them actually have had a heart attack, the Food and Drug Administration (news - web sites) said in announcing the approval.

The new test measures blood levels of modified albumin, an altered version of a protein. Studies have shown the amount of modified albumin rises in heart-attack patients.

"If it's a negative test, it increases the likelihood it is not a heart attack," said Dr. Steve Gutman, director of the FDA's Office of In Vitro Diagnostics.

The FDA said doctors should not rely on the new test alone to tell if someone has had a heart attack. The modified albumin test should be used with an electrocardiogram--a measure of electrical activity in the heart--and a test for troponin, a protein found in the blood after a heart attack.

A study of more than 200 patients with severe chest pain found physicians were 70% accurate in ruling out a heart attack using all three tests, the FDA said. With an electrocardiogram and troponin test alone, they correctly ruled out a heart attack 50% of the time.

"The real advantage is that many patients can be sent home much, much earlier," said Peter Crosby, president and chief executive of test maker Ischemia Technologies Inc., a private company based in Arvada, Colorado.

The company will sell the new test, called the Albumin Cobalt Binding Test, to hospitals for $30 each, Crosby said. The test already is available in Canada and Europe.

Back to the Top

Make the Medicine Go Down

HealthScoutNews
Friday, February 14, 2003

(HealthScoutNews) -- Some children's medicines come in pill form, and while it's tough enough to get kids to take liquid medications, how can you get them to swallow a pill?

Fairview Health Services in Minnesota offers these alternatives:

  • Put the pill in your child's mouth and have him fill up his cheeks with water, swallowing as few times as possible. The pill should go right down.
  • Place the pill under your child's tongue and have him drink water in gulps from a cup. The pill will often slip out and go down undetected.
  • A thicker liquid like milk may make pills easier to swallow, but ask your doctor or pharmacist before you try this.

Back to the Top

Asthma Drug Helps Infant Lung Infection
 

By Alison McCook

Reuters Health
Friday, February 14, 2003

NEW YORK (Reuters Health) - New research suggests that a pill normally used to treat asthma and other breathing difficulties may also ease breathing in infants who develop potentially serious lung infections.

All of the children, who were between 3 months and 3 years old, were hospitalized as a result of bronchiolitis, an infection of the lung's small airways. After bronchiolitis, infants are in danger of developing other potentially serious symptoms that resemble asthma.

The researchers discovered that children given the drug montelukast (Singulair) during a four-week period experienced six symptom-free days and nights, while infants who received an inactive, or placebo, treatment, were free of symptoms on only one day and night during the study period.

Montelukast-treated infants also had less of a cough during the daytime than others, the authors report in the February issue of the American Journal of Respiratory and Critical Care Medicine.

Study author Dr. Hans Bisgaard of University Hospital of Copenhagen told Reuters Health that none of the children in the study appeared to have any side effects from the treatment.

Despite its apparent benefits, montelukast is currently only approved for people older than 2. Bisgaard said that further research is needed before doctors can prescribe it to infants with bronchiolitis-related breathing problems.

During the study, Bisgaard and his colleagues gave montelukast to half of 130 children who were hospitalized with bronchiolitis as a result of infection with a common virus known as respiratory syncytial virus (RSV).

For 28 days, the children received either 5-milligram chewable tablets of montelukast once each night or a placebo.

In an interview, Bisgaard explained that babies with this type of breathing problem are often treated with inhaled steroids, but not always successfully.

Montelukast differs from other treatments in that it blocks leukotrienes, he noted, which are substances produced by a type of blood cell. Leukotrienes appear to play a role in the lung inflammation that characterizes asthma.

Bisgaard said he is a consultant and member of pediatric advisory boards for a number of pharmaceutical companies, including Merck, the makers of Singulair. He has also received research funding and honoraria for lectures from Merck, along with other drug companies.

The current study was funded by the University Hospital of Copenhagen.

Source: American Journal of Respiratory and Critical Care Medicine 2003;167:379-383.

Back to the Top

Ginseng Improves Memory in Dementia Patients

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews
Friday, February 14, 2003

FRIDAY, Feb. 14 (HealthScoutNews) -- Ginseng tablets improved the memories of people with vascular dementia, new research has found.

Vascular dementia is memory loss and difficulty communicating that is often caused by a series of small strokes in the brain. About one-fourth of people with dementia have stroke-induced dementia; most of the rest have Alzheimer's disease (news - web sites).

Chinese researchers gave 25 patients with mild-to-moderate stroke-induced vascular dementia a tablet containing an extract from Chinese ginseng roots and panax notoginseng. Panax notoginseng is a different herb but one that has chemical properties similar to ginseng, says Dr. Jinzhou Tian, lead author of the study.

"The effect we are seeing is actually from the both," says Tian, a professor in the department of care of the elderly at the Beijing University of Chinese Medicine.

Another 15 people with vascular dementia were given Duxil, the brand name for the drugs almitrine and raubasine, which have been shown to increase oxygen to brain tissue and are used to boost the memories in people with vascular dementia, Tian says.

Participants were given a series of memory tests at the outset of the study and after 12 weeks.

The patients in the group taking the ginseng showed a significant increase in their average score on five memory tests, including immediate and delayed story recall, delayed word recall, verbal learning and verbal recognition.

Their total memory score was significantly higher than for the group taking Duxil, though the scores for individual tests showed no statistically significant difference, Tian says.

"I would like to recommend doctors consider this herb for use in the treatment of dementia sufferers," he says.

Ginseng is a less expensive alternative to Duxil and other pharmaceuticals on the market, Tian adds.

He presented his research Feb. 14 at a meeting of the American Stroke Association in Phoenix.

But U.S. doctors caution that Tian's study was too small, and for too short a duration, to recommend ginseng to people with vascular dementia.

"It's premature to recommend it," says Dr. Robert Adams, chairman of the Stroke Council of the American Heart Association (news - web sites) and a spokesman for the American Stroke Association. "For us to really become convinced, I think we need larger, randomized controlled trials."

Furthermore, the study design was somewhat unusual in that, instead of a placebo, the researchers compared ginseng to another drug, Adams says.

If you are going to take ginseng, be sure to tell your doctor. Many people have the misconception that herbs are harmless, Adams says. In fact, ginseng may be as potent as any drug and can interfere with other prescriptions, he says.

Side effects of too much ginseng include insomnia, dry mouth and constipation, Tian says. Chinese doctors typically recommend about 3 grams (2 grams of ginseng extract and 1 gram of panax notoginseng) taken in the morning.

More information

Find out more about ginseng at Memorial Sloan-Kettering Cancer Center's herbal remedy Web site. Fore more on herbal supplements, check out the Mayo Clinic.

Back to the Top

Smoking, Pelvic Infections Up Tubal Pregnancy Risk 

Reuters Health
Friday, February 14, 2003

NEW YORK (Reuters Health) - Smoking and sexually transmitted pelvic infections can more than triple a woman's risk of having an ectopic pregnancy, French researchers report in the February issue of the American Journal of Epidemiology.

The new findings back up previous research on risk factors associated with the disorder.

An ectopic pregnancy occurs when the fertilized egg is implanted outside the uterus, usually in the fallopian tubes. These pregnancies can result in bleeding and death if the embryo is not removed surgically.

While smoking, infections, past history of ectopic pregnancy, tubal surgery and tubal sterilization can increase the risk, in many cases, the cause is unknown.

Now Dr. Jean Bouyer of The French Institute of Health and Medical Research in Le Kremlin-Bicetre and colleagues report on risk factors for ectopic pregnancy identified in a group of 803 women diagnosed with the condition.

The researchers collected a variety of information from the women including smoking habits, previous spontaneous or surgical abortions, and history of pelvic infection. The women's responses were compared to those from 1,683 women who delivered babies after a normal pregnancy.

Women who reported a past sexually transmitted pelvic infection such as chlamydia had a 3.4-fold increased risk for ectopic pregnancy compared to women who had never had such infections. Smokers were 3.9 times more likely to have an ectopic pregnancy than women who never picked up the habit, the authors report.

Other risk factors associated with ectopic pregnancy, according to the report, included previous miscarriage. The researchers also found that women who'd had medically induced abortions were more likely to have ectopic pregnancy, but these "new findings" must be confirmed by future research, the authors say.

"In terms of public health, increasing awareness of the role of smoking may be useful in the formation of ectopic pregnancy prevention policies," they conclude.

Source: American Journal of Epidemiology 2003;157:185-194.

Back to the Top

HRT Linked to Increased Stroke Risk

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews
Friday, February 14, 2003

FRIDAY, Feb. 14 (HealthScoutNews) -- The first jolt came less than a year ago, when a national study revealed that combined hormone therapy wouldn't protect a woman from heart disease as previously believed.

Now a new analysis of that same research has found the estrogen-progestin combination also appears to increase a woman's risk of stroke, in some instances by as much as 70 percent. The increases were not just limited to women with high blood pressure, which is a known risk factor for stroke.

"We saw an increase in stroke in all postmenopausal women across the board, in healthy women and in women with high blood pressure, in younger women and older women," says study author Sylvia Wassertheil-Smoller, a professor of epidemiology and social medicine at Albert Einstein College of Medicine in New York City. "There is no doubt in my mind that the use of the estrogen/progestin combination should not even be considered as a strategy for protecting a woman's health."

Smoller's research is a re-analysis of data previously released from Women's Health Initiative (WHI), a study designed to examine the health effects of hormone replacement therapy (HRT). Although slated to last eight years, part of the trial ended after five when sufficient data showed combined hormone therapy not only failed to protect women, but also appeared to increase health risks, particularly for cardiovascular disease. The estrogen-only arm of the study is continuing.

The new analysis was devised to see whether the same links appeared in relation to stroke. The researchers looked at data on 8,506 women aged 50 to 79, all of whom received the combined estrogen/progestin therapy. The control group was comprised of 8,102 women of the same age who took a placebo.

The study also took into consideration the women's ages, race, blood pressure status and baseline risk for stroke, none of which were detailed when WHI was halted last year.

The end result: Overall, researchers saw 133 strokes in the group taking the hormones, compared to 93 in the control group. Women aged 50 to 59 who were taking hormones had the most dramatic increases in strokes -- as much as 70 percent over the control group. Those aged 70 to 79 saw the least risk -- only 26 percent.

The most surprising finding of all, Smoller says, was that even in women who had no history of heart or blood vessel disease, stroke rate climbed by 40 percent when the combined hormone therapy was used.

Not everyone agrees with the conclusions, which were presented Feb. 14 at the American Heart Association (news - web sites)'s International Stroke Conference in Phoenix.

For gynecologist Dr. Steven Goldstein, the new analysis has serious flaws and its conclusions are premature. Among the most obvious problems, he says, is the lack of information concerning other risk factors for stroke, particularly in women with normal blood pressure.

"The study cannot tell us, for example, if these women might have had high cholesterol, if they smoked, if they were overweight -- all factors that could have easily influenced the risk of stroke, irrespective of hormone use," Goldstein says.

He adds that unless researchers can say for certain that these other mitigating factors were not present, then it is impossible to link the incidence of stroke to hormone use in any kind of meaningful way.

"It is very unfair to women to draw conclusions that create fear without sufficient proof that there is even cause for alarm," he says.

While doctors aren't certain how or why the combination of estrogen and progestin appears to increase stroke risks, Smoller believes individual bio-markers and genetic fingerprints may play a role.

According to the American Stroke Association, almost 100,000 women die of stroke each year, almost twice as many as from breast cancer (news - web sites).

More information

To learn more about the other findings from this major study, visit the Women's Health Initiative.

To learn more about risk factors for stroke, check out American Stroke Association.

Back to the Top

Study: Deaths from Food Poisoning Underestimated 

By Patricia Reaney

Reuters
Friday, February 14, 2003

LONDON (Reuters) - Deaths from food poisoning caused by bacteria such as Salmonella kill more people than previously thought, Danish scientists said on Friday.

Salmonella in poultry products and eggs, and Campylobacter, which is found in chicken, are leading causes of food poisoning.

In most people the infections are not serious and will result in a few days of diarrhea, stomach cramps or fever, but in the very young, the elderly and people with chronic illnesses like diabetes or HIV (news - web sites) they can be deadly.

Kare Molbak and scientists at the Statens Serum Institute in Copenhagen believe deaths from food poisoning could be twice as high as current estimates and can occur up to a year after infection.

"This has never been studied before because people have always thought of Salmonella and Campylobacter as acute infections. But what we observe is that for some patients there is a late excess mortality up to one year after infection," Molbak said in an interview.

The Centers for Disease Control (CDC) in the United States estimates that about 5,200 people there die each year from food poisoning, but the Danish researchers believe the true figure could be nearly twice as high.

They said deaths from food poisoning are underestimated because they usually occur within 30 days after infection and there is very little long-term data. Food poisoning deaths can also be wrongly attributed to other illnesses.

"It has been due basically to a lack of data," said Molbak.

In research reported in The British Medical Journal, the Danish scientists studied the medical history of 1,071 people who had died within a year of being infected with Salmonella, Campylobacter, Yersinia enterocolitica and Shigella.

Yersinia enterocolitica is bacteria found in pork and Shigella is found mainly on imported fruits and vegetables.

Deaths within the first year after infection were 2.2% in the people who had had food poisoning, compared to 0.7% in a control group of 3,636 people.

Molbak advised people to cook meat thoroughly and to wash fruits and vegetables in clean water to avoid food poisoning, which can be treated with antibiotics.

He added that the overuse of antibiotics can lead to the development of strains of bacteria resistant to the drugs.

In Denmark about 90 deaths a year are due to food poisoning, according to the research. Molbak said the number in Britain, which has a much bigger population, would be about 10 times higher.

Back to the Top

Helping Kids Cope With a Suddenly Unsafe World

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews
Friday, February 14, 2003

FRIDAY, Feb. 14 (HealthScoutNews) -- The U.S. government warns of possible terrorism -- "dirty bombs" or attacks with chemical or biological weapons. Americans flock to stores to buy duct tape and sheets of plastic to seal off rooms from poisons. The prospect of war in Iraq grows.

And another ominous threat looms: North Korean ballistic missiles could reach American soil, intelligence officials say.

Little wonder a chilling sense of vulnerability haunts Americans -- not least, the littlest Americans, the children growing up in an age of anxiety.

"Pediatricians around the country are telling us kids are having trouble sleeping and concentrating because of worries about terrorism and war," says Margaret Heldring, president of America's Health Together, a broad-based partnership of mental health and primary care organizations.

"This is not just a two- or three-week problem the country has; this is a whole new era," says Heldring, a Washington, D.C., clinical psychologist. "And our kids need to grow up now learning how to handle anxiety."

How can parents best help their children amid such national angst? The answers, of course, depend largely on the age of the child, experts say.

"With preschool kids, you want to build a wall around them -- like a brick wall -- so all the information comes from parents," says Richard Gallagher, director of the Parenting Institute at the New York University Child Study Center.

Of course, that's not always possible. Even preschool classmates could spread word of danger. So, Gallagher and other experts say, it's important to talk to young children to try to find out if they know about terrorism alerts and possible international conflicts.

Preschool-age children, experts say, can confuse facts with fantasy and easily become overwhelmed by news reports. Thus, the toddlers need parents to reassure them.

Joy Faini Saab, an associate professor of early childhood education at West Virginia University, has been researching the effects of televised war on children since the Persian Gulf War (news - web sites) 10 years ago.

"The younger children don't understand some concepts relative to time and space, Saab explains. "If they see violence on TV, it could [seem to] be right next door. They don't understand how far away it is or that it's a historical clip from the Persian Gulf War."

By school age, children will likely pick up news from TV, the radio, the Internet or peers. These youngsters need to know they can talk about their fears with parents, who should avoid minimizing or dismissing the fears, Gallagher says.

"A family could make an effort to be overly protective and find information seeps in, and I think there can be dangers of that, especially for children who are school-age," he says. "Children may ask, 'Why aren't my parents helping me with this?'"

The American Academy of Child and Adolescent Psychiatry recommends parents strive to foster an open and supportive environment, acknowledging children's thoughts, feelings and reactions and answering them honestly.

"One of the worst things that can happen is kids hide their fears, and when they hide their fears, the fears get worse," Heldring says. "We don't want to drive fears underground where they can become monsters in the mind."

Experts offer other tips on talking to children about possible war and terrorism:

  • Don't make unrealistic promises -- for instance, that no more planes will crash or no one else will get hurt.
  • Limit TV coverage of terrorism threats and war (and eliminate it altogether, if possible, for preschool kids).
  • Reassure children by informing them of steps you're taking such as buying extra food or medicine, just in case. But don't make a big deal of it and explain it's unlikely their schools or houses, for instance, will become terrorism targets.
  • Maintain routines and schedules; this reassures children. Keep them involved in activities such as sports, arts and crafts, school groups and religious observances.
  • Avoid stereotyping others by nationality or religion.
  • Stay in touch with your child's school to find out about lessons related to terrorism or war and to ask about fears or questions a child may have raised. For younger children, contact day-care centers or preschools to find out if your child is exposed to topics such as terrorism and war.
  • Get the family together more often through shared activities and increase one-on-one activities like playing games.

Even if you do all you can to help your child cope, you should watch for excessive anxiety, stress or other signs that might signal a need for counseling.

These warning signs can include physical symptoms such as headaches or stomachaches; preoccupation with war, fighting or terrorism; significant changes in behavior; depressed or irritable moods; trouble sleeping or nightmares; changes in appetite; social withdrawal; recurring fears or anxiety about leaving parents to go to school.

More information

For more on helping children cope with threats of war and terrorism, visit the New York University Child Study Center or the American Academy of Child and Adolescent Psychiatry.

Back to the Top

French Red Wines Show Blood-Vessel Benefits 

By Amy Norton

Reuters Health
Friday, February 14, 2003

NEW YORK (Reuters Health) - A flood of research suggests that modest drinking is heart-healthy, but could getting your wine from France make le différence?

Probably not. But German scientists have found that French red wines may have at least one blood-vessel benefit that a handful of German reds lack.

Their experiments with human blood-vessel cells showed that the French wines boosted the cells' production of nitric oxide (NO), a compound that helps dilate blood vessels and prevent blood clotting.

Endothelial cells--which line the insides of blood vessels--produced up to three times more NO when "treated" with French wine than when wine-free, according to findings published in the February 5th issue of the Journal of the American College of Cardiology.

No such effect was seen in cells doused with German red wine.

According to the study authors, the NO boost brought on by red wines from France "and probably other locations" may be one reason the beverage is tied to a lower risk of cardiovascular disease.

Dr. Thomas Wallerath and colleagues at Johannes Gutenberg University in Mainz conducted the study.

Many studies have suggested that alcohol, in moderation, may help protect against coronary artery disease. Various mechanisms, including elevations in "good" HDL cholesterol and blood-thinning effects, are thought to be at work.

Some research, particularly in Europe, has pinpointed red wine as being especially heart-healthy. One theory is that antioxidant compounds derived from the grapes used to make red wine provide additional heart benefits. Antioxidants, found in a variety of fruits and vegetables, neutralize cell-damaging compounds in the body called free radicals.

Wallerath's team speculates that these grape compounds caused the NO increase they found--and could explain the difference between the French and German wines. French red wines, they note, have been found to harbor particularly high levels of antioxidants called polyphenols.

But the findings "don't necessarily mean French wine is better," Dr. Robert A. Vogel of the University of Maryland Medical Center in Baltimore told Reuters Health.

Vogel, who wrote an editorial accompanying the report, pointed out that the study looked only at isolated endothelial cells.

"The translation of that to what we should drink may be a stretch," he said.

US studies, he noted, have suggested that when it comes to the heart benefits of drinking, all alcohol-be it wine, beer or spirits--is basically created equal.

Still, according to Vogel, the study does offer a "plausible explanation" for why European, but not American, studies have suggested red wine might be the heart-healthiest of alcoholic beverages--that is, if the wines Americans typically drink have different NO effects than French wines do.

Source: Journal of the American College of Cardiology 2003;41:471-478,479-481.

Back to the Top

Gambling and Drinking Is a Losing Hand

By Ross Grant
HealthScoutNews Reporter

HealthScoutNews
Friday, February 14, 2003

FRIDAY, Feb. 14 (HealthScoutNews) -- Drinking while gambling is a bad bet.

That's the conclusion of a group of new studies that indicate that gamblers take greater risks and play longer when they are drinking, especially those with gambling problems.

Meanwhile, gambling addicts say they think of alcohol more often when they're winning. And they are better able to recover from that addiction when they also tackle their alcoholism, the studies find.

"Therapy needs to focus on finding ways to break these over-learned or 'unconscious' associations between winning and drinking," says Sherry Stewart, an associate professor at Dalhousie University in Nova Scotia.

The findings, published in the February issue of Alcoholism: Clinical and Experimental Research, are striking in light of the fact that about half of casinos serve free drinks.

At the same time, 82 percent of Americans participated in some form of gambling in 2002, up from 61 percent in 1975, according to another study in the current issue of the Journal of Gambling Studies.

Casino executives say they take seriously the responsibility that comes with serving alcohol. Most casino employees are trained to deal with drunk patrons, cutting off their drinking and gambling privileges and preventing them from driving.

"The bottom line is that anyone who appears to be past their limit, we won't let them gamble. We want a fair game. We're not trying to make money off people being intoxicated," says Rob Stillwell, a spokesman for Boyd Gaming Corp., which runs 12 casinos in five states.

But the tradition of serving free drinks -- legal at commercial casinos in Colorado, Iowa, Louisiana, Mississippi, New Jersey and Nevada -- has stood for decades, and likely won't pass away.

"It's something that customers have come to expect," Stillwell says, adding that casinos also often give free meals and rooms to guests.

Still, gambling industry leaders discount the significance of the new research, since much of it applied only to pathological gamblers, who make up 1 percent to 2 percent of the gambling population.

While Stewart admits that the findings are still undergoing peer-review, that three of the four studies focused on addicted gamblers, and that most of the research was funded by gambling addiction recovery associations, she says some of the findings do apply to general gamblers.

In one study, her team brought 44 people into a simulated casino in a laboratory. Half of them were problem gamblers and half were normal gamblers. Half of each group was given moderate doses of alcohol, and all of them gambled for up to 30 minutes, using video lottery terminals. The gamblers with alcohol in their system played longer and doubled their bets more frequently.

"Across the board for everybody, gamblers are more likely to take risks when drinking. But those with gambling problems took even greater risks," Stewart says.

When asked if such findings might persuade casinos to stop giving free drinks, American Gaming Association President and Chief Executive Officer Frank Fahrenkopf Jr. says it depends on the level of proof and guidance from state authorities.

"If there's extensive peer-reviewed research, it's clearly something that the industry and state legislators should be looking at. Remember, casinos have to be licensed," Fahrenkopf says. "But you know, the industry changes when things have been shown to be wrong."

More information

For help with a gambling addiction, visit the National Council on Problem Gambling or the North American Gaming Regulators Association. To take a virtual tour of the Dalhousie Gambling Laboratory, click here.

Back to the Top

Women Less Likely Than Men to Have a Second Stroke 

By Martha Kerr

Reuters Health
Friday, February 14, 2003

PHOENIX (Reuters Health) - Men have a higher rate of recurrent strokes than women, but the recurrence rate in women is still "alarmingly high," Yale researchers reported here Thursday at the American Stroke Association's' 28th International Stroke Conference.

Dr. Judith Hillevi Lichtman and her team followed 433,454 Medicare patients hospitalized for stroke in 1993. Patients, whose average age was 78, were followed for six years.

Between 1993 and 1999, about 15% of women and 16% of men had another stroke. After accounting for other factors that can increase stroke risk, women's repeat stroke risk remained 8% lower than men's.

Women were 24% less likely to be hospitalized for a heart attack than men, and were 5% less likely to be admitted to the hospital for any cause. Overall mortality for all study participants in the six years following their stroke was 60%. After adjusting for other variables, women's death risk was 19% lower than men's.

"It is important to go beyond just the current stroke," Lichtman noted. "Women seem to do better in the long run, but this rate is exceedingly, unacceptably high. We need better prevention, and women need to be treated, and more aggressively."

Lichtman told Reuters Health there are likely several reasons for the gender differences seen in recurrent strokes. "Maybe women metabolize medications differently, maybe they have a different type of support system, maybe they seek medical attention differently." She said that she plans to study these factors in future research.

Back to the Top

Neglect Can Cause Child Development Problems

HealthScoutNews
Friday, February 14, 2003

FRIDAY, Feb. 14 (HealthScoutNews) -- Infants in orphanages who are neglected during their first few months of life can suffer development problems that last for years.

A panel of scientists reported that finding Feb. 14 at the annual meeting of the American Association for the Advancement of Science (news - web sites) in Denver.

More research into the biological aspects of these developmental difficulties may suggest ways to improve the lives of some of these troubled children and also provide more information on brain development during early childhood.

In the last decade, the number of children from other countries adopted by U.S. families has increased from 7,000 to 17,000. Currently, about 85 percent of foreign children adopted by American families have spent some part of their lives in institutions.

The panel of scientists provided some examples of the type of potential social and emotional problems experienced by children who spend their early lives in institutions.

These children don't have the chance to form close bonds with their parents. They tend to be indiscriminately friendly towards all adults. However, according to normal patterns of child development, they should be somewhat wary of strangers.

More information

Here's where you can learn more about child development.

Back to the Top

Common Painkiller Cuts Heart Benefits of Aspirin 

By Patricia Reaney

Reuters
Friday, February 14, 2003

LONDON (Reuters) - Ibuprofen, a common over-the-counter painkiller, can reduce the effects of low-dose aspirin in preventing cardiovascular disease, researchers said on Friday.

Low-dose aspirin cuts the risk of heart disease and stroke by making blood-clotting cells less sticky, which prevents clot formation.

But ibuprofen, a hugely popular drug taken to relieve aches and pains, diminishes the benefits of aspirin and can also increase the risk of stomach bleeding.

"If you have proven cardiovascular disease and you take prescribed aspirin to prevent further disease it would not be a good idea to take prolonged, chronic ibuprofen," Professor Tom MacDonald of Ninewells Hospital and Medical School in Dundee, Scotland, told Reuters.

The occasional ibuprofen will not cause any problems, but MacDonald warned that the two should not be taken together for any extended period of time.

He and his colleague Li Wei studied the medical history of more than 7,000 patients with cardiovascular disease who had been discharged from hospital and were taking low-dose aspirin alone or in combination with ibuprofen.

"There is about a doubling of mortality if you take both," said MacDonald.

"It looks like there has been a significant attenuation of the beneficial effect of aspirin."

Ibuprofen belongs to a class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). They relieve pain by blocking the action of an enzyme called Cox-1, which is found in the stomach and the blood, and Cox-2, which is in the skin and joints and is also produced at the site of a wound or pain.

MacDonald found no increased risk of death in patients taking aspirin and diclofenac, another NSAID.

In a commentary in the journal, Garret FitzGerald of the University of Oxford said aspirin's role in preventing heart attacks and strokes is well-documented.

"When patients taking aspirin for cardioprotection require chronic treatment of inflammation with an NSAID, the addition of diclofenac or a conventional selective COX-2 inhibitor would seem preferable to ibuprofen," he said.

Back to the Top

Helping Stroke Patients Breathe Easier

HealthScoutNews
Friday, February 14, 2003

FRIDAY, Feb. 14 (HealthScoutNews) -- A combination of two devices that clear secretions from the lungs can protect hospitalized stroke patients from respiratory problems.

That's the finding of a study that will be presented Feb. 14 at the American Stroke Association's annual conference in Phoenix.

Stroke can affect your swallowing and breathing functions and interfere with your body's ability to clear normal lung secretions. That can lead to pneumonia or the collapse of air sacs in the lungs.

All these conditions can lead to hypoxemia -- a condition in which there is a less-than-normal amount of oxygen in the bloodstream, resulting in less life-sustaining oxygen being delivered to organs and tissue.

In this study, researchers at the University of Alabama Medical Center at Birmingham tested a combination of an air-filled vibrating vest and a mechanical cough-assist device. The vest vibrates at high frequency, loosening secretions lodged in the lungs and creating friction between the air and mucus.

The vest's action helps move secretions from the lower lungs to the upper airways.

Then it's the turn of the cough-assist device. This consists of a mask that fits over the face and a mechanism that pushes a big breath of air into the lungs and then rapidly sucks the air out, bringing the mucus along with it.

Each treatment lasts 5 to 10 minutes.

Both devices already have U.S. Food and Drug Administration (news - web sites) approval.

The study compared the effectiveness of this vest/cough-assist device to the conventional method of loosening lung secretions in stroke patients by thumping them on the back and turning them over.

The study found the vest/cough-assist device combination offered significant advantages in a number of areas, including an improvement in oxygen saturation.

More information

Here's where you can learn more about stroke-related health complications.

Back to the Top

THURSDAY, FEBRUARY 13, 2003 

Managing Chronic Disease Online

 

HealthScoutNews

Thursday, February 13, 2003

THURSDAY, Feb. 13 (HealthScoutNews) -- Stanford University Medical Center is looking for people who have been diagnosed with heart disease, lung disease or Type 2 diabetes to take part in a study of a workshop that teaches disease self-management skills.

This free, six-week online workshop is designed to help participants learn skills to manage their chronic disease and to maintain or increase their activity levels.

The Stanford researchers plan a two-year study of the workshop to determine how effective this kind of Internet-based program can be in helping people with chronic health conditions live better, more active lives.

The study is open to any U.S. resident. Participants need to have Internet access and an active e-mail account. Each person taking part will be enrolled with 15 to 20 other people who have also been diagnosed with heart disease, lung disease or Type 2 diabetes.

The workshops are led by two leaders and participants are asked to log on two to three times a week for a total of one to two hours. Workshop topics include dealing with frustration, fatigue, pain and isolation; appropriate use of medications; exercise to maintain and increase strength, flexibility and endurance; healthy eating; and making informed treatment decisions.

More information

If you want more information or are interested in enrolling in the study, go to the program's Web site, or phone toll-free 1-800-366-2624.

Back to the Top

Ibuprofen Could Be Bad for Heart Patients 

By Emma Ross

AP Medical Writer

The Associated Press
Thursday, February 13, 2003

LONDON - Fresh evidence adds to suspicions that ibuprofen could be dangerous for most heart patients because it can block the blood-thinning benefits of aspirin.

New research published this week in The Lancet medical journal found that those taking both aspirin and ibuprofen were twice as likely to die during the study period as those who were taking aspirin alone or with other types of common pain relievers.

Scientists believe ibuprofen clogs a channel inside a clotting protein that aspirin acts on. Aspirin gets stuck behind the ibuprofen and cannot get to where it is supposed to go to thin the blood.

Aspirin is considered the most important medicine for heart disease. Nearly all heart patients take it every day because it prevents the clots that cause heart attacks and strokes. Ibuprofen, which is in Motrin and Advil among other brands, is widely used for arthritis and other aches and pains.

Scientists at the Medicines Monitoring Unit of Britain's Medical Research Council checked the medical records of 7,107 heart patients who had been discharged from hospitals between 1989 and 1997 with aspirin prescriptions and had survived at least one month after leaving the hospital.

They were divided into four groups according to their prescriptions.

The first group included those on aspirin alone.

The second were given aspirin and ibuprofen and the third group had aspirin with another pain killer, diclofenac. Ibuprofen and diclofenac both belong to a widely used class of pain relievers known as nonsteroidal anti-inflammatory drugs, or NSAIDs.

The last group included those taking aspirin with any other NSAID, such as acetaminophen, which is in Tylenol.

The researchers found that those taking ibuprofen were almost twice as likely as those taking aspirin alone to die by 1997. That meant that for every 1,000 patients treated, there were 12 extra deaths a year when ibuprofen was taken with aspirin.

For heart-related deaths, ibuprofen was linked to three extra deaths per 1,000 patients treated per year.

Experts say it is important to track both heart-related deaths and deaths in general because deaths are sometimes attributed to the wrong cause and heart-related cases may be missed. For instance, a death certificate may say the person died in a car crash when, in fact, a heart attack or stroke at the wheel caused the crash.

No extra deaths were seen in the groups taking the other types of NSAIDs.

"The message here is beginning to be 'go for something other than ibuprofen,'" said Garret FitzGerald, who was not connected with the latest study, but whose research sparked concerns about the combination just over a year ago.

"Mechanistically, you have a very clear rationale for why it should happen," said FitzGerald, professor of cardiovascular medicine and chair of pharmacology at the University of Pennsylvania. "Now we have four studies each coming out with the same message. It's several pieces of ancillary evidence that when assembled are more persuasive than when taken in isolation."

"Lots of people take these two kinds of drugs chronically and probably a large number take both together chronically," FitzGerald said. "Talk to your doctor before you embark on this combination thinking that it's totally innocuous because both are available over the counter."

Dr. Tom MacDonald, who led the Lancet study, said taking the odd ibuprofen for a few days would not be a problem. It's regular use that seems to be at issue.

But the findings are not rock solid, experts said.

"This definitely raises a red flag ... but I don't think this can be viewed as the definitive answer on the question," said Dr. Veronique Roger, head of cardiovascular research at the Mayo Clinic in Rochester, Minn., who was not connected to the study.

It could be that heart patients who take ibuprofen have additional conditions that in turn make them more prone to premature death and were not accounted for in the study, she noted.

On the Net:

The Lancet, http://www.thelancet.com

Back to the Top

Poison Pointers

HealthScoutNews

Thursday, February 13, 2003

(HealthScoutNews) -- Many household items, from laundry detergent to over-the-counter medications, can be a poison hazard for curious young children. Ideally, you should keep any potentially toxic substance out of your kid's reach.

But if your child ingests anything that may be poisonous, the American Association of Poison Control Centers suggests you immediately call a poison center and have the following information ready:

  • Your child's condition, age and weight.
  • The product (not just the name) that your child swallowed.
  • The time the incident occurred.
  • Your name and telephone number.

In an emergency, the Council on Family Health suggests you call the nationwide poison control number at 1-800-222-1222. The call is free.

Back to the Top

1 in 5 Hand Surgeons Have Operated on Wrong Site 

Reuters Health

Thursday, February 13, 2003

NEW YORK (Reuters Health) - One fifth of hand surgeons in a new US survey admit they have operated on the wrong site at least once in their careers--most often on the wrong finger.

But on a more positive note, researchers report, a campaign begun in 1998 by the American Academy of Orthopedic Surgeons (AAOS) to reduce wrong-site procedures seems to be getting through to many surgeons.

According to the survey findings, published in the February issue of The Journal of Bone and Joint Surgery, 21% of 1,050 hand surgeons said they had operated on the wrong site at least once in their careers.

One surgeon admitted to doing three wrong-site procedures.

Nearly two thirds of the errors involved surgery on the wrong finger, while a few dozen involved the wrong hand or wrist.

Drs. Eric G. Meinberg and Peter J. Stern at the University of Cincinnati College of Medicine in Ohio conducted the study. Meinberg is now with the Carolinas Medical Center in Charlotte, North Carolina.

Surgical mix-ups and other medical mishaps, such as errors in prescribing drugs, have been receiving growing attention. One study released last month highlighted the risk, albeit small, of sponges and other surgical tools being "left behind" in patients.

Legal claims against orthopedic surgeons account for around 10% of all medical malpractice claims, Meinberg and Stern note in their report. And only a small percentage of orthopedic claims involve wrong-site surgery.

However, plaintiffs win the large majority of these cases.

"Wrong-site surgery," the study authors write, "is a preventable and largely indefensible surgical complication."

In response to the problem, the AAOS in 1998 launched a campaign called "Sign Your Site," which encouraged orthopedic surgeons to write their initials on the intended surgical site as part of their pre-operative routine.

In their survey, Meinberg and Stern found that 70% of orthopedic surgeons had heard of the campaign, and 45% of them "had changed their practice habits as a result."

However, the survey also included general surgeons and plastic surgeons who performed hand surgery, and these doctors were less likely to have heard of the campaign.

And, the researchers add, "while many surgeons voluntarily mark the operative site, much more must be done to ensure that this practice becomes a standing policy in North American hospitals."

They advocate that, besides marking the spot, surgeons verbally verify the intended site and procedure. And in the operating suite, they add, surgeons should routinely check that they've got the right site, as well as the right patient.

Source: Journal of Bone and Joint Surgery 2003;85-A:193-197.

Back to the Top

Take Off Your Thinking Cap

By Janice Billingsley
HealthScoutNews Reporter

HealthScoutNews

Thursday, February 13, 2003

THURSDAY, Feb. 13 (HealthScoutNews) -- Thinking through your problems is a good thing, right?

Not necessarily, particularly if you're a woman, says a University of Michigan psychologist.

Because women place so much importance in emotional connections, they are at risk for endlessly over-thinking problems to the point where they never solve them, Susan Nolen-Hoeksema says.

That can sometimes result in unhealthy behavior, according to the latest research she has done on the subject.

In a study of 1,300 men and women to be published next month in the Winter 2003 Journal of Cognitive Psychotherapy: An International Quarterly, Hoeksema and her colleagues found that over-thinkers were significantly more like to abuse alcohol than were those who did not ruminate too much.

The study, which was conducted by personal interviews, assessed the levels of over-thinking using a scale developed by Nolen-Hoeksema and her colleagues a decade ago. Called the Response Style Questionnaire (RSQ), it elicits a person's level of rumination by asking them how they respond to certain situations when they feel sad, and rates their responses on a scale of one to four.

Questions include whether they ask themselves, "Why do I think this way? when they are feeling sad, and whether they worry about their symptoms, such as thinking how hard it is to concentrate.

In the study, those who scored higher on the test also reported significantly higher levels of alcohol abuse, in terms of drinking rather than spending time with friends, or drinking more than they'd planned.

In her new book, Women Who Think Too Much: How To Break Free of Overthinking and Reclaim Your Life , and in other studies she has conducted over the past 15 years, Nolen-Hoeksema has found that women who over-think, which is defined as repeating the same thoughts over and over again without coming to a resolution, are more depressed and anxious than those able to focus on their problems.

Part of this, she says, is societal.

"Women are raised to be more sensitive to others, which is good, but can be taken too far," Nolen-Hoeksema says. "By endlessly analyzing the past, present and future, they repeat the same things over and over without moving into a problem-solving mode."

An example would be an over-thinking woman whose mother had breast cancer (news - web sites). The woman might be rightly concerned about her own risk for the disease, but instead of making an appointment for a mammogram, she would start thinking about who would take care of her child if she got sick, and the fact that she doesn't trust her husband's care-taking abilities.

"Her thoughts go into other domains," says Nolen-Hoeksema.

Eleanor Sloan, a Philadelphia psychologist who deals with depression and women, agrees.

"Women are encouraged by their roles in society to listen to everyone's feelings, but when they begin to think of all the problems, they can get lost in that forest of thought, and then the decision-making process becomes compromised," she says.

"It's not just women who do it, but women are more prone to it than men," she adds.

Nolen-Hoeksema notes, "We speculate that men are taught to be more proactive problem solvers from an early age."

However, Nolen-Hoeksema says over-thinkers can curb their ruminating tendencies.

There are three levels of response to over-thinking, she says, the first being to immediately switch gears when you finding yourself beginning to over-think.

"Do some physical activity, cook something really elaborate, or play with your child, anything that pleases you," she says.

Second, do something concrete rather than just think about what's troubling you.

"If you have a concern about breast cancer, call the doctor and make an appointment for a mammogram, or call your sister. Do something to move toward problem-solving," she says.

Lastly, make some long-term changes to the way you respond to situations. Changing your schedule to remove the times when you mostly likely begin ruminating, scheduling a particular time period when you let yourself think about a problem, and mediating as way to relax are all helpful strategies, Nolen-Hoeksema says.

More information

The National Alliance for the Mentally Ill has information about women and depression, as does The National Institute of Mental Health.

Back to the Top

Virus May Block HIV's Destructive Power

By Daniel Q. Haney

AP Medical Editor

The Associated Press
Thursday, February 13, 2003

BOSTON - An ancient virus that has tagged along harmlessly through human evolution appears to improve people's chances of surviving AIDS (news - web sites) by blocking HIV (news - web sites)'s ability to infect blood cells, new research shows.

Several recent studies have found that people who are infected with the recently discovered bug, called GB virus C, are substantially less likely than usual to die from AIDS. Experts assumed that GBV-C somehow interferes with HIV, but just how this protection works has been a mystery.

Now experts think they have the answer: It thwarts HIV's ability to infect cells by wiping away one of the chemical docking posts that HIV needs to make its entry.

"There is not a way for the virus to get into the cells. The doors are gone," said Carolyn Williams of the National Institute of Allergy and Infectious Diseases (news - web sites).

Whether this is more than a medical curiosity, however, is still unclear. Some researchers say they would be reluctant to intentionally give GBV-C to people with HIV, because they fear the approach could backfire, ultimately doing more harm than good.

However, others say experiments to give it a try are possible, perhaps on patients whose HIV resists all standard drugs. "I think it may well be tested in a controlled setting," said Dr. Jack Stapleton of the University of Iowa.

Stapleton presented the latest discovery Thursday in Boston at the 10th Conference on Retroviruses.

HIV is harmless unless it gets inside blood cells. Once it enters a cell, it commandeers the cells' own machinery to copy itself, killing the cell in the process.

The AIDS virus uses three different chemical spots as attachment points to enter cells. Stapleton's team found that if the body is already infected with GBV-C, it makes fewer copies of one of these chemicals, called CCR5. The result: HIV cannot get in as readily as usual.

GBV-C was discovered in 1995. It was at first mistakenly thought to be a hepatitis virus and called hepatitis G. Now, however, scientists say that, while the virus is closely related to hepatitis C, it causes no disease they can find.

Like HIV, GBV-C is transmitted mainly through blood contact or sex. Because the virus is harmless, blood donations are not routinely screened for it. However, studies show that 1 percent to 2 percent of blood donors have active infections, as do about 40 percent of all people with HIV.

Research suggests that the virus has been around as long as people have. "The virus was present in Lucy and evolved in humans as the races evolved," Stapleton said.

A study by Williams followed 271 men who caught HIV in 1985. Those who also had GBV-C fared considerably better than usual, while men who lost the virus after getting HIV did substantially worse.

After 11 years, 75 percent of those with GBV-C were still alive, compared with 39 percent who never had the virus and 16 percent of those who had the virus but then lost it.

Her study looked at GBV-C's effects before the advent new drug combinations that have greatly improved the outlook of people with AIDS. Nevertheless, a variety of other research suggests that people with GBV-C respond better to these drugs.

Among other research at the meeting:

·        Doctors worry that AIDS drugs may damage the heart by causing arteries to harden. Researchers from Hvidovre University Hospital in Denmark studied 23,490 patients and found that AIDS drug treatment appears to raise the risk of heart attacks by about 27 percent a year.

·        People with HIV are routinely denied liver transplants because of concern that immune-suppressing drugs would aggravate their infections. However, a study from the University of Pittsburgh found that HIV patients' survival after three years is just as good as uninfected people's.

·          The cost of AIDS drugs has fallen to about $300 a year in poor countries, but the testing needed to monitor the drugs can cost as much as $1,000. Researchers from Harvard Medical School (news - web sites) described a battery-operated, handheld machine that can do blood counts in remote areas. The device will cost about $600 and do the tests for about $1 apiece, compared with the usual cost of $25.

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

On the Net:

Conference: http://www.retroconference.org/2003

Back to the Top

Scientists Identify Genetic Marker for Longevity 

By Deena Beasley

Reuters

Thursday, February 13, 2003

LOS ANGELES (Reuters) - Scientists for the first time have identified a common genetic mutation in people over 100 years old, a finding they say could be a key to discovering a way to avoid the ravages of aging.

In a study conducted at the California Institute of Technology in Pasadena, California, researchers found that centenarians were five times more likely than others to have the same mutation in their mitochondrial DNA.

Mitochondrial DNA, the portion of DNA located in the mitochondria or "powerhouses" of the cell, passes only from the mother to offspring. The mitochondria capture the energy released from the oxidation of metabolites and convert it into energy.

"It is possible that in the process of replication these molecules are less damaged by oxidation, but we don't know that yet," said Dr. Guiseppe Attardi, Caltech professor of molecular biology, and an author of the study.

He said further lab studies are underway to determine the exact physiological effect of the genetic mutation.

The key mutation shifts the site at which mitochondrial DNA starts to replicate, and perhaps that may accelerate its replication, allowing the individual to replace damaged molecules faster, he said.

In the study of a group of 52 Italian centenarians, the researchers found a common mutation in the same main control region. Looking at mitochondrial DNA in white blood cells, they found that 17% of the 52 had a specific mutation called C150T transition, compared with only 3.4% of 117 people under the age of 99.

The results are published in the latest issue of the Proceedings of the National Academy of Sciences (news - web sites).

To see whether the mutation is inherited, the team studied skin cells collected from the same individuals between nine and 19 years apart.

In some, both samples showed that the mutation already existed, while in others, it either appeared or became more abundant during the intervening years. These results suggest that some people inherit the mutation from their mother, while others acquire it during their lifetime, Attardi said.

"The selection of the C150T mutation in centenarians suggests that it may promote survival," he said.

Back to the Top

Say Ahh for Eating Disorders

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews
Thursday, February 13, 2003

THURSDAY, Feb. 13 (HealthScoutNews) -- Dr. Sally Cram knew her patient, a woman in her 20s, had a history of eating disorders.

At one point, Cram, a periodontist, had to put crowns on nearly all of the woman's teeth because her frequent purging had worn down the enamel.

For a few years, the woman seemed to gain control of her disorder -- bulimia nervosa.

Then Cram noticed the enamel under the crowns was again disappearing. She immediately notified the woman's doctor and therapist -- she was vomiting again.

"The mouth is often the first place that eating disorders show," says Cram, a gum disease specialist in Washington, D.C., and a consumer advisor for the American Dental Association.

"It's really important to have a joint relationship between the dentist, the therapist and the general practitioner," she says. "We can alert them to things they might not otherwise see, because, of course, they don't look in the mouth."

Eating disorders are among the most common mental health problems in the United States. Anorexia, or self-starvation, affects as many as one in 100 girls and young women, according to the American Psychiatric Association. The rate for bulimia, or purging after meals, is similarly high.

However, spotting these diseases can be exceedingly difficult, says Rita DiGioacchino DeBate, an assistant professor of health behavior and administration at the University of North Carolina at Charlotte.

People with eating disorders take great pains to hide or disguise their behavior. And until the disease reaches a severe stage, there may be few obvious physical signs. A woman with bulimia can still be overweight, DeBate says.

That's where dentists can help. Because the mouth is one of the first places to show evidence of eating disorders, dentists are in a perfect position to spot them.

A dry mouth, cracked lips, enlarged glands on the sides of the face and neck, hypersensitive teeth, bleeding gums and a sore throat are all signs of frequent vomiting, DeBate says.

Stomach acids can also lead to erosion of the enamel on the teeth, leaving the back of the top front teeth looking yellowed and pitted. One study found 38 percent of bulimics had evidence of teeth erosion or other symptoms, she says.

One symptom of the severe loss of body fat associated with anorexia is lanugo -- a fine, white, downy hair that the body grows to keep itself warm. You have to look closely to notice it, DeBate says. "Dentists are very close to the face and arms, meaning they can definitely identify it," she says.

However, many dental practitioners are reluctant to get involved with aspects of their patient's health that don't deal directly with the mouth, Debate says.

"Dentists and hygienists are not trained to talk to patients about this," DeBate says. "Some dental programs train dentists to fix the problems in the mouth, rather than look at the patient as a whole. The focus is on filling the cavities, rather than finding out what's causing the cavities."

DeBate recently received a $130,000 grant from the National Institute of Dental and Craniofacial Research to teach dentists to look for eating disorders and make referrals to therapists, nutritionists and others trained to treat the problem.

The first step of her research was a national survey to figure out how much dentists know about eating disorders. Preliminary results found 68 percent of dentists who responded to the survey had identified an eating disorder in a patient, but only 15 percent referred the patient to an expert who could treat the condition.

"There is some kind of disconnect there," DeBate says. "They are seeing it, yet they are not taking that step to refer them. They may believe it's not their role. If that's so, that's what we need to change."

The next step in her research, DeBate says, will be to test a health education program at 20 North Carolina dental practices. The program will help dentists identify signs of an eating disorder, approach the patient and make appropriate referrals.

Once the results of this study are in, DeBate plans to apply for more funding to make the program available to more dental practices throughout the United States.

More information

Eating disorders can be serious and life-threatening. For help with anorexia or bulimia, visit the National Eating Disorders Association or the Eating Disorders Referral and Information Center.

Back to the Top

Osteoporosis a Risk for Fragile X Gene Carriers 

Reuters Health

Thursday, February 13, 2003

NEW YORK (Reuters Health) - Women who carry a partial mutation in a gene linked to an inherited form of mental retardation do not--as has been suspected--have an increased risk of heart disease and several other diseases, results of a new study suggest.

But these women, who tend to begin menopause at an early age, are more likely than other women to develop the brittle-bone disease osteoporosis.

Fragile X syndrome is a hereditary type of mental retardation caused by mutations in a gene called FMR-1. Some people, however, have only a partial mutation in the gene. People with one of these so-called premutations were thought to be perfectly healthy, but now it is known that woman with a fragile X premutation often begin menopause before age 40.

Since levels of the heart-protective hormone estrogen plummet during menopause, researchers have worried that women with fragile X premutations may be at increased risk of heart disease and, perhaps, other diseases.

That does not seem to be the case, a team led by Dr. D. D. M. Braat, of the University Medical Center Nijmegen in The Netherlands, reports in the American Journal of Medical Genetics.

In a study of 152 women with partial mutations and 112 who had either a complete mutation or none at all, having a partial mutation did not increase the risk of cardiovascular disease or autoimmune diseases.

However, several women with partial mutations, but none of the other women, developed osteoporosis. All these women had started menopause before turning 45, so the researchers suspect that their brittle bones are due to a drop in estrogen levels and are not a direct result of the partial mutation.

The results of the study are "important" for the counseling of women with premutations, according to Braat's team. Since women with premutations tend to begin menopause early, boosting the risk of osteoporosis, they may want to consider treatments that prevent bone-thinning, the investigators state.

An estimated 1 in 700 men and 1 in 250 women carry a partial form of the fragile X mutation. Fragile X syndrome is the leading cause of inherited mental retardation, and affects approximately 50,000 people in the US.

Source: American Journal of Medical Genetics 2003;117A:6-9.

Back to the Top

The Right Dose

 

HealthScoutNews

Thursday, February 13, 2003

(HealthScoutNews) -- If your child has a fever and you have no children's Tylenol on hand, don't be tempted to administer a "child's dose" of an adult medication.

According to the University of Texas Southwestern Medical Center, not all medications work the same in kids as they do in adults. Sometimes children may need smaller doses, other times they may require larger amounts.

In all cases, consult your doctor if you're not sure about the medicine you're about to give to your child.

Back to the Top

Fitness May Prevent Cancer Deaths Among Men: Study 

By Merritt McKinney

Reuters Health

Thursday, February 13, 2003

NEW YORK (Reuters Health) - Staying fit and trim may do more than keep your heart healthy, researchers report. It could also reduce your risk of dying from cancer.

In a 25-year study, men who were most fit at the start of the study were less likely to die from cancer. And women who were overweight when the study began were at higher risk of dying from cancer.

"The current recommendations from the American Cancer Society (news - web sites) emphasize a physically active lifestyle and the prevention of overweight/obesity," the study's lead author, Dr. Kelly R. Evenson, told Reuters Health. "Our results support those recommendations."

Evenson and her team examined the relationship between fitness and obesity and the risk of dying from all types of cancer.

Evenson, who is at the University of North Carolina at Chapel Hill, said that "it would be nice in future studies if we could examine the relationship of fitness and obesity on certain types of cancers, such as breast cancer (news - web sites)."

The findings are published in the February issue of the journal Medicine and Science in Sports and Exercise.

The study included 2,585 women and 2,890 men who were followed from the early- to mid-1970s to 1998. At the start of the study, volunteers performed a treadmill test to measure their heart health and had their body mass index, or BMI, measured. BMI is a measure of weight in relation to height used to gauge obesity.

After taking into account factors that could influence health, Evenson's team found that the fittest men were about half as likely to die from cancer as less fit men. Fitness levels did not have a significant effect on cancer deaths in women, however.

But a woman's BMI at the start of the study was related to her chances of dying from cancer during the next 25 years, according to the report. Women with the highest BMI were almost 50% more likely to die from cancer than less obese women.

Evenson's team did not examine how fitness and obesity may affect the odds of dying from cancer, but physical activity is believed to reduce cancer risk by influencing levels of certain hormones and growth factors, by decreasing body fat and possibly by enhancing the immune system.

Source: Medicine and Science in Sports and Exercise 2003;35:270-277.

Back to the Top

Study: Foodborne Illnesses Deadlier Than Thought

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Thursday, February 13, 2003

THURSDAY, Feb. 13 (HealthScoutNews) -- More people may be dying of foodborne illnesses than originally thought, says a new study.

Infections with several different bacteria were associated not only with increases in the short-term risk of death, but also with longer-term risks of up to one year.

"It's possible that those people who get foodborne infections are also people with severe underlying illness or who have a generally poor health status than most people, but we accounted for this problem and we still observed this excess mortality," says Dr. Kare Mølbak, the senior author of the study and a senior medical officer with the department of epidemiology at Statens Serum Institute in Copenhagen, Denmark.

"To our surprise, for some of the agents, the mortality risk was up to one year after the acute phase of the infection," Mølbak adds.

The study, which appears in the Feb. 15 issue of the British Medical Journal, comes on the heels of an announcement by U.S. Rep. Rosa L. DeLauro (D-Conn.) that that she was again co-sponsoring the Safe Food Act, which would create a single food-safety department out of the 19 existing U.S. departments and agencies. .

The U.S. Centers for Disease Control and Prevention (news - web sites) estimates that foodborne diseases cause 76 million illnesses, 325,000 hospitalizations and 5,200 deaths each year. DeLauro, who contracted Salmonella poisoning as a child and was quarantined for two weeks, reports that 6.6 million pounds of potentially contaminated meat were recalled last year.

More than 250 foodborne diseases have been described, most of them caused by viruses, bacteria, or parasites.

This study looked specifically at four bacteria -- Salmonella, Campylobacter, Yersinia enterocolitica, and Shigella in 48,857 Danish people. This group was compared with 487,138 controls from the general population.

More than half (55.2 percent) of the patients in the foodborne-illness group were infected with Salmonella, one-third (33.1 percent) with Campylobacter, 8.3 percent with Yersinia enterocolitica, and 3.4 percent with Shigella.

Each of the four bacteria listed can cause diarrhea, cramping, abdominal pain, and fever. Most cases resolve on their own but some patients need further care and even hospitalization.

As a group, the people with a foodborne bacterial infection had a 3.1 times higher mortality than the controls. In total, 2.2 percent of the people who got gastrointestinal infections from the bacteria died within one year, compared with only 0.7 percent of the controls.

The mortality rate among those who contracted a specific strain called Salmonella dublin was 12 times higher than for the controls. For the other types of Salmonella, Campylobacter, and Yersinia enterocolitica, mortality was 1.86 to 2.88 times higher.

According to the study authors, the findings are more or less in line with existing fatality records for Yersinia but are higher than those previously reported for Salmonella, Campylobacter, and Shigella.

"There are a number of possible explanations," Mølbak says. Some of the patients may have had a relapse of the infection, even though it appeared to have cleared. Patients who had surgery may have had complications arising from the procedure.

"It makes perfect sense to me," says Dr. Philip Tierno, the director of clinical microbiology and immunology at New York University Medical Center and the author of The Secret Life of Germs and Protect Yourself Against Bioterrorism.

"When you understand how these agents cause disease in an individual, you realize that the lymph system is involved, your immune system obviously is involved. Maybe an allergic reaction might even occur," he says.

Dr. James Nataro, a professor of pediatrics, medicine and microbiology at the University of Maryland School of Medicine in Baltimore, is not so sure.

 

 

"Is it plausible that if you get diarrhea due to one of these organisms that there is an increased risk of death for six months to a year? Yes, it's plausible," he says. "That negative impact could make you susceptible to other unrelated diseases. But are we ready to accept the conclusions based on these data? I think we're very far from it."

It's possible that one underlying factor contributed both to the person contracting a foodborne bacteria and later dying, Nataro says.

Mølbak advises people who think they have a foodborne infection to seek medical attention. He also calls on food producers to use antibiotics sensibly, because the misuse of antibiotics can contribute to bacteria that are resistant to available drugs.

More information

The Centers for Disease Control and Prevention has information on Salmonella, on Campylobacter, on Shigella, and on Yersinia enterocolitica.

Back to the Top

Picking Up on Stroke Can Be as Easy as 1, 2, 3

 

By Martha Kerr

Reuters Health

Thursday, February 13, 2003

PHOENIX (Reuters Health) - Three simple steps that take less than one minute can be used to determine if a person is having a stroke and should be rushed to the hospital, researchers announced here Thursday at an American Stroke Association meeting.

Rapid recognition and treatment of stroke is crucial. Patients with the most common type of stroke do much better if treated with a clot-busting drug, but they only have a three-hour window to get the treatment. After that, the risk of the drug outweighs its benefits.

Now experts say that three steps--asking a person to smile, to raise both arms and keep them up, and to speak a simple sentence clearly-can help bystanders gather enough information to mobilize emergency services and get the patient to the hospital rapidly.

The test takes less than a minute to administer, Amy S. Hurwitz, a medical student at the University of North Carolina-Chapel Hill School of Medicine, told meeting attendees.

Hurwitz, Dr. Jane H. Brice and other colleagues took the Cincinnati Prehospital Stroke Scale (CPSS), a tool used by doctors to identify stroke, and modified it into a script to be used over-the-phone by a dispatcher and a bystander or family member. They recruited 100 hospital visitors and a group of patients from a stroke survivor support group.

The volunteers played the role of a bystander, and the stroke survivors acted as the "patient" who was experiencing symptoms. A researcher acted as an emergency medical services dispatcher.

Nearly all--96%--of the volunteers were able to accurately administer the three-item test under the direction of the "dispatcher," Hurwitz reported. They correctly identified arm weakness 95% of the time, facial weakness 71% of the time and speech deficits 88% of the time.

Stroke treatment requires a high level of medical training, but quick identification of stroke symptoms takes less than a minute under the direction of a medically trained individual, Hurwitz told Reuters Health.

"Please keep in mind that the CPSS does require a trained individual to administer the instructions and properly interpret the findings. Still, the general public should remember the three items tested by the CPSS," Hurwitz said.

"Therefore, if a family member's speech unexpectedly becomes slurred or incomprehensible, you should call 911 immediately. Similarly," Hurwitz continued, "if one side of someone's body 'goes numb,' or if one side of the face droops down, you should call for help immediately."

"We plan to train dispatchers in our area to administer the test as part of the next phase of our study," Hurwitz said. "We will also note the eventual diagnoses of the patients."

Back to the Top

Before Doctor's Visit, Many Surf Internet for Info 

By Hannah Cleaver

Reuters Health

Thursday, February 13, 2003

BERLIN (Reuters Health) - One in four Internet users search online for medical information before or after a visit to the doctor, according to a new survey conducted in Germany.

This growing tendency is seen as a two-edged sword by doctors, who feel that an involved patient is a better patient, but worry about the quality of information people are getting, an expert said.

The poll showed that 7% of Internet users go online to search for medical information before a visit to the doctor, while 8% check things out on the web after an appointment and 10% look on the Internet before and afterwards.

A further 53% of the more than 1,700 Internet users questioned by polling company TNS Emnid said they could imagine themselves using the Internet as a source of information in conjunction with a visit to the doctor.

Roland Ilzhoefer, spokesman for the KVB, the association covering most general practitioners and non-hospital specialists, told Reuters Health there were two sides to such use of independent information sources.

"On the one side it is good when a patient is interested in their injury or illness, interested enough to get information for themselves from whatever source, be that newspapers, magazines or books and of course the Internet."

Those patients are more likely to follow-through with prescribed treatments, he said.

"But of course, on the other hand, the question remains of how dependable the information that the patient has found, actually is. And even if it is useful information, it cannot be tailored to the individual patient--so a diagnosis which has been found online can be wrong for that particular person."

"This can create problems for the doctor if the patient turns up with a diagnosis and a decision on what therapy they need and just demands a prescription."

It can be hard for the doctor to explain why his diagnosis and prescription for treatment might be different than the online information, Ilzhoefer said.

"In an extreme case where the patient may be totally convinced, they might even leave that doctor in search for one who will prescribe what they have read about," he said. "They may end up not going to see a doctor at all, if they feel they have got the information they need from their own sources."

Ilzhoefer also warned that many Web sites are sponsored, or created in conjunction with companies keen to promote their own treatment or products. But he stressed that the information available on the Internet could be just as useful as information found in books, magazines or on television.

Back to the Top

Interferon Treatment of MS Questioned

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Thursday, February 13, 2003

THURSDAY, Feb. 13 (HealthScoutNews) -- While interferons are widely used to treat multiple sclerosis, the evidence to support their long-term value is too weak to be trustworthy, Italian researchers contend.

A search of the medical literature indicates that while interferons may help patients in the first year after the disease is diagnosed, "their clinical effect beyond one year is uncertain and new trials are needed to assess their long-term effectiveness and side effects," says a report in the Feb. 15 issue of The Lancet.

"We found a modest benefit in the first year of treatment," says Dr. Graziella Filippini, director of the epidemiology unit of the National Neurological Institute in Milan. "There is not sufficient data to estimate the effect after the first year of treatment."

Arney Rosenblat, a spokeswoman for the National Multiple Sclerosis Society, says the report comes as a surprise and the society's medical advisors must study it in detail before making a response.

Meanwhile, she says, "what is important is that people read the American Academy of Neurology (news - web sites) guidelines on treatment with interferon." The guidelines list interferon as an accepted treatment.

Multiple sclerosis (MS) is a disease in which the body's immune system, for unknown reasons, attacks and destroys myelin, the tissue that forms a protective sheath around nerve cells. About 85 percent of MS patients have the relapsing form of the condition, with flare-ups that cause symptoms ranging from numbness and tingling to paralysis.

The U.S. Food and Drug Administration (news - web sites) has approved three different forms of interferon, biologically engineered versions of a natural immune system molecule, to treat those flare-ups. However, "widespread discussion continues about their true effectiveness, benefits, side effects and costs," the journal report says.

Filippini and her colleagues reviewed all the scientifically controlled studies of interferon treatment on patients with the relapsing form of multiple sclerosis done between 1993 and 2002. They picked out seven trials including 1,215 patients, 667 of whom were followed for one year and 917 of whom were followed for two years.

"Interferon seemed to reduce the number of patients who had exacerbations [flare-ups] during the first year of treatment, but results at two years follow-up were not robust and were difficult to interpret because of the many dropouts," the researchers report.

Those results "do not give a reason to continue treatment after the first year," Filippini says.

Interferon treatment also causes significant side effects, such as fever, muscle pains and headache, the review finds. In one trial that studied the quality of life, patients who received interferon reported consistently lower scores than those who got a placebo, an inactive substance. Overall, medical problems, many affecting the blood, were more common in patients receiving interferon, and "acute toxic effects adversely affected quality of life," the report says.

The case for or against interferon remains to be proved, Filippini says. "There should be a European or world collaboration to consider this problem, and to propose a new study design to define this problem better," she says. "We need a collaboration between the best neurological centers in the world to consider this problem."

More information

You can learn more about multiple sclerosis and its treatment from the National Multiple Sclerosis Society or Medline.

Back to the Top

Study Challenges View Of Blood Pressure Pill

The Associated Press
Thursday, February 13, 2003

New research appears to contradict a widely publicized study that concluded that inexpensive, old-fashioned diuretics should be the first drug given to people with high blood pressure.

The conclusion that "water pills" are as good as, if not better than, newer and more expensive drugs called ACE inhibitors came in a major government-financed study published Dec. 18 in the Journal of the American Medical Association.

But a large study from Australia, the results of which were published today in the New England Journal of Medicine, found that ACE inhibitors are somewhat better at preventing heart attacks -- at least in men.

But the new study is unlikely to end the debate -- partly because of differences in the two studies, but also because the question is more complex than which drug is better. Many patients need two or three drugs to control blood pressure.

For nearly two decades, the question has not been "is drug A better than drug B. The question is: Do you have to use A and B or A, B and C to control blood pressure?" said James Reed of Morehouse School of Medicine, a participant in the U.S. study.

Diuretics, used for more than 50 years to treat blood pressure, move water and salt out of the body, reducing the volume of blood so the heart does not have to work as hard. ACE inhibitors, introduced in 1981, ease blood pressure by reducing production of a chemical that squeezes arteries.

The Australian study followed 6,083 people ages 65 to 84 for an average of just over four years. Half were randomly assigned to get a diuretic, the other half an ACE inhibitor as their first treatment.

Drugs in any of three other groups -- beta blockers, calcium channel blockers and alpha blockers -- could be added to decrease blood pressure.

Overall, patients in the ACE inhibitor group had 11 percent fewer deaths and "cardiovascular events," such as heart attacks or strokes. But the greater benefit was entirely among the men.

Men in the ACE inhibitor group had 17 percent fewer deaths or cardiovascular events than those in the diuretic group, but there was no difference among the women. The men also had nearly twice the number of "events" -- 907 vs. 524 -- even though half the participants were women.

Since this research was not designed to tell whether men get more benefits from ACE inhibitors than women do, more study is needed to see whether that is true, said the researchers, led by Christopher M. Reid, head of the cardiovascular disease prevention unit of the Baker Heart Research Institute in Melbourne.

Reid said much of the disparity between his study and the U.S. one may have been caused by differences among the people enrolled.

Back to the Top

Drinking and Domestic Violence

HealthScoutNews

Thursday, February 13, 2003

THURSDAY, Feb. 13 (HealthScoutNews) -- Members of couples involved in alcohol-related domestic disputes remember those incidents in different ways, say researchers who specialize in the field.

That's one of the findings that appears in the February issue of Alcoholism: Clinical and Experimental Research.

Other findings include:

·         New evidence shows there is low agreement about details of the incidents by couples who report partner violence and alcohol-related violence. This is due to differences in memory and perception of the dispute. To collect valid data, researchers need to develop precise and standardized methods of collecting data from these couples.

  • When a male partner in a couple has a fairly recent history of committing violence against his partner, drinking is a significant risk factor for repeated incidents of domestic violence. Specifically, there is an eight times greater probability of domestic violence on days when the man drinks heavily compared to days without heavy drinking.
  • An analysis of United States national data shows the prevalence, incidence and stability of intimate partner violence (IPV) are higher among blacks and Hispanics than whites.
  • Male-perpetrated IPV seems to decrease following personalized alcoholism treatment.

More information

Here's where you can learn more about the link between domestic violence and alcohol and drugs.

Back to the Top

WEDNESDAY, FEBRUARY 12, 2003

Preemies' Brain Damage Seen Decreasing

By Lindsey Tanner

AP Medical Writer

The Associated Press
Wednesday, February 12, 2003


CHICAGO - Neurological damage in very small premature babies may decrease over time, according to research that tracked children through age 8 and found substantial mental gains.

Many youngsters once considered retarded ended up scoring in the nearly normal range on tests of verbal function and IQ, the study found.

Children who received early intervention such as speech therapy, those from two-parent families, and those whose mothers had high levels of education were found to experience the greatest improvement in mental function.

The findings are surprising because previous research has found negative long-term results for very small preemies, and conventional thinking says that IQ doesn't change — at least in people born at a normal weight.

"We were thrilled by the findings and surprised because previous reports suggested that there's an adverse outcome for very low birth-weight babies," said lead researcher Dr. Laura Ment, a Yale University pediatric neurologist.

"We found children progressively getting better between 3 and 8 years of age," Ment said.

The study involved 296 children born at 28 weeks and weighing just over 2 pounds on average. Results appear in Wednesday's Journal of the American Medical Association (news - web sites).

Children born extremely prematurely are at risk for a variety of neurological problems, ranging from cerebral palsy, mental retardation and vision trouble to more subtle learning and behavior difficulties.

Ment said the study results echo recent research in animals showing that the developing brain can repair itself.

A JAMA editorial suggests that broader tests of mental function would have had poorer results and notes that IQ improvements were still in the average to low-average range.

"Despite improvements in scores, such low average functioning can place a child at significant academic disadvantage," said editorial author Glen Aylward, a developmental specialist at Southern Illinois University's medical school.

The youngsters were given a test of verbal abilities and three different IQ tests starting at age 3.

The average IQ scores increased from 90 to 95.

The average score on the verbal test increased from 88 points at age 3 to 99 points at age 8. Data from normal birth-weight children suggest average verbal scores improve by about 4.5 points over time, the authors said.

Nearly half of the children with verbal scores in the mental retardation range — below 70 — at 3 years of age scored at least in the borderline range — 70 to 80 — at age 8. And about two-thirds of the children with borderline scores on both tests at age 3 had scores in the normal range at age 8.

A score of 100 would be average on both the IQ and verbal tests for a normal birth-weight 8-year-old.

Less significant improvements were found in children born with bleeding in the brain — a common complication in very low birth-weight babies.

Prominent preemie researcher Dr. Maureen Hack was skeptical of the results and said the children studied were not given tests designed to measure problems usually linked with prematurity, such as attention deficits and visual-motor impairments.

Hack also faulted the researchers for not comparing the prematurely born children with youngsters born at normal weight and said the preemies likely would have fared worse if such a comparison had been made.

"I personally feel that basically, the functional problems persist," said Hack, of Rainbow Babies and Children's Hospital in Cleveland.

On the Net:

JAMA: http://jama.ama-assn.org

Back to the Top

Drug-Resistant HIV Passed Through Breast Milk 

By Deborah Mitchell

Reuters Health
Wednesday, February 12, 2003

BOSTON (Reuters Health) - HIV (news - web sites)-infected women given a single dose of the anti-AIDS (news - web sites) drug nevirapine during labor to prevent them from transmitting the virus to their baby harbor HIV in their breast milk that is resistant to the drug, according to the results of a small clinical trial.

The most common mutation found in the new study is associated with resistance to all other drugs in nevirapine's class, a team of researchers from California and Africa report. This could mean that the women are at risk of transmitting drug-resistant disease to their infants through breast milk.

Dr. Constance A. Benson of the University of Colorado Health Science Center in Denver, who did not participate in the study, said the findings don't warrant a change in policy. In settings where health care resources are scarce, she explained, the benefits of giving laboring HIV-positive women nevirapine to prevent their baby from becoming infected probably still outweigh the risks.

Dr. John Mellors of the University of Pittsburgh, Pennsylvania agreed. "To change policy based on these data would be a very big mistake."

The concentration of drug-resistant virus in breast milk was significantly higher than levels detected in the blood, Dr. E. Lee of Stanford University in Palo Alto noted here at the 10th Conference on Retroviruses and Opportunistic Infections on Wednesday.

Lee and colleagues at Stanford and at the University of Zimbabwe, Harare, followed HIV-infected women in Chitungwiza, Zimbabwe, who participated in a study in which they received a single dose of nevirapine at the onset of labor.

The women were subsequently monitored for HIV levels in plasma, the cell-free portion of the blood, and breast milk at two, eight, 16 and 20 weeks after delivery. Complete information was available for plasma samples and breast milk samples for 33 and 20 women, respectively.

After eight weeks, mutations in breast milk associated with nevirapine resistance were detected in 13 of the 20 women (65%), while such mutations were found in plasma in eight of the 33 women (40%). Four infants had confirmed HIV infection.

The most common mutation the researchers found is known to confer resistance to other drugs in the same class of drugs as nevirapine, known as non-nucleoside reverse transcriptase inhibitors.

All of the women were infected with a type of HIV known as subtype C. Whether these findings can be generalized to other HIV subtypes must be confirmed.

Back to the Top

Crohn's Drug Can Lose Its Punch 

By Amanda Gardner
HealthScoutNews Reporter

Wednesday, February 12, 2003

WEDNESDAY, Feb. 12 (HealthScoutNews) -- Almost two-thirds of patients who take the drug infliximab for Crohn's disease produce antibodies to the drug that erode its effectiveness, a new study has found.

Crohn's is an autoimmune disease that causes inflammation of the intestines. The inflammation can cause pain and make the intestines empty frequently, resulting in diarrhea.

Infliximab, which is sold under the brand name Remicade, was approved in 1998 to treat people with Crohn's who weren't responding to treatments of first resort. It is also approved to treat rheumatoid arthritis.

The drug, which is an antibody, binds to tumor necrosis factor alpha. That's believed to be behind the inflammatory process.

When the drug works, it really works. "It's the best we have," says Dr. Paul Rutgeerts, senior author of the study and a professor of medicine at the University of Leuven in Belgium.

The study appears in the Feb. 13 issue of The New England Journal of Medicine (news - web sites).

The problem is that because infliximab is produced partly from mouse tissue, the body sometimes mounts an immune response and develops antibodies to attack the drug.

"The body makes antibodies to the antibody, and that's what causes the side effects and what limits its effectiveness," says Dr. Steven Field, a clinical assistant professor of medicine at New York University School of Medicine.

In this study, researchers looked at 125 patients with Crohn's disease in Europe who were given infliximab "on demand." In other words, the drug was given only when the patient had relapsed, which is the only application infliximab is approved for in Europe. In the United States, the U.S. Food and Drug Administration (news - web sites) recently approved infliximab for regular maintenance -- once every eight weeks to keep the disease at bay -- in addition to its original "on demand" approval. The drug is given intravenously.

Over the course of the study, antibodies were found in 61 percent of the study subjects. When concentrations exceeded a certain threshold, the drug didn't last as long in the body (35 days versus 71 days) and there was also a higher risk of side effects called "infusion reactions." These infusion reactions -- an allergic reaction to the drug that includes shortness of breath and lightheadedness -- also appeared to be an indicator of antibody formation.

"Thirty seven percent of patients had a higher titer [concentration] of antibodies against infliximab and these patients had all sorts of problems, meaning they had infusion reactions. They also had shortened response duration due to the fact that the infliximab is immediately cleared from the blood," Rutgeerts says. "At four weeks after infusion, almost no drug is left in circulation."

Taking infliximab in conjunction with immunosuppressive drugs, however, lowered the number of antibodies produced and thereby increased the drug's efficacy, the study found.

Rutgeerts also discovered that antibody production is suppressed by giving infusions of infliximab regularly every eight weeks, although this was not covered in this paper. "It would be an argument for approving [scheduled maintenance]," he says.

That's the position of Centocor Inc., the company that manufactures Remicade.

"The message is when you treat on demand you get more antibodies," says Dr. Michael Elliott, Centocor's vice president of immunology. "The best way to use the drug is with a regular schedule. There are antibodies but much less." Elliott points to a recent study conducted by the company in which antibodies were seen in 30 percent of "on demand" patients and only 10 percent of maintenance patients.

The issue of how often to administer infliximab has been the subject of some controversy. Although a regular schedule admittedly helps suppress antibodies, no one knows how long patients should be on the drug. "When do you decide to stop and see what happens, whether treatment is not needed any more?" Rutgeerts asks. "This is a problem."

Dr. Daniel Present, clinical professor of medicine at Mount Sinai School of Medicine in New York City who did some of the original studies on infliximab, says the drug should not be a treatment of first resort.

"Why give infliximab with IV infusion when you can give someone a pill or a shot once a week?" Present says. If the patient doesn't respond to more conventional treatments, then infliximab should be tried, he says.

These points may be moot in the future because scientists are working on developing antibodies to treat Crohn's that aren't made with mouse tissue.

Infliximab has its place, though. "I think it's a terrific drug, but it has to be used appropriately," Present says. "You shouldn't rush into that."

More information

For more on Crohn's disease, visit the Crohn's & Colitis Foundation of America or the National Institute of Diabetes & Digestive & Kidney Disorders.

Back to the Top

A Little Sun May Boost Kids' Skin Cancer Risk 

Reuters Health
Wednesday, February 12, 2003

NEW YORK (Reuters Health) - German researchers report that even moderate sun exposure is tied to the appearance of moles that may one day develop into melanoma, the most deadly form of skin cancer.

And, according to the new study, a parent's mole count can help predict how many moles a child will develop, suggesting a possible genetic component associated with melanoma.

Sun exposure is the main risk factor for skin cancer, though the link is less strong for melanoma, the most rare type of skin cancer. It is known that the risk of developing melanoma goes up in relation to the number of sunburns in childhood or adolescence, according to public health experts.

In the current investigation, Dr. Tine Sander Wiecker of Eberhard-Karls-University in Tuebingen and colleagues report on their study of sun exposure and moles in 1,812 German nursery school children aged 2 to 7. The researchers also evaluated moles on the children's parents.

The number of moles on children's bodies increased with age. Half of 2-year-olds had at least three moles, while half of 7-year-olds had at least 19 moles, the authors report in the February 1 issue of the journal Cancer.

"High numbers of nevi (moles) in children were associated with the number of weeks on sunny holidays, outdoor activities at home, skin type, facial freckling, ethnicity of parents, and the number of nevi on the arms of parents," Wiecker and colleagues note.

This finding underscores the need for general sun protection in children as a means to prevent skin cancer, and not just sunburn avoidance, according to the report.

What's more, the investigators found a "strong association between nevus (mole) development in children and the number of parental moles, which most likely points to an inherited factor."

However, the number of previous sunburns was not associated with formation of moles that might later become cancerous, the study indicates.

The researchers conclude that even the mild to moderate sun exposure experienced by youngsters who spend time outdoors in Germany during the summer can produce moles with the potential to become cancerous. Light-skinned individuals, as well as those with a family history of skin cancer, are at elevated risk.

Source: Cancer 2003;97:628-638.

Back to the Top

Which Blood Pressure Drug Is Best?

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews Reporter

Wednesday, February 12, 2003

WEDNESDAY, Feb. 12 (HealthScoutNews) -- An Australian study of drugs to control high blood pressure challenges the results of a widely publicized American trial saying that diuretics are better than the newer ACE inhibitors or calcium channel blockers.

The American ALLHAT trial showed diuretics were superior to ACE (angiotensin-converting enzyme) inhibitors and calcium channel blockers in controlling blood pressure.

"However, we have showed that the ACE inhibitor is a little better; 11 percent," says study author Dr. Christopher M. Reid of the Baker Heart Institute in Melbourne. The report appears in the Feb. 13 issue of The New England Journal of Medicine (news - web sites).

It was not so much the results of the American trial but the way they were announced -- at a press conference in December with great fanfare -- that caused controversy in the cardiology community. However, there were also complaints that the ALLHAT report did not include a logical endpoint of treatment -- death from cardiovascular disease.

"I was absolutely passionate about it," says Dr. Michael A. Weber, a professor of medicine at the State University of New York Downstate College of Medicine and past president of the American Society of Hypertension.

The differing results could have been due to the difference in the ethnic makeup of the two trials, Reid says. "Thirty percent of the ALLHAT subjects were black Americans, who are known not to respond to ACE inhibitors," he explains.

Almost all the 6,083 people in the Australian trial were white. Blood pressure reduction was the same in those who took a diuretic and those who took an ACE inhibitor. The incidence of stroke was the same in both groups, but the number of deaths from cardiovascular disease was 11 percent lower in the ACE inhibitor group.

For most patients, the conflicting results of the two trials will not make much difference, the cardiologists agree. There is general agreement that almost all people with high blood pressure need to take to more than one drug, Reid and Weber say.

"From our study, if you were over 65, we should recommend starting with an ACE inhibitor and then using a diuretic," Reid says. "From ALLHAT, you would recommend starting with a diuretic and then adding a calcium channel blocker or an ACE inhibitor. Irrespective of the studies, the choice of agent that best suits the patient and the agent with which they are most compliant and comfortable would be the agent of choice."

Other individual factors can affect the choice, says Dr. Edward D. Frohlich, who holds the title of distinguished scientist at the Ochsner Clinic Foundation. He has just stepped down as editor of the journal Hypertension and wrote an accompanying editorial.

"All other things being equal, I would prescribe a diuretic," Frohlich says. "If the patient has diabetes, I would use an ACE inhibitor. If he or she has angina (news - web sites), I would use a calcium channel blocker."

The two studies have one thing in common, Weber says: "Both emphasize how important it is to get blood pressure under control."

Guidelines for treatment "are being rewritten at the moment," Reid says. "I think we will get to the situation where there will be specific recommendations for groups [elderly, diabetic, ethnic]. However, I don't think the message will be very different. The key factor will be the gent which best suits that individual."

More information

Learn about the medications used to control blood pressure from the American Heart Association. Meanwhile, read about the ALLHAT trial at the National Heart, Lung, and Blood Institute.

Back to the Top

Primitive Blood Vessel Cells Tied to Heart Risks 

By Amy Norton

Reuters Health
Wednesday, February 12, 2003

NEW YORK (Reuters Health) - A type of early blood-vessel cell that travels in the blood could turn out to be a new marker of cardiovascular disease risk, according to preliminary research released Wednesday.

The cells, called endothelial progenitors, are precursors to the endothelial cells that form the lining of the blood vessels. The progenitor cells are released from the bone marrow into the blood circulation, and research suggests that they tend to move to areas of blood vessel injury.

The new study found that, among healthy men, the number of endothelial progenitor cells in the blood was associated both with "classic" risk factors for cardiovascular disease and with blood vessel function.

Men with higher odds of developing heart disease--based on factors like smoking, age, high blood pressure and diabetes--had fewer circulating endothelial progenitors.

And men with better blood-vessel function--measured by how well the brachial artery in the arm responded to blood flow--tended to have more progenitor cells.

The findings are published in the February 13th issue of The New England Journal of Medicine (news - web sites).

It's not yet clear whether a drop in endothelial progenitors might directly impair blood-vessel function, according to study author Dr. Toren Finkel, a researcher at the National Heart, Lung, and Blood Institute in Bethesda, Maryland.

But he said the findings do suggest that endothelial progenitors are important in keeping the vasculature running smoothly.

"We think they're circulating in the blood...as part of the (blood-vessel) repair mechanism," he told Reuters Health.

He and his colleagues speculate that, over time, damage done to the blood vessels by traditional risk factors may eventually deplete the body's store of endothelial progenitors, depriving vessels of a key means of repair.

But that's just a theory for now.

On a practical level, Finkel said, the findings suggest that the number of circulating endothelial progenitors a person has could serve as a marker of endothelial function--basically, how well the blood vessels are "opening and closing" in response to blood flow.

Endothelial function can be impaired even in a person without conventional cardiovascular risk factors such as high cholesterol or high blood pressure. Because traditional risk factors don't pinpoint all people at increased disease risk, Finkel noted, "people are looking for other markers."

He and his colleagues are planning large studies to see whether endothelial progenitor cells are indeed a reliable marker of cardiovascular disease risk.

Looking further down the road Finkel also said it's possible that therapies to enhance a person's endothelial-progenitor supply could help treat vascular disease.

Source: The New England Journal of Medicine 2003;348:581-582, 593-600.

Back to the Top

Record Number of Cancer Cases Predicted

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews Reporter

Wednesday, February 12, 2003

WEDNESDAY, Feb. 12 (HealthScoutNews) -- The number of new U.S. cancer cases is expected to increase 3.8 percent, to a record 1.33 million this year, but the death rates for the top four killer cancers will decline, the American Cancer Society (news - web sites) predicts.

Cancer deaths will rise slightly this year, to 556,500 from 555,500 last year, but the increase reflects the aging of the population, the cancer society says in its annual Cancer Facts & Figures report.

The five-year survival rate for all cancers except non-melanoma skin cancer and most non-invasive cancers is expected to be 62 percent -- the same as last year, the report says.

Death rates, however, will decline for lung, breast, colon and prostate cancer (news - web sites), according to the report.

Lung cancer, the top cancer killer, is expected to claim 157,200 lives this year; colorectal cancer, 57,100; breast cancer (news - web sites), 39,800; and prostate cancer, 28,900. The society predicts new cases of lung cancer in 2003 will total 171,900; colorectal cancer, 147,500; breast cancer, 211,300; and prostate cancer, 220,900.

Cancer is the second leading cause of death in America behind heart disease, accounting for one in every four deaths and claiming more than 1,500 lives a day, the cancer society says.

For blacks, the cancer death rate is about 30 percent higher than that of white, and prostate cancer death rates are more than twice as high in black men, the cancer society says.

Dr. Michael Thun, vice president for epidemiology and surveillance research at the cancer society, says poverty and lack of access to health care contributed to higher cancer rates among blacks.

On a positive note, cancer incidence and mortality has decreased more among black men than any other racial or ethnic group between 1992 and 1999, statistics show.

Tobacco use remains the most preventable cause of death and is expected to account for about 180,000 deaths in 2003 -- about 30 percent of all cancer deaths and 87 percent of lung cancer deaths, the cancer society says.

Many other cancer deaths could also be prevented because they result from disease linked to poor nutrition, physical inactivity, obesity and other factors related to lifestyle.

"There's great progress still to be made in improving treatment for cancer, but I think there is much we can do to apply what we already know," Thun says.

Most of the variation in cancer death rates among states, Thun says, relates to lung cancer. Nationwide, about 23 percent of adults over 18 smoke, the cancer society says. Kentucky had the highest percentage of adult smokers, about 31 percent, and the highest lung cancer death rate in men.

Thun called for more aggressive anti-smoking efforts, such as tobacco taxes, public smoking restrictions, anti-smoking ads, and smoking-cessation programs.

On the up side, Thun points to declines in smoking among high school students between 1999 and 2001 after years of increases.

Noting budget crunches in many states, Thun says, "Now is not the time to shift money away from smoking prevention. Now's the time to build on ongoing success."

Among nonsmokers, diet and physical activity are the two most important lifestyle factors in determining cancer risk, the cancer society says in Cancer Prevention & Early Detection, a report accompanying the annual statistical survey.

 

 

Poor nutrition causes about a third of U.S. cancer deaths, and Americans still fall well short of the cancer society's dietary guidelines. For example, less than one in five adults eats the recommended five or more fruits and vegetables a day.

Sedentary lifestyles also contribute to cancer, as exercise reduces the risk of breast and colon cancer and possibly pancreatic, prostate, lung and endometrial cancers. Yet, in 2000, 39 percent of American adults had no leisure-time physical activity and only about a third had moderate physical activity, the cancer society says.

Inactivity combined with overeating, of course, contributes to obesity, a risk factor for cancers including colon, endometrial, prostate, kidney, esophageal and, in postmenopausal women, breast cancer. And the percentage of obese Americans aged 20 to 74 has soared from about 13 percent in 1960 to 31 percent in 2000, the cancer society says.

"A huge challenge is to stop obesity and help people achieve and maintain healthy body weight," Thun says.

The cancer society also stresses early detection through screening for breast, colon, rectal, prostate and uterine cancer. And it recommends cancer-related checkups that can detect thyroid, oral, skin lymph node, testicular and ovarian cancers.

Dr. Anna Pavlick, an oncologist and assistant professor of medicine at the New York University School of Medicine and the NYU Cancer Institute, says the findings highlight the fact that many people remain unaware of the relationship between risk factors and cancer.

"It's just not looked at as a priority," Pavlick says. "I think because of the hours we work and the crazy life we live, things like exercise and proper nutrition -- things that should be obvious -- just kind of fall by the wayside."

Some continue risky habits, she says, because of a lack of awareness about risks. For example, she says, many of those who visit tanning booths and sunbathe on the beach without sunscreen don't distinguish between non-melanoma skin cancer and the much more dangerous melanoma.

More information

For information on cancer prevention, visit the American Cancer Society. To help determine your cancer risk, check out the Harvard Center for Cancer Prevention.

Back to the Top

Location of Body Fat Key in Elderly's Diabetes Risk 

By Amy Norton

Reuters Health
Wednesday, February 12, 2003

NEW YORK (Reuters Health) - Although obesity is closely tied to type 2 diabetes, normal-weight older adults may face an increased risk when they have excess fat in all the wrong places, new research shows.

The study found that greater fat in the gut or within the muscle tissue of the thighs was related to diabetes risk among normal-weight men and women in their 70s.

Obese individuals were also at a greater diabetes risk, but obesity was clearly not "requisite" for study participants to develop the disease, according to the authors.

In fact, about one third of men and less than half of women with type 2 diabetes were obese, they report in the February issue of the journal Diabetes Care.

"Just because an older person is not overweight or obese does not necessarily mean that they are not at risk for diabetes," Dr. Bret H. Goodpaster, the study's lead author, told Reuters Health.

Normal-weight older people can still have excess body fat, and "where they put the fat is an important factor in their risk for this disease," said Goodpaster, of the University of Pittsburgh Medical Center in Pennsylvania.

Type 2 diabetes arises when the body becomes resistant to insulin, a hormone that after meals helps shuttle sugar from the blood and into cells to be used for energy. It is closely associated with obesity, but other risk factors such as family history and older age also contribute to the disorder.

While the association between obesity and type 2 diabetes among young and middle-aged people has "undisputed strength," the link has seemed less strong among the elderly, Goodpaster and his colleagues note.

For one, type 2 diabetes remains most common among the elderly, although their rate of obesity is lower than that of middle-aged adults.

According to the study authors, their findings support the hypothesis that a person can be "metabolically obese," despite a normal weight. This theory holds that body-fat distribution is a key factor in whether a person develops insulin resistance and abnormal blood sugar levels.

In this study, of nearly 3,000 men and women, those with either type 2 diabetes or impaired glucose tolerance--a prediabetic condition--had greater amounts of fat deep in the abdomen or interspersed throughout the thigh muscles than those with normal glucose tolerance.

These regional fat deposits were associated with insulin resistance among normal-weight, but not obese, men and women.

On the brighter side, Goodpaster noted that exercise has been found to be particularly effective at cutting abdominal fat.

He said his team is now studying whether exercise and weight loss can similarly reduce fat within muscular tissue in older adults.

Source: Diabetes Care 2003;26:372-379.

Back to the Top

A Battle for the Ages

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews Reporter

Wednesday, February 12, 2003

WEDNESDAY, Feb. 12 (HealthScoutNews) -- Anti-aging researchers, who often claim the products and therapies of doctors specializing in anti-aging medicine are unproven, are shooting themselves in the foot.

That's the opinion of a gerontology expert who has analyzed this ongoing battle.

It's partly a "boundary" issue, says Bob Binstock, a professor of aging, health and society at Case Western Reserve University in Cleveland, whose analysis appears in the February issue of The Gerontologist.

Anti-aging researchers, who worked for years to obtain credibility -- and funding -- for their research, want to separate themselves from physicians whom they see as promoting quackery, Binstock says.

However, waging war on the anti-aging movement may be counterproductive, Binstock adds. Instead, the researchers should highlight the potential health benefits to be realized from research on the process of aging, such as the ability for longevity free of disability or dependence.

So far, the war's been less than positive.

Academic researchers, such as S. Jay Olshansky, professor in the School of Public Health at the University of Illinois at Chicago, and anti-aging medicine physicians such as Dr. Ronald Klatz, president of the American Academy of Anti-Aging Medicine, frequently square off in the press and sometimes in person at medical meetings.

In a nutshell, Olshansky fumes that products such as human growth hormone and other so-called anti-aging products pushed by some anti-aging doctors are without scientific basis. Klatz complains that Olshansky overlooks what he says is the commitment on the part of anti-aging physicians to health promotion and managing risk factors for chronic disease, as well as legitimate research conducted by them.

Last year, 51 leading anti-aging researchers, including Olshansky, signed an essay, "No Fountain of Youth," that appeared in Scientific American. It advised the public to avoid human growth hormone and DHEA (dehydroepiandosterone), as well as other products promoted as aging remedies.

Olshansky and two of his co-writers also appointed themselves to a committee to bestow annual "Silver Fleece Awards" to products and organizations that make untenable claims or lead the public astray about what's possible in the anti-aging arena. Klatz's academy got one.

Binstock isn't denying that some products on the market that claim to reverse aging are pure snake oil. However, he says the anti-aging researchers "would really be better off emphasizing the positive things they can accomplish." And the criticism also gives much publicity to the anti-aging medicine doctors, Binstock says.

Asked to comment on Binstock's analysis, Olshansky says, "I think it's a fantastic paper, the most scholarly piece I have seen on the issue of anti-aging medicine." He adds he intends to develop a more positive strategy. However, the Silver Fleece Awards will remain, since he sees them as providing a useful platform for discussing the issues.

However, Klatz wasn't as pleased with Binstock's article.

"I thought the paper was not balanced," he says. Anti-aging researchers overlook legitimate research that is also done by anti-aging medicine doctors, Klatz says.

"They don't attack anti-aging medicine on the basis of science or academics," Klatz adds. "It's purely a political argument. All they do is point a finger and say, 'Bad, bad, bad, bad, bad.'"

More information

To read the paper written by anti-aging researchers in the Scientific American, click here. For information on the American Academy of Anti-Aging Medicine, visit its Web site.

Back to the Top

Bandage Made of Blood Clotting Factor on Horizon 

By Keith Mulvihill

Reuters Health
Wednesday, February 12, 2003

NEW YORK (Reuters Health) - A team of scientists and engineers at Virginia Commonwealth University say they are close to perfecting a new type of bandage made of the natural blood clotting agent fibrinogen.

So far, the team has tested the bandage in small animals. If tests in larger animals and humans prove successful, one of the researchers says the fibrinogen bandage could be commercially available in two or three years. The findings are published in the February 12 issue of Nano Letters, a journal published by the American Chemical Society.

Fibrinogen increases the "stickiness" of clotting cells, thickens blood and promotes the formation of fibrin, the stringy protein that forms the basis of blood clots, lead investigator Dr. Gary L. Bowlin explained in a telephone interview from his laboratory in Richmond.

The bandage, which Bowlin says feels like a flannel shirt, is made up of a long strands of fibrinogen that creat a mesh-like, fibrous webbing.

Referring to the invention as a "natural bandage," Bowlin explained that it would aid people who have suffered a traumatic wound such as a gunshot or stabbing where stopping blood flow as quickly as possible is critical to their survival.

Smaller pieces could be used to stop localized bleeding during surgery, he added.

While an ordinary gauze bandage made of cotton acts like a dam to block blood loss, a bandage of fibrinogen could have the advantage of immediately arresting blood loss by enhancing the body's ability to form a natural blood clot, the researcher said.

What's more, the bandage wouldn't need to be removed. Since it is made up of the same components as a real blood clot, the body would naturally degrade the bandage during the healing process, Bowlin explained.

In the current study, the team of researchers conducted a structural analysis of fibrinogen fibers that they manufactured using a technology known as electrostatic spinning or "electrospinning."

By pumping a fibrinogen-containing solution into a syringe exposed to a very high electric charge, the researchers were able to draw out a tiny strand of fibrinogen with the aid of an electric field.

As the stream of fibrinogen is shot out of the syringe, the solution evaporates and a continuous strand of fibrinogen forms a non-woven mat of fibers.

The key to the electrospinning of fibrinogen is that it creates a fibrous mat or sheet with a very large surface area, meaning it provides more sites where blood can react to form clots.

If further animal testing, as well as human studies, go well, the "natural bandage" could reach the market in two or three years, Bowlin said.

Source: Nano Letters 2003;3:213-216.

Back to the Top

Want to Lose Weight? Beef Up

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews Reporter

Wednesday, February 12, 2003

WEDNESDAY, Feb. 12 (HealthScoutNews) -- If you're trying to slim down, are you better off eating a big bowl of pasta or a grilled steak with a couple of veggies on the side?

You might be surprised to learn that the meat dish wins, hands down, according to new research.

In findings that could turn the food pyramid upside down, a new study says a diet that's moderately high in protein and low in carbohydrates helps you lose weight while maintaining muscle mass.

However, this is no endorsement of the famous Atkins Diet, which advocates cutting out virtually all carbohydrates, says study author Donald Layman, a professor of nutrition at the University of Illinois at Urbana-Champaign.

Instead, Layman suggests a less drastic shift -- laying off refined grain products such as bread, pasta, cereal and snack foods, while beefing up the intake of lean meat, poultry and dairy products. He calls his diet the "Sensible Solution."

Layman and his colleagues put 24 overweight women who were 45 to 56 years old on a diet of 1,700 calories a day.

One group followed the USDA's Food Guide Pyramid and ate a diet that was high in carbohydrates from bread, rice, pasta and cereal sources and low in protein from animal products including meat, poultry, eggs, cheese and milk.

The other group ate more protein and fewer carbs -- about 10 ounces of meat a day (much of it beef) and three servings of low-fat milk or cheese. One egg, or one cup or milk, equals one serving.

After 10 weeks, both sets of women lost about the same amount of weight, about 16 pounds. Howewver, the women on the higher protein diet lost more fat and less muscle.

The women in the high-carb group lost about two pounds of muscle, while the women who ate more protein lost little or no muscle.

The study appears in the February issue of the Journal of Nutrition.

During the carbohydrate craze of the '80s and '90s, Americans were told that dietary fat was bad for your heart and caused weight gain, Layman says.

Animal products were believed to be a big source of fat in the diet, so people watching their weight decreased their consumption of meat and dairy products.

However, they didn't eat fewer calories overall, he says. Instead, they loaded up on carbohydrates from refined grain products, including pasta, rice, bread and snack foods.

Now, Layman says, Americans aren't getting enough protein in their diets from the right sources -- animal products.

"We became obsessed with fat in our diet, and we were told that animal products are high in fat," Layman says. "So we decreased our consumption of high-quality proteins and increased our consumption of refined grain products. But this hasn't resulted in a decrease in obesity. And it's pretty hard to make a case that our overall nutrition is better."

"This is why our research is so novel," he adds. "We are the first to come to the table with a discussion about protein. Everyone else is fixated on carbohydrates and fats."

The women in the high-protein diet consumed on average about 170 grams of carbohydrates per day, well within the accepted nutritional guidelines, says Althea Zanecosky, a Philadelphia-based spokeswoman for the American Dietetic Association.

The Atkins diet, by comparison, recommends abound 30 grams of carbs per day, while the average American is eating about 300 grams per day, Layman says.

Layman attributes his results in part to leucine, an amino acid that previous research has shown regulates muscle. Meat, poultry, fish, eggs and dairy products are rich in leucine, he says.

Furthermore, both sets of women showed a decrease of about 10 percent to 12 percent in the total blood cholesterol. However, only the high protein group saw a decrease in harmful triglycerides.

None of this should give you carte blanche to start stuffing yourself with high-fat pepperoni, sausage or fast-food burgers.

"I'm in no way saying fat is a freebie," Layman says. "The point is that the conventional wisdom that we get fat from protein sources is wrong."

Zanecosky says the nutrition experts are beginning to again emphasize the importance of lean meat and dairy products in a healthy diet.

"People have gotten afraid of animal products. We were fat phobic and carb crazy," she says. "But the pendulum is beginning to swing back."

Still, she says, the bottom line is limiting your calories by reducing portion size. Remember, she adds, all of the women in Layman's study were restricted to 1,700 calories a day.

"As long as your portion size is under control, the choice of foods are really up to you," she says.

More information

Read the American Dietetic Association's position paper on weight loss.

Or read more about protein in the diet from the National Institutes of Health.

Back to the Top

Former Surgeon General Says Addiction Neglected 

By Alicia Ault

Reuters Health
Wednesday, February 12, 2003

WASHINGTON (Reuters Health) - The problem of addiction has been neglected by the federal government and the public health establishment out of ignorance and prejudice, just as HIV (news - web sites)/AIDS (news - web sites) was in its early days, said former surgeon general C. Everett Koop here Wednesday.

Koop, surgeon general from 1981-1989, said that there's too much focus on going after drug dealers, and not enough compassion--or treatment options--for the addicted. Addicts are blamed for their behavior, instead of being offered help for what is clearly a disease, he said.

"We must expand greatly our efforts to help those with addictions so that getting treatment will be as easy as getting addictive drugs," Koop said, speaking to addiction specialists and government officials at a meeting on innovative substance abuse treatment sponsored by the Robert Wood Johnson Foundation and Johns Hopkins University.

The government's war against manufacturers and suppliers of illicit drugs is taking away resources for treatment, Koop said. He likened the addiction fight to the war on terrorism, noting that "the enemy is constantly moving, changing his tactics, attacking from within and without and from unexpected places."

The terrorists are not just the "drug lords," but also tobacco company executives, he said.

"What is the difference between a drug lord in Columbia, his lieutenant in Miami, or an executive of a cigarette company? None," Koop said. "I would gladly spend the rest of my life bringing them to their knees, where I confess, I would deal with them without mercy," said the 86-year-old, adding, "They are the real terrorists."

The former surgeon general has long considered tobacco an enemy, and told Reuters Health that he still believes the Food and Drug Administration (news - web sites) (FDA) has the authority to regulate the industry. Nicotine is a drug, and cigarettes are a delivery device, he said.

Koop also called for big changes in the public health establishment's approach to addiction. It should be treated as a controllable, public health problem, he said.

"Drug addiction can be modified by a variety of factors and we need to do a better job controlling those," he said, noting that smoking rates had dropped in the last several years due to higher taxes, more restrictions on public smoking, and anti-smoking ad campaigns.

Finally, Koop urged the nation's drug czar to focus on "the burden of abuse of legal drugs like tobacco and alcohol instead of concentrating solely on illicit drugs."

The comment brought a long round of applause.

Back to the Top

Don't Stress Your Unborn Child

HealthScoutNews Reporter

Wednesday, February 12, 2003

WEDNESDAY, Feb. 12 (HealthScoutNews) -- The heart rate of a developing fetus can be affected when a pregnant woman suffers chronic anxiety and experiences stress-induced changes in her heart rate and blood pressure.

A Columbia University-led study confirmed that changes in a woman's cardiovascular activity caused by emotion do affect a fetus. However, the study, which appears in the February issue of Developmental and Behavioral Pediatrics, didn't report any negative health effects on fetal health.

The study collected data on the heart rate, breathing rate and blood pressure of 32 healthy women in their third trimester of pregnancy. The data was gathered before, during and after a psychological test meant to cause a stress response in the women. Fetal heart rates were monitored at the same time.

The women also filled out a questionnaire that measured their overall anxiety levels.

The researchers found fetal heart rate increases were related to a mother's overall anxiety level. Fetal heart rate increases were not related to elevated heart rate and blood pressure while the mothers took the stress test.

The study found changes in fetal heart rate were highly associated with the mother's general anxiety level and cardiovascular activity during the mothers' recovery period following the stress test.

More information

Here's where you can learn more about fetal development.

Back to the Top

Doctors Group Develops Diabetes Management Tools

By Karen Pallarito

Reuters Health
Wednesday, February 12, 2003

NEW YORK (Reuters Health) - To help patients with diabetes, the National Association of Managed Care Physicians on Tuesday said they have developed a "report card" that allows patients to track measures of their health over time.

Diabetes, one of the fastest growing epidemics in the nation, affects an estimated 17 million Americans, according to the American Diabetes Association.

The report card includes space for recording hemoglobin A1 levels (a measure of blood sugar control), the presence of protein in urine samples, LDL or "bad" cholesterol, blood pressure, body mass index and flu shots. Patients also may keep a log of their exercise activity.

The association also said it has created an "audit tool" for physicians to assess the care they provide their diabetic patients.

Both instruments are part of an effort by the NAMCP to offer tools for managing chronic conditions. Future report cards may target asthma and congestive heart failure, for example.

NAMCP hopes "to empower the patient to take an active role in their care and move toward accountability on the patient side," said Dr. Bill Williams, executive vice president of the Glen Allen, Virginia-based association, whose members include medical directors and physicians involved in various healthcare delivery systems.

Both tools are available by calling NAMCP and will be available on the association's Web site shortly.

Back to the Top

Another Piece of Breast Cancer Puzzle Found

HealthScoutNews Reporter

Wednesday, February 12, 2003

WEDNESDAY, Feb. 12 (HealthScoutNews) -- The 3-D structure of a receptor that goes awry in some breast cancers has been identified by American scientists.

Researchers from Johns Hopkins Medical Institutions and the biotechnology company Genitope also determined how this receptor, called HER2, interacts with an antibody (Herceptin) that's commonly used to treat women with breast cancer (news - web sites). The study appears in the Feb. 13 issue of Nature.

The research provides exact information about which building blocks of the Herceptin antibody interact with specific building blocks of the HER2 receptor. That knowledge may help scientists develop better drugs to treat breast cancer.

Herceptin received U.S. Food and Drug Administration (news - web sites) approval as a breast cancer treatment in 1998. Herceptin kills cancer cells carrying excess HER2, but it wasn't clear until now precisely how Herceptin interacted with HER2.

More information

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

Back to the Top

Risk from Beta Blockers Minimal, Study Says 

Reuters
Wednesday, February 12, 2003

CHICAGO (Reuters) - Heart failure patients given beta-blocker drugs do not face undue risks in the initial stages of treatment as previously feared, a drug company-funded study said on Tuesday.

The study of 2,289 heart failure patients, financed by Roche Holding AG and GlaxoSmithKline Plc, has previously found taking beta blockers reduced patients' risk of death compared to those taking an placebo. Both groups took other drugs commonly prescribed for heart failure.

Beta blockers such as Roche's brand Eucardic and GlaxoSmithKline's Coreg block receptors for selected stress hormones and are approved for use to treat high blood pressure and heart attacks of varying severity.

Last month however, investigators for the US Food and Drug Administration (news - web sites) questioned the benefit of prescribing beta blockers for some heart attack victims. An FDA advisory panel recommended Coreg for some heart attack survivors but rejected claims that the drug lowered the risk of suffering another heart attack.

Manufacturers of beta blockers hope to increase their use among victims of heart failure, a growing malady where a weakened heart progressively loses its ability to pump oxygenated blood through the body.

It is not clear exactly how beta blockers help ease the risks from heart failure.

Writing in this week's issue of the Journal of the American Medical Association (news - web sites), Henry Krum of Monash University, Melbourne, Australia, said the group who took beta blockers "experienced no increase in cardiovascular risk but instead had fewer patients who died.

"Differences in favor of (beta blockers) became apparent as early as 14 to 21 days following initiation of treatment," Krum wrote.

Heart failure worsened among 6% of beta blocker users, which was similar in frequency to the 5% risk among those taking a placebo.

"Patients treated with (beta blockers) had no increase in the risk of worsening heart failure, pulmonary edema, cardiogenic shock, or other serious adverse cardiovascular events, including death," Krum wrote.

"If concerns about efficacy and safety during the initiation of beta-blocker therapy have caused physicians to deny or delay the use of these drugs, our findings should provide the reassurance needed to encourage the high levels of use that are warranted by the results of clinical trials," the report said.

Back to the Top

Booze Blackouts Lead to Bad Judgements

 

HealthScoutNews Reporter

Wednesday, February 12, 2003 

 

WEDNESDAY, Feb. 12 (HealthScoutNews) -- College students are engaging in risky behaviors during alcohol-related memory blackouts, and female students may be more at risk than males during those blackouts.

 

 

So says a study in the most recent issue of the Journal of American College Health.

Duke University Medical Center researchers did an e-mail survey of 772 undergraduate Duke University college students. It revealed that 74.2 percent of the respondents reported consuming alcohol in the two-week period before the survey.

Of those students, nearly 1 in 10 (9.4 percent) experienced at least one blackout during that same time period, and 40 percent reported having at least one alcohol-related blackout during the previous year.

During an alcohol-related blackout, a person is capable of taking part in emotionally charged activities and events but won't have a memory of them when sober.

Many of the students in the survey who experienced alcohol-induced blackout reported they later learned they had engaged in a wide range of risky behaviors. That included having unprotected sexual intercourse, vandalizing property and driving a car -- all which could have serious health or legal consequences.

More information

Here's where you can learn more about the problem of college student drinking.

Back to the Top

Study: Success of Heart-Lung Transplants Growing 

Reuters Health
Wednesday, February 12, 2003

NEW YORK (Reuters Health) - More patients are now surviving heart-lung transplants than in the procedure's early days, according to a new German study.

Researchers at the University Hospital Grosshadern found that among 51 patients who received a heart-lung transplant there between 1983 and 2000, short-term survival "markedly improved" after 1994.

From that year on, 78% of patients were alive one year after receiving a new heart and lungs, compared with 63% in previous years.

And deaths soon after surgery dropped significantly--from 35% of 19 transplant recipients between 1983 and 1993 to just 12.5% of 32 patients from 1994 on.

Dr. Bruno Reichart and his colleagues reported the findings in a recent issue of the journal Transplantation.

The doctors credit changes the hospital made in the transplant procedure during the 1990s for the improvement in patients' prognoses. For instance, they say a change in the solution used to preserve the donated organs helped "markedly" reduce early postoperative deaths.

In addition, new immune-suppressing drugs have helped prevent short-term organ rejections, and changes in surgical methods and drugs aimed at blood clotting have kept patients from dying of bleeding complications.

These advances, the researchers write, have led to an "acceptable" one- to two-year survival rate of more than 70% among their heart-lung recipients.

However, they point out, long-term survival still has a significant obstacle in a complication called obliterative bronchiolitis (OB), in which obstructive changes develop in the airways.

Half of their patients developed OB within three years of their transplant surgery, and there is currently no therapy that can reliably prevent the complication, the researchers note.

"Only an effective treatment for OB syndrome," they write, "can reduce morbidity and result in better long-term survival."

Since the first successful heart-lung transplant at Stanford University in 1981, more than 2,000 people worldwide have undergone the procedure. The combination transplant is performed when a patient will die of end-stage lung disease that also involves the heart, such as when cystic fibrosis is accompanied by heart failure.

Source: Transplantation 2003;75:127-132.

Back to the Top

Parents Use Subtle Cues to Ask Docs for Antibiotic

By Alison McCook

Reuters Health
Wednesday, February 12, 2003

NEW YORK (Reuters Health) - Doctors are more likely to give a child an unnecessary prescription for antibiotics if they suspect the parent wants them to, and new research suggests that, in many cases, parents use subtle means to convey their desires for antibiotics.

Researchers discovered that doctors said they believed parents wanted an antibiotic for their child if parents offered their own diagnosis for the problem, or questioned the doctor when he or she offered a diagnosis that did not require antibiotics.

"Our research shows that, for the most part, doctors experience pressure to prescribe from much less obvious communications that parents use," study author Dr. Tanya Stivers of the University of California, Los Angeles told Reuters Health.

"Some parents who communicate in this way do expect antibiotics, but some do not," she added.

Occasions where parents were more "overt" in their requests for antibiotics were "quite rare," Stivers and her colleagues note in the February issue of The Journal of Family Practice.

All of the children in the current study were suffering from acute respiratory infections, the majority of which would not benefit from antibiotics. Over-prescription of antibiotics is blamed for the growing drug resistance seen among various types of bacteria.

"We hope that our findings will make it easier for doctors to recognize the communications that are making them feel pressured, to understand that these communications may not always mean that a parent wants an antibiotic, and to counsel parents about their actual expectations for antibiotics," Stivers said.

Between October 1996 and March 1997, Stivers and her colleagues surveyed 306 parents of children with respiratory infections. The researchers also surveyed doctors after the visits, and taped the visits themselves.

Eight full-time doctors in two practices participated in the current study.

In almost 50% of cases, parents said they had expected antibiotics, while doctors said they thought parents wanted antibiotics during 34% of the visits.

Doctors were more than five times as likely to believe parents wanted antibiotics when they offered their own diagnoses as when parents simply described their child's symptoms. Questioning a physician's diagnosis increased the likelihood doctors would believe the parent wanted antibiotics almost three-fold.

In an interview, Stivers said that the current study discovered that physicians may sometimes misread parents' signals, thinking they want antibiotics for the child, when all parents may want is simple reassurance about their child's condition.

"It appears that many parents do not expect antibiotics but use similar behaviors to those used by parents who do expect antibiotics. Physicians, though, read this behavior the same for all parents: as pressure," she said.

When faced with a parent who wants antibiotics for a child who won't benefit from them, Stivers recommended that doctors take the time to explain why antibiotics won't work.

"Part of the issue is a lack of parent understanding of viral and bacterial illnesses," she noted.

"So, one thing physicians can do--and many already do--is to provide parents with information/education about the role of antibiotics in treating infections," Stivers added.

Source: The Journal of Family Practice 2003;52:140-147.

Back to the Top

TUESDAY, FEBRUARY 11, 2003 

Early Pregnancy Bleeding Less Risky Than Thought

 

By K.L. Capozza
HealthScoutNews Reporter

HealthScoutNews

Tuesday, February 11, 2003

TUESDAY, Feb. 11 (HealthScoutNews) -- As many as 30 percent of women experience bleeding during the first three months of pregnancy, yet until recently little was known about how the symptom affects pregnancy outcome.

Now, new research suggests that while women with first trimester bleeding are more likely to have a miscarriage than women who don't bleed, the risk is much lower than had been thought. Although previous research had pinpointed the risk of miscarriage after bleeding at up to 30 percent, the new study shows the risk is actually less than 5 percent.

"If you have bleeding and a viable pregnancy at the time of ultrasound, your chances of going to term are very good," says lead author Dr. Joshua Weiss of Columbia University in New York City.

Nonetheless, early bleeding should be a red flag to physicians that patients should be closely monitored and screened for pregnancy complications, Weiss adds.

That's because the study, based on data collected from 13,752 women treated at 15 medical institutions, also showed that women with first-trimester bleeding are more likely to experience complications such as premature delivery and hypertensive disorders. And it found that pregnancy outcomes worsen when vaginal bleeding is heaviest.

Women with heavy bleeding were between two times and four times more likely to experience a host of complications that included premature labor, early membrane rupture and separation of the placenta from the uterus.

"When a patient has heavy bleeding, physicians should consider a cervical length scan as well as a fetal growth scan at 28 to 36 weeks," Weiss says.

A number of factors cause vaginal bleeding during the first trimester of pregnancy, including cervical infection, spontaneous abortion or implantation of the fertilized egg outside the uterus.

The study is important, in part, because early bleeding is so alarming to women and yet so little information is currently available to explain what the symptom means for their pregnancy.

"When you have a patient that has bleeding, there's really not a whole lot of data to counsel them with. We hoped to find out: What are the outcomes? What are the complications?" Weiss explains.

"We had thought that when women present to you with bleeding in the first trimester, at least a third would miscarry," adds Dr. Ashi Daftary, medical director of maternal-fetal medicine at Magee-Womens Hospital at the University of Pittsburgh.

The study's more conservative estimate of miscarriage rates may influence the prognosis that doctors convey to their patients, Daftary says.

"This study shows that there's clearly an increase in miscarriage, but the overall risk is relatively low. And once you clear the first trimester, the overall risk is only less than 5 percent," he says.

Daftary notes, however, that one limitation of the study design is that it examined the experience of women close to the end of the first trimester, when vaginal bleeding is usually less problematic. Women who bleed very early in their pregnancy face a much higher risk of miscarriage, with as many as 20 percent losing their pregnancy, he adds.

"The information you'd really like to have is on the women who present even earlier, because they're a very different population of women at higher risk," he says.

The findings were presented at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco, which ended over the weekend.

More information

For more on early pregnancy bleeding, visit the University of Michigan. For information on high-risk pregnancies, see this.

Back to the Top

Preemies With Brain Damage Seen Improving

 

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, February 11, 2003

CHICAGO - Very small premature babies born with brain damage are not necessarily doomed to below-normal intelligence after all, according to a surprising new study that found that many youngsters' IQ scores improve over time.

Children born extremely prematurely run the risk of a variety of neurological problems, ranging from cerebral palsy, retardation and vision trouble to more subtle learning and behavior difficulties.

But the study found that many youngsters considered borderline retarded make up for lost ground and end up scoring in the nearly normal IQ range by age 8.

The findings are surprising because previous research has found long-term consequences in very small preemies and because the conventional wisdom says that IQ does not change — at least in people born at normal weight.

"We were thrilled by the findings and surprised because previous reports suggested that there's an adverse outcome for very low birth-weight babies," said lead researcher Dr. Laura Ment, a Yale University pediatric neurologist. "We found children progressively getting better between 3 and 8 years of age."

Ment said the study results echo recent research in animals showing that the developing brain can repair itself.

In the study, children who received early attention such as speech therapy, those from two-parent families and those whose mothers had high levels of education showed the most improvements in intellectual ability.

The study involved 296 children born at 28 weeks and weighing just over 2 pounds on average. The findings appear in Wednesday's Journal of the American Medical Association (news - web sites).

In an accompanying editorial, Glen Aylward, a developmental specialist at Southern Illinois University's medical school, suggested that broader tests of mental function would have had poorer results. And he noted that the IQ improvements were still in the average to low-average range.

"Despite improvements in scores, such low-average functioning can place a child at significant academic disadvantage," Aylward said.

The youngsters were given a test of verbal abilities and three different IQ tests starting at age 3. A score of 100 would be average on both the IQ and verbal tests for a normal birth-weight 8-year-old.

The premature youngsters' average IQ scores increased from 90 to 95.

Their average score on the verbal test increased from 88 points at age 3 to 99 points at age 8 — an 11-point improvement. By contrast, the average verbal scores of normal birth-weight children improve by about 4.5 points over time, the researchers said.

Nearly half of the children with verbal scores in the mental retardation range — below 70 — at 3 years old scored at least in the borderline range — 70 to 80 — at age 8. And about two-thirds of the children with borderline scores on both tests at age 3 had scores in the low-normal range at age 8.

Less significant improvements were found in children born with bleeding in the brain, a common complication in very low birth-weight babies.

Dr. Maureen Hack, a leading researcher in the field, was skeptical of the findings and said the children studied were not given tests designed to measure problems usually associated with prematurity, such as attention deficits and poor hand-eye coordination.

"I personally feel that basically, the functional problems persist," said Hack, of Rainbow Babies and Children's Hospital in Cleveland.

On the Net:

JAMA: http://jama.ama-assn.org

Back to the Top

Red Meat and Fatty Foods Spell Trouble for Your Colon

HealthScoutNews

Tuesday, February 11, 2003

TUESDAY, Feb. 11 (HealthScoutNews) -- Women who eat a lot of red meat, fats and refined grains could be increasing their risk of colon cancer.

A new study, led by the Harvard School of Public Health, examined the associations between dietary patterns and colon and rectal cancer risk in women.

The researchers examined dietary information from 76,402 women, aged 38 to 63 years old, who had no history of cancer in 1984. The information about the women, who were part of the Nurses' Health Study, was collected in 1984, 1986, 1990 and 1994.

The researchers identified two major dietary patterns in the women -- prudent and Western. The prudent eaters ate more fruit vegetables, legumes, fish, poultry and whole grains. The Western eaters ate more processed and red meats, sweets and desserts, french fries and refined grains.

During 12 years of follow-up on the women, the researchers identified 445 cases of colon cancer and 101 cases of rectal cancer.

The study, published in this week's issue of the Archives of Internal Medicine (news - web sites), found a much greater colon cancer risk for women ranked in the highest category of Western dietary pattern.

There was no association between diet and rectal cancer, the study found.

More information

Here's where you can learn more about colon and rectal cancer.

Back to the Top

Antibiotic Overuse Varies with State, Specialty

 

By Keith Mulvihill

Reuters Health

Tuesday, February 11, 2003

NEW YORK (Reuters Health) - Doctors in the US are overusing "broad-spectrum" antibiotics for common infections, such as the common cold, according to a study by three California doctors released on Tuesday. "The overuse of broad-spectrum antibiotics (drugs that are used to combat a variety of organisms) causes bacteria to become resistant to these powerful drugs," said lead author Dr. Michael Steinman in an interview with Reuters Health.

"So, when we need these antibiotics to treat people with severe and complicated infections, the bacteria will already have become resistant--and there will be few treatment options left," added Steinman, who is with the San Francisco VA Medical Center.

Broad-spectrum antibiotics are effective against certain types of bacteria that cannot be treated by other, narrow-spectrum antibiotics, explained Steinman. These types of bacteria most often cause problems in severe, complicated infections, and are much less likely to be a problem in garden-variety respiratory tract infections treated in the clinic setting, according to the investigator.

In the current investigation, Steinman and colleagues evaluated drug-prescribing data for nearly 2,000 patient visits to doctors for the common cold or upper respiratory tract infections.

"Antibiotics were prescribed to 63% of patients with an acute respiratory tract infection...(and) broad spectrum agents were chosen in 54% of patients prescribed an antibiotic," the authors report.

Steinman's team also found that certain types of primary care physicians are more likely to prescribe broad-spectrum antibiotics, "particularly doctors trained in the specialty of internal medicine, and doctors practicing in the Northeast and Southern United States," Steinman told Reuters Health.

"This suggests that medicine is not a purely scientific enterprise," noted Steinman.

"Rather, doctors can be influenced by a number of non-scientific sources such as pharmaceutical industry marketing, patient demand, and the attitudes and "culture" of their medical colleagues."

Addressing such non-scientific factors that influence prescribing can help to improve the quality of care for all patients, according to the report in the February 12th issue of the Journal of the America Medical Association.

"Many previous studies have found that doctors are overusing antibiotics for respiratory tract infections (but) our study is new in looking at the type of antibiotics that are being prescribed for these conditions," said Steinman.

Not only should physicians prescribe fewer antibiotics for people with respiratory tract infections, but when they decide that an antibiotic is needed, they should be particularly careful about prescribing a broad-spectrum drug, concluded Steinman.

Source: Journal of the American Medical Association (news - web sites) 2003;289:719-725.

Back to the Top

Sleep Apnea May Help Cause Heart Failure

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Tuesday, February 11, 2003

TUESDAY, Feb. 11 (HealthScoutNews) -- Scientists appear to have solved another chicken-and-egg problem, this one having to do with heart failure and sleep disorders.

Specifically they say that sleep apnea, a disorder marked by breathing interruptions during sleep, may contribute to the development of heart failure, rather than the other way around.

"This has been an area of great interest," says Dr. Virend Somers, one of the study's authors and a professor of medicine and cardiology at the Mayo Clinic in Rochester, Minn. The work appears in the Feb. 11 issue of Circulation: Journal of the American Heart Association (news - web sites).

Both obstructive sleep apnea (which involves an actual obstruction of the airways) and central sleep apnea (in which breathing reflexes just stop for brief periods of time) exist in people with heart failure. Central sleep apnea is the more common of the two among heart patients. "We don't know why. We've always assumed it was a consequence of heart failure," Somers says.

In fact, the opposite seems to be the case. "This study raises suspicion that central apnea is doing bad things to vulnerable people," Somers says. "Certainly, it seems to come before overt heart failure."

The study team, which was led by Dr. Paola Lanfranchi of Fondazione Salvatore Maugeri in Veruno, Italy, looked at 47 people who were considered at high risk for heart failure because they had problems with their left ventricular heart pumping function. None of the participants had actually developed full-blown failure yet, making this study somewhat unusual. More than half (55 percent) of the study subjects also had central sleep apnea; 36 percent had severe apnea. Some 11 percent had obstructive sleep apnea.

"Two main things came out of the study," Somers says. "Yes, there's a fairly high likelihood that someone with dysfunction of the heart will have central sleep apnea, and it turns out that those with central sleep apnea and heart dysfunction have an increased likelihood of heart arrhythmias even during the day."

It's not clear what the underlying biological mechanisms may be. "It may be related to activation of the sympathetic [adrenaline-producing] nerves that is known to occur during central sleep apnea," Somers postulates. "Adrenaline-like substances have detrimental effects in heart failure patients."

That would also be the guess of Dr. Thomas Kilkenny, director of the Institute of Sleep Medicine at Staten Island University Hospital. Sleep apnea -- whether central or obstructive -- can begin early in life, although it doesn't usually manifest until a person reaches adulthood. "This is a slowly progressive disorder, and a significant amount of damage occurs to the heart," he says.

A person with sleep apnea suffers little or not-so-little interruptions to their breathing. "You have some people that choke for 45 seconds or a minute and oxygen levels can dip to almost half of what they should be," Kilkenny says. "At the end, the body gets upset with the fact that it's not breathing correctly, and then there's the awakening."

And it's the awakening that may be at the heart of the problem, so to speak.

"That awakening causes damage to the heart because it releases a whole cascade of the fight-or-flight chemicals, such as norepinephrine and epinephrine," Kilkenny says. "The body thinks it's suffocating. All the chemicals rev up. Blood pressure goes sky high and, when the body figures out that you're taking breaths, the chemicals go back down," he says. But then the cycle repeats itself.

Kilkenny says he has seen people go through this cycle 110 times an hour. The worst was 220 times an hour. Multiply that by 30 years and you can see how the heart might suffer.

Answering this "why" question will be crucial in formulating prevention and treatment strategies. The current research points to which direction to go in.

"This doesn't provide a clear-cut next step to diagnosis and treating, but it suggests that we should be more careful in evaluating people at risk for heart failure for an apnea," Somers says. "We don't know for sure if people with central apnea are more likely to go on for bad heart failure, but our findings suggest that, yes, they are going to be at higher risk."

More information

For more on sleep apnea, visit the National Heart, Lung and Blood Institute or the National Sleep Foundation.

Back to the Top

Special Pacemakers May Extend Lives

By Lindsey Tanner

AP Medical Writer

The Associated Press

Tuesday, February 11, 2003

CHICAGO - Special pacemakers designed to correct a defect that affects close to 2 million heart failure patients in the United States can also prolong their lives, an analysis found.

While such pacemakers have been shown to improve quality of life and exercise capacity, their effects on survival had been unclear.

"I was surprised by the magnitude" of the effects, said lead author Dr. David Bradley, a Johns Hopkins Hospital cardiologist.

Industry-funded studies have shown that the special devices improve the heart's pumping action in a process called cardiac resynchronization. Some studies had hinted that they might also extend lives but lacked the statistical power to make that link.

By pooling the results of four recent studies involving 1,634 patients, the researchers found that the devices reduced the death rate from heart failure by 51 percent among heart failure patients. Of these, 1.7 percent died within three to six months of getting the special pacemakers, compared with 3.5 percent of patients who got similar pacemakers but had the special feature inactivated.

The activated devices also were linked to a 29 percent reduction in hospitalization for complications related to heart failure.

The results appear in Wednesday's Journal of the American Medical Association (news - web sites).

Patients were mostly men in their 60s with moderate to severe heart failure. All also received heart failure medication such as beta blockers and ACE inhibitors.

The American Heart Association (news - web sites)'s Dr. Clyde Yancy called the results "phenomenal" and said they could lead to a substantial change in practice. Currently, only about 2 percent of eligible patients get the special devices, Yancy said.

The devices are intended for about one-third of the 5 million Americans with heart failure who also have pumping problems caused by an electrical "short-circuit" in the heart, said Dr. William Abraham, chief of cardiology at Ohio State University and an author of one of the studies analyzed. The abnormality prevents the heart's pumping chambers from squeezing at the same time.

While regular pacemakers speed up hearts that beat too slowly, the special devices use an electrical charge to synchronize the pumping action to make the heart beat more effectively.

Cardiac synchronization devices cost roughly $20,000 to $50,000, plus doctors' and hospital fees, Bradley said. Whether those costs are offset by the reduced hospitalization found in the study is unclear, he said.

On the Net:

JAMA: http://jama.ama-assn.org

Back to the Top

Device Halves Heart Patient Deaths

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews

Tuesday, February 11, 2003

TUESDAY, Feb. 11 (HealthScoutNews) -- A pacemaker-like device that uses electrical currents to boost the pumping power of patients' weakened hearts halved the short-term death rate from progressive heart failure and reduced hospitalizations by nearly a third, researchers say.

In a new study, published in the Feb. 12 issue of The Journal of the American Medical Association (news - web sites), the Johns Hopkins researchers analyzed four separate trials of the device involving 1,634 patients. All suffered from progressive heart failure, or a steadily weakening heart, causing it to pump less and less effectively.

About half the patients underwent "cardiac resynchronization therapy" (CRT), which relies on a device that makes the heart beat more normally by emitting electrical charges that cause the right and left ventricles to work together more efficiently. A defibrillator component of the device also detects and treats life-threatening heart rhythms.

Hopkins researchers analyzed trials for 809 patients who received CRT and 825 in a control group who did not, with follow-ups at three to six months. Of those who received CRT, 14, or 1.7 percent, died of heart failure, compared with 29, or 3.5 percent, of those who did not receive the therapy, the study found.

CRT also reduced hospitalization for heart failure within three to six months. Of those who received CRT, 13 percent were hospitalized, compared to about 17 percent of those who did not receive the therapy.

Dr. David J. Bradley, a Hopkins cardiology fellow, said the FDA (news - web sites)-approved therapy had demonstrated improvements in patients' ability to exercise and had improved the quality of life. But, he said, before the Hopkins study, whether CRT could save lives remained uncertain.

Electrical stimulation of both the left and right ventricles appears to be a key factor in the effectiveness of the therapy, Bradley said.

"When you stimulate both the left and right sides of the heart at the same time, you get the main pumping chamber of the heart pumping more efficiently," he said.

"This study extends the benefits of the technology beyond quality of life and beyond improved exercise capacity to include reduced mortality from heart failure," Bradley said. "It's one more way we can treat a very serious health problem."

CRT differs from more traditional heart failure treatment, in which leads are placed in contact with the right atrium, right ventricle or both to provide electrical currents that help pace the heart so it pumps blood more effectively.

CRT relies on an implanted device consisting of a battery and electronic circuitry, including a pulse generator usually implanted below the collarbone. One lead is placed in the right atrium, and one on each of the right and left ventricles. The left ventricular lead is usually threaded through a coronary vein.

Dr. Robert Bonow, president of the American Heart Association (news - web sites), said the study bodes well for CRT's prospects for sufferers of progressive heart failure.

With advancements in treatment, more and more patients are surviving with weakened hearts, said Bonow, who also is chief of cardiology at Northwestern University Medical School.

"I think it is exciting news and particularly important for people with progressive heart failure," he said. "As we get better and better at treating people with acute heart disease and heart attack, we have more people surviving with weakened hearts. People who might have died in previous decades are now still alive."

And the study shows "overall the very beneficial effect of this therapy for these particular patients," Bonow said. But, he added, more research is needed on longer-term benefits.

Each year, heart failure afflicts nearly 5 million people in the United States, kills about 287,000 and results in almost 1 million hospitalizations, according to the study.

Still, while CRT shows at least short-term promise, the therapy is expensive, with the necessary devices costing $20,000 to $50,000, Bradley said. Further study is needed to determine whether the costs of CRT ultimately would be offset by reduced spending for heart failure hospitalizations, which exceeded $14 billion in 2000.

 

 

Bradley also acknowledged that the analysis followed patients for a maximum of six months and that more research would be required to assess longer-term benefits.

Only two of the four trials analyzed by Hopkins researchers had been reported in peer-reviewed medical journals, the study noted, but results of the two unpublished trials had undergone Food and Drug Administration scrutiny.

A major national trial of CRT with numerous participating U.S. institutions, including Hopkins, is tracking patients for about two years, Bradley said. Results are to be presented in April at an American College of Cardiology meeting, he added.

More information

For more about cardiac resynchronization therapy, visit the U.S. Food and Drug Administration. Learn more about heart failure from the American Heart Association.

Back to the Top

Hypertension Tied to Worse Post-Meal Fat Clearance

 

Reuters Health

Tuesday, February 11, 2003

NEW YORK (Reuters Health) - People with high blood pressure may experience a higher-than-normal increase in blood fats after meals, according to a small study from Greece.

This spike in blood fats could provide one more reason why people with high blood pressure are more prone to heart disease, investigators say.

It is normal for blood fats to rise after a high-fat meal, but an abnormally large increase in fats--a condition called postprandial lipemia--has been shown to increase the risk of heart disease.

That high blood pressure increases the risk of heart disease is well known, but heart risk can remain above normal even after people get their blood pressure under control. So a team led by Dr. Genovefa D. Kolovou of the Onassis Cardiac Surgery Center in Athens set out to see whether an abnormally high increase in blood fats might explain some of the increased risk of heart disease in people with high blood pressure.

The investigators measured levels of blood fats in 25 men who had high blood pressure but who did not have high levels of cholesterol or other blood fats.

Compared to a group of 25 men who had normal blood pressure, men with high blood pressure experienced a sharper rise in triglycerides after a meal, Kolovou's team reports in the Journal of the American College of Nutrition. It also took longer for triglycerides to return to normal in men with high blood pressure.

The results could provide "an additional reason" why people with high blood pressure have an increased risk of heart disease, Kolovou and her colleagues speculate. Targeting this post-meal rise in blood fats may be an additional way to lower heart risk in people with high blood pressure, they suggest.

Source: Journal of the American College of Nutrition 2003;22:80-87.

Back to the Top

Beta-Blockers OK for Heart Failure Patients

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Tuesday, February 11, 2003

TUESDAY, Feb. 11 (HealthScoutNews) -- Doctors can confidently add medications called beta-blockers to the list of drugs used to treat heart failure because a multinational study found that at least one beta-blocker dramatically reduces the rate of death without increasing serious side effects for heart failure patients.

The study, which will appear in the Feb. 12 issue of the Journal of the American Medical Association (news - web sites), found that people who took carvedilol, a beta-blocker, had a 35 percent decrease in their risk of death compared to those taking a placebo. And the medication didn't increase the risk of side effects such as fluid retention and worsening heart failure.

"This study has good implications for practice," says the author of an accompanying editorial, Dr. Sergio Pinski, section head of cardiac pacing and electrophysiology at the Cleveland Clinic Florida in Weston. "If the medicine is started with careful titration [slowly tweaking the dose of a drug to its most useful level] and follow-up, it can be used safely in even very sick patients. It won't make patients worse, and I think you can start seeing benefits early on."

Many drugs, including carvedilol, must be carefully titrated so that doctors can measure the effects of the drug before increasing the dose. If you start with too high a dose, the risk of side effects is greater.

More than 5 million Americans have been diagnosed with congestive heart failure and more than 550,000 are newly diagnosed each year, according to the American Heart Association (news - web sites). In his editorial, Pinski writes that your lifetime risk of developing heart failure is probably about one in five.

For this study, researchers from Australia, Canada, Switzerland, Poland, England, Germany and the United States, conducted a randomized, double-blind, placebo-controlled study at 334 hospitals in 21 countries. The study included 2,289 volunteers who had symptoms of heart failure, but who were not retaining excessive fluid. To be included in the study, the participants' hearts had to be pumping at less than 25 percent of what is considered normal.

Study participants either received a titrated dose of carvedilol or a placebo. More than 1,100 volunteers started on 3.125 milligrams of carvedilol twice a day and were titrated up to as much as 25 mg two times daily. The study volunteers were followed for the first eight weeks of treatment.

The researchers found that fewer people on carvedilol died or were hospitalized than in the placebo group, and there was no statistically significant increase in serious side effects. The benefits of carvedilol treatment started to become apparent as early as two to three weeks after the start of treatment.

Worsening heart failure was the only problem that occurred in more than 2 percent of the participants, and it occurred with similar frequency in the carvedilol patients (5.1 percent) and the placebo group (6.4 percent).

Pinksi says it's unclear whether these results would be similar for other beta-blockers, but that carvedilol has been used in people with different types of heart failure and has had consistently positive results.

Dr. Dan Fisher, a cardiologist at New York University Medical Center, says this study provides reassurance to doctors who might be reluctant to prescribe beta-blockers for their heart failure patients.

"Because beta-blockers slow the heart rate and lower blood pressure, it seems counterintuitive that they would work in heart failure patients. But what we're learning is that you can give beta-blockers and these patients benefit," says Fisher.

Pinski echoes that sentiment, saying that many doctors who went to medical school 20 or 30 years ago were taught not to prescribe beta-blockers for heart failure.

More information

To learn more about congestive heart failure, visit the American Heart Association or the Texas Heart Institute.

Back to the Top

Promising New AIDS Drugs on the Horizon

By Daniel Q. Haney

AP Medical Editor

The Associated Press

Tuesday, February 11, 2003

BOSTON - A variety of highly effective new AIDS (news - web sites) drugs are on the horizon, experts say, easing worries that the fast-mutating virus will outstrip doctors' ability to treat it.

Ever since combinations of AIDS medicines transformed HIV (news - web sites) into a manageable condition in the mid-1990s, doctors have worried that the virus would eventually mutate into forms that would elude their control. While HIV indeed has evolved into many drug-resistant forms, most patients are still able to find combinations that hold their virus in check.

At the 10th Conference on Retroviruses in Boston, experts said the outlook for potent and novel medicines to control HIV has never been brighter.

"The pipeline of new drugs has an impressive number of candidates in it. This is something we haven't seen in past years. It's a bumper crop," said Dr. John Mellors of the University of Pittsburgh.

Currently, 16 drugs are approved by the Food and Drug Administration (news - web sites) to fight AIDS. Most of the medicines are aimed at just two targets in the virus's life cycle, proteins called protease and reverse transcriptate.

However now, doctors say, drugs are in development that are aimed at eight different points in the process by which HIV attaches itself to blood cells, enters them and finally makes new copies of the virus.

The next new drug expected to win FDA approval is T-20, being developed by Roche and Trimeris Inc., a so-called fusion inhibitor that blocks HIV from sticking to the blood cells that it attacks.

At the meeting Tuesday, doctors described encouraging results with the next generation of this drug, called T-1249, that is intended to be used when the virus grows resistant to T-20. Dr. Diego Miralles of Duke University said that even more versions are in the design stage to take over when T-1249 fails.

"I am very encouraged this year that we seem to be keeping up with the virus in terms of our ability to treat resistant virus with new drugs," Mellors said.

At least a half dozen promising drugs are in human testing, he said, and 10 or 12 more are in the pipeline.

Furthermore, AIDS medicines have gotten much easier to take. Just a few years ago, patients had to take 20 or so pills on a carefully timed daily schedule. Now that total is down to just two or three pills taken once or twice a day.

Among the new drugs in testing is one TNX-355, an antibody from Tanox Inc. Unlike other drugs, this one works by blocking the spot on blood cells where HIV normally attaches itself. Initial testing by Dr. Daniel Kuritzkes and others from Brigham and Women's Hospital in Boston found an injection once every one to three weeks dramatically reduced virus levels.

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

On the Net:

Conference: http://www.retroconference.org/2003/

Back to the Top

Celiac Disease More Common in U.S. Than Thought

By Alison McCook

Reuters Health

Tuesday, February 11, 2003

NEW YORK (Reuters Health) - New research shows that some people with no obvious symptoms of the digestive disorder celiac disease can, in fact, have the condition.

A survey of more than 4,000 people with no genetic risk factors or symptoms of celiac disease revealed that about 1 in 130 had the disorder.

Over time, celiac disease can damage the small intestine and interfere with the normal absorption of nutrients from food. The only treatment for the illness is a diet that strictly avoids foods that contain gluten, a protein found in wheat, rye and barley.

However, if patients are unaware of their condition, celiac disease may go unchecked, and lead to other conditions, such as osteoporosis, due to inadequate intake of calcium or other nutrients.

Study author Dr. Alessio Fasano told Reuters Health that it takes a typical patient with celiac disease many years before he or she is properly diagnosed. However, a simple blood test can diagnose whether someone without the "classical" symptoms of celiac disease--chronic diarrhea, bloating and weight loss--does, in fact, have the illness.

As such, he recommended that doctors remain aware of this relatively common genetic disorder, and test anyone who people who may be at risk. Those with certain conditions, such as type I diabetes, Down syndrome, anemia, osteoporosis, infertility and short stature may be at higher risk for the disease.

"I would really love to have primary health physicians very aware about this problem," he said.

"One (related symptom) is definitely more than enough" to warrant a blood test for celiac disease, the University of Maryland School of Medicine researcher added.

Celiac disease is a genetic disorder in which consumption of grains sets off a chain reaction that results in the immune system attacking the body. Many experts believe that the condition is common in Europe, but relatively rare in the US, where there have been no large-scale investigations of how frequently it occurs.

In the current study, Fasano and his colleagues performed blood tests on more than 13,000 people living in the US, some of whom had genetic risk factors or symptoms of celiac disease.

During the blood test, investigators looked for abnormal antibodies found in the blood of people with celiac disease. Whenever possible, those who tested positive were followed up with an intestinal biopsy to check for lesions.

The authors found that, among people with a close relative-such as sibling, child or parent--with celiac disease, one out of 22 also had the condition. One in every 39 people with a second-degree relative--such as a grandparent, aunt, uncle or cousin-with the condition had celiac disease, they report in the February 10th Archives of Internal Medicine (news - web sites).

In a sample of people with classical gastrointestinal symptoms of the condition or one of the related disorders, Fasano and his team discovered that one in 56 had celiac disease.

However, among people with no genetic risk factors for or symptoms of celiac disease, one in 133 did, in fact, have the condition.

Fasano explained that he suspected people have considered celiac disease to be rare in the US because it has taken longer for experts in this country, relative to those in Europe, to realize that disorders such as osteoporosis can be linked to the condition.

He added that early diagnosis of celiac disease can help reverse such conditions. For instance, if a 20-year-old with celiac disease has developed osteoporosis as a result of an inability to absorb calcium from his diet, simply eliminating gluten will help him get the calcium he needs and recoup some of his lost bone.

However, Fasano admitted that a diagnosis of celiac disease does not always make a patient's life easy. Gluten is found in many different foods, he said, and can be added to a diverse range of products such as ice cream and medications.

For the newly diagnosed celiac disease patient, he noted, the next challenge involves "how to find safe foods."

Source: Archives of Internal Medicine 2003;163:286-292.

Back to the Top

Vein Vanity

 

HealthScoutNews

Tuesday, February 11, 2003 

(HealthScoutNews) -- Varicose veins, those unsightly red lines that streak across your legs, are often inherited. So if your mother had them, there's a good chance you will, too.

According to Health Canada, there are some things you can do to keep them in check:

  • Avoid standing still for long periods. If you have no choice, keep the blood circulating by flexing your calf muscles, rising up and down on your toes and squeezing your feet together in your shoes.
  • Avoid wearing knee-high nylons or socks on a daily basis. They can block the movement of blood up the leg.
  • Wear support hose. These stockings apply a gentle, graduated pressure to the leg from the foot upward, which helps decrease expansion of the vein wall.
  • Avoid wearing high-heeled shoes every day.
  • Exercise with care. A well-toned leg muscle will pump out more blood than a weak muscle as you walk or move. But be careful with strenuous exercise. Abdominal pressure can block the flow of blood back to the heart. So when you lift heavy weights, for instance, make sure you blow out. Otherwise you increase abdominal pressure and your veins have to expand to get around this block.

Protein Blocks Obesity in Mice: Study

By Merritt McKinney
Reuters Health
Tuesday, February 11, 2003

NEW YORK (Reuters Health) - Mice that have high levels of a particular blood factor gain much less weight than normal mice when they are fed a high-fat diet, results of a new study show.

"These mice develop less obesity when kept on a high-fat diet," lead investigator H. Roger Lijnen told Reuters Health.

For anyone who's ever struggled with the battle of the bulge, the idea of taking a protein that minimizes weight gain may seem like a dream come true. But Lijnen cautioned that it is too soon to know whether it would be a good idea to increase levels of the blood factor, known as plasminogen activator inhibitor-1 (PAI-1), in people to prevent obesity.

"PAI-1 is also an established risk factor for cardiovascular disease," said Lijnen, who is at the University of Leuven in Belgium. He noted that more research is needed to establish exactly what role PAI-1 plays in obesity.

Results of the study are published in the January issue of the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

PAI-1 works to prevent blood clots from breaking down by counteracting a natural clot-buster called tissue plasminogen activator, or tPA. Treatment with tPA can alleviate the most common type of stroke by breaking up clots that prevent adequate blood from reaching the brain.

Several signs suggest that how the body manages blood clotting plays a role in regulating fatty tissue in the body. To get a better idea of what role PAI-1 may play in obesity, Lijnen's team engineered mice to have higher-than-usual levels of PAI-1.

Extra PAI-1 did not affect mice's weight when they were fed a normal diet. The mice did not gain more weight or fat than ordinary mice.

But high levels of PAI-1 seemed to reduce the fattening effects of a high-fat diet. When the genetically engineered mice ate a high-fat diet, they gained weight and fat, but not nearly as much as normal mice who also ate a fatty diet.

Lijnen and his colleagues are not sure how PAI-1 affects obesity in mice, but they speculate that it may have an effect on the cells that make up fatty tissue.

Source: Arteriosclerosis, Thrombosis, and Vascular Biology 2003;23:78-84.

Back to the Top

Depression Hurts Heart Bypass Recovery

HealthScoutNews

Tuesday, February 11, 2003

TUESDAY, Feb. 11 (HealthScoutNews) -- Depressed men are more likely to suffer poor health after they have coronary bypass surgery.

A study led by a researcher at the VA Connecticut Healthcare System found that men who are depressed before they have coronary artery bypass graft surgery are more likely to suffer pain, have reduced quality of life, or be hospitalized again six months after the surgery than men who aren't depressed before the surgery.

The study, in the January/February issue of Psychosomatic Medicine, may help provide answers about why 15 percent of people who have bypass surgery report little to no improvement in their health.

Researchers collected surgical, medical and psychological data on 89 male veterans before they had bypass surgery and six months after the surgery. Of that group, 25 had significant clinical depression before the surgery.

Of those 25 men, six were hospitalized for cardiac reasons after the bypass surgery. Among the 64 men without depression, two were hospitalized for cardiac reasons after their bypass surgery.

The men who were depressed before the bypass surgery were more likely than the other men to be depressed following the surgery, but their symptoms of depression were often unrecognized and untreated, the study says.

More information

Here's where you can learn more about coronary bypass surgery.

Back to the Top

Western Diet Ups Colon Cancer Risk in Women

Reuters Health

Tuesday, February 11, 2003

NEW YORK (Reuters Health) - A large new study has found that eating a diet rich in fruits and vegetables may cut a woman's risk for colon cancer. However, the investigation found no tie between diet and rectal cancer risk.

 

 

Previous research has suggested that diet plays a significant role in colon cancer, the third most common cancer in the US, according to the American Cancer Society (news - web sites)'s Web site. The ACS estimates that about 105,500 new cases of colon cancer and 42,000 new cases of rectal cancer will be diagnosed this year.

Dr. Teresa Fung of the Harvard School of Public Health in Boston and colleagues analyzed dietary patterns and the development of colorectal cancer in 76,402 women aged 38 to 63 who were participating in the Nurses' Health Study. During the 12-year follow-up period, 445 of the women developed colon cancer and 101 developed rectal cancer, the researchers note in the February 10 issue of the Archives of Internal Medicine (news - web sites).

Women who ate more processed and red meats, soda, sweets, refined breads and high-fat dairy products-what the researchers termed a "Western" diet--had a 46% increased risk for developing colon cancer, compared to women who were consuming the least amount of foods associated with a Western diet.

Women who ate more foods that characterized a "prudent" diet, including fruits, vegetables, whole grain products, poultry and fish, were less likely to develop colon cancer, but the relationship was not statistically significant.

The study also did not identify a relationship between diet and rectal cancer.

"Our study provides further evidence that switching from a typical Western diet to a more prudent diet may reduce the risk of colon cancer," Fung and colleagues conclude.

Source: Archives of Internal Medicine 2003;163:309-314.

Back to the Top

Bacteria May Cause Mental Decline in Bypass Patients

By Gary Gately
HealthScoutNews Reporter

HealthScoutNews

Tuesday, February 11, 2003

TUESDAY, Feb. 11 (HealthScoutNews) -- Heart bypass patients often suffer a decline in mental skills after their surgery.

Now, Duke University researchers think they may know why.

Bacteria from the intestines released into the bloodstream during the surgery causes inflammation of the brain, the researchers say.

When surgeons operate on a stopped heart during a bypass operation, a heart-lung machine circulates blood throughout the body, resulting in less blood flow to the intestines, the researchers say in a study in the February issue of Stroke.

The reduced blood flow weakens a blood barrier in the lining of the large intestine, letting bacteria enter the bloodstream. This, in turn, causes inflammation of the brain in patients with lowered immune response to the bacteria, the researchers say.

Elderly patients seem particularly vulnerable because of lower immune response to endotoxins -- part of bacteria -- including those present in the intestinal tract, the study found.

The Duke team followed 343 patients who had elective bypass surgery, formally known as coronary artery bypass grafting, in which a blood vessel from another part of the body is used to reroute blood around a blocked artery leading to the heart.

Before surgery, researchers measured antibodies to the endotoxins in the patients and gave them cognitive tests measuring abilities such as short-term memory, attention, concentration and language comprehension.

Thirty-six percent of the patients suffered a decline in mental abilities, based on tests six weeks after surgery. Patients over 64 who had low immunity to endotoxins faced nearly twice the risk of cognitive decline after surgery, says Dr. Joseph P. Mathew, the study's principal investigator.

"Even though they recover from the physical symptoms, if we leave them with mental difficulties or memory problems, we haven't really cured the problem," says Mathew, a cardiac anesthesiologist at Duke. "We've given them a different problem, and that's the rationale for trying to address this problem."

Mathew says efforts to improve immunity to endotoxins might reduce the decline in mental ability among older patients. Duke researchers, for example, plan a trial in which they will give "antagonists" designed to block the effects of endotoxins before surgery. Vaccines may be another option, he says.

"We need to address the issue of cognitive decline because we are successfully operating on a progressively older and sicker group of patients," Mathew says. "While many of the complications of cardiac surgery have been minimized, cognitive decline is still one of the main areas where continued research can improve the quality of life for these patients."

Duke researchers reported in 2001 that many heart bypass patients who were on a heart-lung machine had suffered a loss of mental ability. Six months after bypass surgery, 24 percent had suffered declines in mental ability; after five years, 42 percent had, the 2001 study found.

However, that study did not determine why, and Mathew says the latest research was designed to provide some answers.

Dr. Timothy Gardner, a professor of heart surgery at the University of Pennsylvania, says the new study could shed light on the body's possible responses to heart-lung machine use.

However, Gardner, who is also a spokesman for the American Heart Association (news - web sites), says the study's findings do not prove bypass surgery leads to a long-term decline in mental ability.

"I'd put this study in the category of interesting, but preliminary," Gardner says. "It's interesting because they've explained a pathological condition that seems to occur, but I don't think this study, in particular, is important to proving that heart surgery is dangerous to the brain."

 

 

He points out that the study looked at patients' mental ability just six weeks after the operation, and did not assess whether they would recover later.

Patients, Gardner says, frequently suffer depression or confusion after surgery. And, he adds, the study failed to answer whether higher levels of endotoxins in the bloodstream are common only in heart surgery or also other major operations, such as removal of a tumor.

Gardner cites research presented last month by a team from Johns Hopkins University that looked at bypass patients and a control group of heart disease patients that did not have surgery. The Hopkins researchers found that whether the patients had surgery had no bearing on changes in mental ability measured a year later.

Most bypass surgery is performed on a stopped heart while a heart-lung machine keeps the patient alive, the American Heart Association says. However, the number of procedures performed without a pump, while the heart is beating, is increasing.

More information

For more on bypass surgery, visit the American Heart Association. Check the National Heart, Lung, and Blood Institute for more on coronary heart disease.

Back to the Top

MONDAY, FEBRUARY 10, 2003 

Eye Condition May Help Diagnose West Nile

 

The Associated Press

Monday, February 10, 2003

CHICAGO - The condition of a patient's eyes may be one way to diagnose West Nile virus (news - web sites), doctors at Northwestern University say.

In the February issue of the Journal of Ophthalmology, the doctors described a patient who complained of seeing dots — known as "floaters" — in one eye along with fatigue, a headache and a low fever. The 62-year-old Chicago woman had been suffering from the symptoms for two weeks.

The doctors found tiny lesions in her eyes and other abnormalities, and prescribed the standard treatment. When the patient's vision worsened and fever increased, doctors ran a series of blood tests and found the West Nile virus. Her eyesight returned to normal when she was cured of the virus.

The case suggests it may be possible to diagnose West Nile virus by examining the eyes of patients, the doctors wrote.

The United States recorded more than 3,900 cases of the virus and 256 deaths from it last year. The mosquito-borne virus causes fevers and aches and can lead to potentially fatal swelling of the brain.

Back to the Top

Traveler's Diarrhea Bug May Help Treat Colon Cancer 

By Alison McCook
Reuters Health
Monday, February 10, 2003

NEW YORK (Reuters Health) - A toxin released by the bacteria that cause traveler's diarrhea and chronic diarrhea in developing countries may also slow the growth of colorectal cancer, researchers said Monday.

The protective effect of the toxin from the E. coli bacterium responsible for traveler's diarrhea may explain why rates of colorectal cancer are lowest in countries with the highest rates of infection with the bacteria, Dr. Stephen Carrithers of the University of Kentucky in Lexington told Reuters Health.

During the study, the researchers used the toxin to slow the growth of a sample of laboratory-grown colorectal cancer cells originally taken from a human patient.

Eventually, doctors may be able to use this bacterial toxin, known as ST, to treat or even prevent colon cancer in patients, according to study author Dr. Scott A. Waldman of Thomas Jefferson University in Philadelphia.

Waldman told Reuters Health in an interview that small doses of the E. coli toxin ST-- along with medications to prevent diarrhea--could help control the spread of colorectal cancer cells in patients with cancer that has spread throughout the body.

Even if patients have only small polyps inside their colons, he said, ST could help shrink those polyps, or perhaps even prevent colorectal cancer in people who are at risk of the disease.

"You can block diarrhea, but still have the anti-proliferative effects. So that's important," study author Dr. GianMario Pitari, also of Thomas Jefferson University, told Reuters Health.

ST likely protects against colon cancer only while it is inside the body, the authors noted--which suggests that people who suffered one bout of traveler's diarrhea while abroad are no longer enjoying the anti-cancer benefits of the toxin.

Waldman added that the ST appears to only curb the spread of colorectal cancer, so patients whose cancers are advanced enough to spread to other parts of their bodies would likely have to use other chemotherapy treatments as well.

"This doesn't kill the cells, it just makes them slow down," Waldman noted.

Waldman and Pitari, along with researchers at the Mayo Clinic in Rochester, Minnesota, published their findings in the early edition of the journal Proceedings of the National Academy of Sciences (news - web sites).

According to Waldman, ST slows cancer growth by binding to a protein on the surface of cancer cells. This stimulates the production of a substance that in turn allows calcium to enter into the cell. The influx of calcium effectively stops the cell from dividing.

He added that the role of calcium in this mechanism could help explain the observation that people who take calcium have a lower risk of developing colorectal cancer.

E. coli is present in the US and other countries besides those marked by chronic diarrhea, Waldman said. However, only certain strains of E. coli carry the genetic material needed to produce the particular ST featured in the current report, he added.

Carrithers, who wrote a commentary accompanying the study, told Reuters Health that previous research has suggested that this ST may also kill colorectal cancer cells--not just slow them down. This suggests that this treatment could eventually even rid some patients of the disease, he said.

He added that he agreed that the ST toxin holds promise for the treatment of colorectal cancer, and is likely one that patients will embrace if it is shown to be safe and effective in humans.

"If the sacrifice is for one to have occasional diarrhea yet prevent the (tumors) in the colon from ever forming or progressing, it's worth it," Carrithers said.

Source: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.0434905100.

Back to the Top

Gluten Disorder More Common Than Thought

By Lindsey Tanner

AP Medical Writer

The Associated Press

Monday, February 10, 2003

CHICAGO - Celiac disease, a severe digestive disorder triggered by gluten in wheat and other grains, is more common among Americans than previously thought, affecting more than 1.5 million people, a study suggests.

Researchers from the University of Maryland, the University of Chicago and other institutions took blood samples from 13,145 mostly white adults and children, including nearly 9,000 people considered at risk for celiac because of symptoms or family history. Intestinal biopsies confirmed the diagnosis.

The disease was present in one out of 22 people who had a close relative with celiac and in one out of 133 participants who were not at risk.

Previous research suggested the disease occurred in about one in 4,000 people nationwide.

The new findings suggest that more than 1.5 million Americans are afflicted, the researchers said.

Sometimes called celiac sprue and often mistaken for other ailments, the disease can raise the risk of gastrointestinal cancer if left untreated.

The new findings — published in Monday's Archives of Internal Medicine (news - web sites) — could lead to quicker diagnosis of the ailment, the researchers said.

"If physicians believe that celiac disease is rare, they are less likely to test for it," said lead researcher Dr. Alessio Fasano of the University of Maryland.

Many doctors have considered celiac a childhood ailment, with symptoms including diarrhea, vomiting, gas and weight loss. But it can show up at all ages, sometimes with non-digestive symptoms such as anemia and thinning bones, partly caused by the body's inability to absorb proper nutrients.

Gluten is a protein found in wheat, barley and other grains.

Dr. B U.K. Li, chief of gastroenterology at Chicago's Children's Memorial Hospital, said the study is a call for doctors to be "much more aware of this and much more willing to screen our patients who have a variety of symptoms."

On the Net:

Archives: http://www.archinternmed.com

Celiac Disease Foundation: http://www.celiac.org

Back to the Top

Snuff Use During Pregnancy Puts Baby, Mom, at Risk

By Melissa Schorr
Reuters Health
Monday, February 10, 2003

SAN FRANCISCO (Reuters Health) - Women who use smokeless tobacco rather than smoking cigarettes during pregnancy may still put themselves and their babies in jeopardy, government researchers reported Friday at the annual meeting of the Society for Maternal-Fetal Medicine here.

"We need to do more research about whether smokeless tobacco is a safe substitute for smoking, it may not be that simple," said study co-author Dr. Mark Klebanoff, director of the division of Epidemiology, Statistics and Prevention Research at the National Institute of Child Health and Human Development in Bethesda, Maryland.

The researchers hoped to evaluate the effect of snuff, or smokeless tobacco, on the health of the developing fetus. Lead author Dr. Lucinda England of the NIH and colleagues examined data from the Swedish Medical Birth Register for women who delivered babies during 1999-2000.

The researchers compared the 789 snuff users to the 11,242 cigarette smokers and 11,500 women who refrained from using any tobacco, looking at rates of preterm delivery, the pregnancy complication preeclampsia and restriction of fetal growth. The researchers took into account other factors that could influence these outcomes such as the mother's age and weight and the infant's gender.

The researchers found, as expected, that women who smoked gave birth to babies weighing an average of 206 grams (7.3 ounces) less than women who did not use any tobacco. Women who used snuff during pregnancy gave birth to babies weighing an average of 40 grams (1.4 ounces) less than non-tobacco-users.

Women who used snuff during pregnancy were also about twice as likely to deliver their babies prematurely, which is a known risk factor for health problems in infancy and childhood.

Klebanoff noted the slight reduction in birth weight among snuff users may be due to the earlier delivery time. "It's possible that reduction is accounted for by the shorter pregnancies," he said.

However, the snuff users were also more likely to suffer preeclampsia--the development of dangerously high blood pressure during pregnancy--while the risk of preeclampsia to cigarette smokers was actually reduced.

The researchers conclude that using snuff during pregnancy may not be a safe alternative to smoking cigarettes.

"Because of that increase in early delivery and hypertension, we can't assume that it's okay to go over to snuff if you want to try to quit smoking," Klebanoff noted. "It sounds like it may not be safer."

Back to the Top

Black Diabetics Less Likely to Get Proper Care

By Randy Dotinga
HealthScoutNews Reporter

HealthScoutNews

Monday, February 10, 2003

MONDAY, Feb. 10 (HealthScoutNews) -- It's no secret that blacks in America often receive worse health care than whites. However, while a string of studies have confirmed the problem, finding the culprit hasn't been easy.

Now, new research suggests that some of the usual suspects -- including poverty -- may not be entirely to blame.

Blacks with diabetes are less likely to get proper medical care -- including such things as flu shots -- than white diabetics (news - web sites), even after taking income level and access to doctors into account, says a new study.

"We're not sure what exactly this means, but what it does tell us is that these factors are not responsible for the differences," says study co-author Leonard E. Egede, an assistant professor of medicine at the Medical University of South Carolina.

The study results leave open the possibility of other causes for the lesser care, such as how blacks and whites view medical treatment and what they expect from their doctors, Egede says.

However, he's skeptical that racism plays a major role.

Egede and a colleague examined national survey statistics from 1998 and selected 1,906 diabetics. The researchers then determined how many received flu shots and were vaccinated against a common group of diseases known as pneumococcal infections, including some of the most deadly strains of pneumonia.

Only 39 percent of blacks reported getting flu shots, compared to 55 percent of whites. The numbers were 22 percent and 38 percent, respectively, for pneumococcal vaccinations.

Significant differences between the races remained even when the researchers adjusted the figures for access to health care, insurance coverage and socioeconomic status.

Federal guidelines suggest the vaccinations should be routine, especially for people aged 65 and older. Flu shots must be given once a year, while people only need to be vaccinated once against pneumococcal infections.

"Immune response and the ability to fight infection is lowered with people with diabetes," Egede explains. "There's a lot of evidence that they do tend to have high mortality rates during flu epidemics."

The findings of the study appear in the February issue of the American Journal of Public Health.

Egede is cautious about speculating why whites get more vaccinations than blacks. "White patients may be more likely to seek care and blacks may have more distrust [of doctors]," he says. "That's one possibility, but we don't have the data to support that."

In searching for an explanation, Egede says he prefers to look at how whites and blacks communicate with each other: "People may not know how to deal with people from other races, and they may find it difficult to convince them to take a flu shot."

The role of race in the doctor's office is difficult to study, says Dr. Giselle Corbie-Smith, an assistant professor of social medicine and internal medicine at the University of North Carolina. Egede's study is a "really nice first step" because it peels away the layers to get to the root causes of differences in treatment, she says.

"There's nothing biologically different between a black person with diabetes and a white person that would make one get the vaccine and the other not," she says. "There is something about their skin color, maybe their interactions with other people or the health system, that makes it less likely they'll be offered or accept a vaccination."

More information

To learn more about health issues affecting minority groups, visit the U.S. Department of Health and Human Services or the Minority Health Center.

Back to the Top

Study Finds Riskiest Viruses for Cervical Cancer

 

By Linda Carroll

Reuters Health

Monday, February 10, 2003

NEW YORK (Reuters Health) - It's long been known that some types of human papilloma virus (HPV) are more dangerous than others when it comes to triggering cervical cancer. Now a large new study has found a total of 18 strains of the sexually transmitted virus that seem to be high risk--including a handful that can boost one's cancer risk more than 200-fold.

The results of this new study identifying cancer-inducing HPV types may help doctors diagnose early signs of cancer when women have ambiguous Pap smears, researchers report in the February 6th issue of The New England Journal of Medicine (news - web sites).

"Knowing which HPV types cause cervical cancer will be of great help in preventing cervical cancer because it will identify those types that should be included in HPV diagnostic tests being used in screening programs," Dr. Nubia Munoz, an emeritus scientist at the International Agency for Research on Cancer, told Reuters Health.

"It will also tell us which types to include in the HPV vaccines currently under development," Munoz added.

There are around 100 HPVs, some of which cause genital warts. Some types--usually the ones that do not cause warts--have been linked to an increased risk of cancer of the cervix, vulva, vagina, anus and penis. Up to 50% of sexually active men and women between the ages of 15 and 49 are believed to be infected with HPV at some point in their lives, although most people clear the infection on their own and never develop cancer.

For the study, the researchers combined the results of 11 smaller studies, which allowed them to compare 1,918 women with cervical cancer to 1,928 healthy women. The study included women from nine countries, including Morocco, Mali, Colombia, Brazil, Paraguay, Peru, Thailand, the Philippines and Spain.

HPV was detected in 91% of the women diagnosed with cervical cancer and in 13% of the women who were cancer free. Ultimately, the researchers determined that 15 types of HPV carried a high risk of leading to cancer, while three were classified as likely to be high risk. Compared with women who are HPV-free, those with one of four types--HPV 16, 59, 33 and 18--had a more than 200-fold increased cancer risk.

The researchers classified another 12 types as low risk.

Scientists know how HPV sparks cancer growth, Munoz said. The high-risk HPV types contain two oncogenes--genes that cause or promote cancerous changes in cells. These two genes block two tumor suppresser genes, known as p53 and pRB, that would normally combat cervical cancer.

Two cancer specialists, who wrote an editorial accompanying the article, cautioned that using the new results in everyday screening of patients might lead to over-diagnosis.

Women often get the cancer-linked forms of HPV but quickly clear the virus from their systems, according to Drs. Thomas C. Wright, Jr. and Mark Schiffman. And it appears that the virus only causes cancer when it stays in a woman's system for years, they added.

"Regardless of how it is implemented, the incorporation of HPV DNA testing into primary screening will result in informing millions of women with normal (Pap smears) that they are at increased risk for cervical cancer," Wright and Schiffman wrote. "The challenge is to develop clinical strategies that allow us to reap the benefits of HPV DNA testing without unduly alarming or overtreating large numbers of women."

Wright is an associate professor of pathology at the College of Physicians and Surgeons of Columbia University in New York City and Schiffman is an epidemiologist at the National Cancer Institute (news - web sites) in Bethesda, Maryland.

Source: The New England Journal of Medicine 2003;348:518-527.

Back to the Top

Taking Your Illness on the Road

HealthScoutNews

Monday, February 10, 2003

(HealthScoutNews) -- If you're about to travel and have a chronic illness such as diabetes or emphysema, you should get a medical "tune-up" before you depart, advises the Medical College of Wisconsin.

Also, stash a card in your purse or wallet that lists all of your medical problems, medications or allergies. And pack your clearly labeled medications in a place where they can be easily accessed.

Back to the Top

Some Types of Infant Wheezing a Harbinger of Asthma

 

Reuters Health

Monday, February 10, 2003

NEW YORK (Reuters Health) - Infants hospitalized for wheezing caused by a rhinovirus, such as the common cold, may be at greater risk for asthma during their childhood years than children whose wheezing was brought on by a different type of viral infection, a team of Finnish and Turkish researchers reports.

Rhinoviruses are the family of viruses that have long been known to cause upper respiratory infections in people of all ages. Respiratory syncytial virus (RSV), in contrast, has been considered the most common virus associated with infant wheezing. RSV infection is the leading cause of hospital admissions in young children.

Yet, in the current study, one third of 82 children hospitalized for respiratory infection-related wheezing from 1992 to 1993 had rhinovirus (RV) symptoms at the time of their hospital admission.

And at follow-up, an average of six years later, the researchers found that the RV-infected children were more than four times as likely to develop childhood asthma compared to those with non RV-associated wheezing.

Dr. Anne Kotaniemi-Syrjanen from Kuopio University Hospital in Finland and her colleagues published their findings in the January issue of The Journal of Allergy and Clinical Immunology.

Infants who had previously experienced a wheezing episode and those with a skin allergy condition known as atopic dermatitis were, respectively, four times more likely to have childhood asthma than their peers, study findings indicate. The latter finding suggests "that there is active asthma-like bronchial inflammation in children wheezing during RV infection," the researchers state.

On the other hand, infants with respiratory syncytial virus were about 80% less likely to have developed asthma.

"RV-induced wheezing leading to hospitalization seems to predict the development of asthma," Kotaniemi-Syrjanen and her colleagues conclude. But, they note, the reason for the association is unknown.

Source: Journal of Allergy and Clinical Immunology 2003;111:66-71.

Back to the Top

Fasting May Stave Off Huntington's Disease

HealthScoutNews

Monday, February 10, 2003

MONDAY, Feb. 10 (HealthScoutNews) -- Cutting back on the number of meals and calories consumed helped delay the onset of Huntington's disease in mice and extended the lives of those with the disease.

That kind of fasting also protects nerve cells from genetically induced damage, says new research from the U.S. National Institute on Aging.

The study is the first to suggest that changes in diet can have an effect on the course of Huntington's disease.

If decreasing food intake has the same effect on humans, low-calorie diets or diets that feature reduced meal frequency may help delay the onset of Huntington's disease and extend the lives of people with the disease.

This study included mice with the human gene that causes Huntington's. They were fed a low-calorie diet or were subjected to intermittent fasting in which they were deprived of food for a 24-hour period every other day. A control group of mice could eat whenever they wanted.

The mice on the intermittent fasting diets developed clinical signs of Huntington's disease about 12 days later than the mice with the Huntington's gene that were allowed to eat as much as they wanted. The fasting mice also lived 10 percent to 15 percent longer than the other mice.

They were also better able to regulate their glucose levels and didn't lose body weight as fast as the mice on the unrestricted diet.

More information

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

Back to the Top

Colon Cancer Tests Don't Boost Anxiety: Study

 

By Stephanie Riesenman

Reuters Health

Monday, February 10, 2003

NEW YORK (Reuters Health) - While many may cringe at the thought of having a sigmoidoscopy, a cancer screening test in which a tube is inserted into the rectum to check the colon for abnormalities, UK researchers say the test does not increase patients' anxiety and actually eases their fears.

And, the researchers note, catching colorectal cancer early with screening tests like sigmoidoscopy can dramatically cut the risk of death from the disease. The American Cancer Society (news - web sites) predicts 105,500 Americans will be diagnosed with colon cancer this year, and an additional 42,000 will be found to have rectal cancer.

US public health authorities urge everyone over the age of 50 to be screened regularly for bowel cancer with techniques such as sigmoidoscopy, colonoscopy and fecal occult blood testing, in which clinicians look for blood in the stool that is shed by tumors.

In flexible sigmoidoscopy, a lighted tube is used to view the lower portion of the colon and check for any polyps, or small growths, that can develop into cancer. A colonoscopy is similar, but allows the entire colon to be examined. Colonoscopy requires a patient to be sedated and is more expensive.

Studies show less than half of Americans over 50 are getting screened for colorectal cancer. Some experts suggest patients ignore the recommendations because they're too embarrassed or find the procedures uncomfortable.

Researchers from the University College in London and St. Mark's Hospital investigated the psychological impact of cancer screening on more than 4,000 patients who agreed to a flexible sigmoidoscopy. Several more people received invitations to participate in the study, but did not show up for a screening. The results are published in a recent issue of Health Psychology.

Of the patients who had a sigmoidoscopy, all received one of three letters stating the results. Either the test found no polyps; polyps had been removed and sent for biopsy; or large polyps were found and a follow-up colonoscopy was recommended.

Three months after the procedure, the researchers mailed questionnaires to the participants to assess their anxiety levels about cancer risk and their overall well-being.

Some patients were also randomly selected to answer a questionnaire before their sigmoidoscopies. This allowed the researchers to evaluate the change in patients' stress levels after cancer screening.

Responses to the surveys showed that colorectal cancer screening was not associated with any increase in anxiety or decrease in feelings of well-being, and that fear of developing cancer was also alleviated after having the procedure done.

Dr. Karen Hurley, a clinical psychologist at Memorial Sloan-Kettering Cancer Center in New York, said that the participants' anxiety levels may have been low following cancer screening because colorectal cancer can be successfully treated if found early.

But the researchers found that fear of developing bowel cancer was higher among patients called back for a follow-up colonoscopy. There were more men in this high-risk group than women.

This is an important group to pay attention to, said Hurley, because they may be apprehensive about having colon cancer screening tests in the future.

The researchers conclude that "perceived risk and worry about bowel cancer as well as overall anxiety were significantly reduced post-screening, and there was no sign of significant psychological costs associated with positive screening results."

"It is reassuring that for most people the screening process did not appear to be stressful," Hurley said. "But we need to pay better attention to those patients who were invited and did not come in for a sigmoidoscopy to help them overcome their anxiety about colorectal cancer screening."

Source: Health Psychology 2003;22:54-59.

Back to the Top

Re-Balancing Your Pregnancy Odds

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Monday, February 10, 2003

MONDAY, Feb. 10 (HealthScoutNews) -- Doctors have known for decades that a hormone imbalance might keep a woman from getting pregnant.

However, new research suggests even a slight increase of one hormone over another could be enough to keep a pregnancy from succeeding.

In studies on mice, researchers from Vanderbilt University revealed how even a tiny excess of the hormone estrogen can disrupt communication between an embryo and the uterus, reducing chances for implantation.

"The beauty of this study is that it was designed under very tight experimental conditions to define that even a small variation in the estrogen level can trigger such a marked effect in a physiologically relevant system at the gene expression level," says S.K. Dey, a professor of pediatrics and cell and developmental biology at Vanderbilt University.

The research appears in the Feb. 10 online edition of the Proceedings of the National Academy of Sciences (news - web sites).

Traditionally, the hormone progesterone was believed to have the primary effect on implantation by influencing the thickness of the uterine lining.

Dey's research, however, suggests that no matter how thick a uterine lining might be, even a small excess of estrogen dramatically reduces the window of opportunity for implantation.

"If the estrogen level is higher it would put the uterus into a non-receptive phase so the embryo will not have any chance to interact with the uterine lining for adhesion," Dey says.

For Dr. Jaime Grifo, New York University's director of reproductive endocrinology, the study is well done. However, he notes, women are not mice, and there are few similarities between their reproductive systems.

"The low implantation rate in humans is more about the embryo than it is about estrogen levels," says Grifo, president of the Society for Assisted Reproductive Technology.

By way of proof, he offers one of his own studies in which estrogen levels in women were measured just before implantation -- and the pregnancy outcomes then compared.

"Higher or lower levels of estrogen did not translate into better pregnancy rates in one group or the other," Grifo says. "So, if tiny amounts of estrogen would make a difference, as this study suggests, we would have seen some indication of that in our study. And we did not."

The new Vanderbilt research utilized several pairs of mice that were allowed to mate naturally. Once pregnant, the female mice's ovaries were removed, halting natural production of both estrogen and progesterone. Daily doses of progesterone were then administered to keep the developing embryo viable and ready for implantation.

At the same time, the mice were injected with estrogen at levels that varied from 3 nanograms to 5 nanograms to 10 nanograms -- all extremely tiny amounts, with very little difference between them.

The result: A single injection of any amount of estrogen initiated implantation. However, at 3 nanograms, the window of implantation opportunity lasted four days. When 10 nanograms were administered, that window closed after just 24 hours.

What's more, Dey says, a second dose of estrogen didn't change matters -- once the chance for implantation was lost, it was gone for good.

Since women undergoing in vitro fertilization (IVF) often utilize egg-stimulating medications -- drugs that cause estrogen levels to soar -- Dey proposes these treatments could theoretically contribute to some implantation failures.

For Grifo, the Vanderbilt research is important, but not clinically relevant to patients undergoing IVF right now.

"Every piece of research adds another piece to the puzzle, but there is no evidence to show that the finding applies to women," Grifo says.

More information

For easy-to-read fact sheets on many factors that can affect implantation, visit The American Society For Reproductive Medicine. For information on preparing for pregnancy, check with The March of Dimes.

Back to the Top

Higher Chance of Thyroid Cancer After Hysterectomy

 

By Alison McCook

Reuters Health

Monday, February 10, 2003

NEW YORK (Reuters Health) - A woman's chance of developing thyroid cancer appears to increase immediately after she undergoes surgery to remove her uterus, a procedure called hysterectomy, according to researchers from Finland.

The authors note that the risk of thyroid cancer likely increases as a result of the conditions that cause a woman to undergo hysterectomy, and not from the procedure itself.

Dr. Riitta Luoto and colleagues discovered that women who had a hysterectomy were twice as likely to be diagnosed with thyroid cancer within 6 months to 1 1/2 years after the operation, relative to women in the general population.

The overall risk of thyroid cancer among women who underwent hysterectomy--either with or without the removal of their ovaries as well--was almost 40% higher than average, but these risks dropped significantly 1 1/2 years after the surgery.

In an interview with Reuters Health, Luoto explained that women often undergo hysterectomies as a result of benign tumors called uterine fibroids, or due to bleeding disorders, often marked by heavy bleeding during menstruation.

And it is likely these conditions which lead to the increased risk of thyroid cancer, Luoto said.

"Hysterectomy itself does not cause increased risk of thyroid cancer," the University of Tampere researcher said.

"The operation itself does not increase the risk, but stands as a marker for an increased risk," Luoto added. "Thyroid cancer and bleeding disorders...may share a common background."

The precise reason why menstrual problems might be linked to thyroid cancer remains unknown, Luoto noted.

The researchers obtained their findings from a review of the records of almost 18,000 women who underwent hysterectomies between 1986 and 1995 who were tracked to see if any developed thyroid cancer.

Thyroid cancer occurs three to four times as often in women than in men, the authors note in the January issue of the American Journal of Obstetrics and Gynecology (news - web sites). The cancer is also diagnosed more frequently in women after they go through menopause than while they are menstruating; however, whether there are hormonal risk factors for thyroid cancer remains unclear, they write.

More people are living longer now after thyroid cancer diagnoses in comparison to previous decades, Luoto and colleagues note. As of 1994, they write, 88% of people diagnosed with the disease were still alive five years later.

Source: American Journal of Obstetrics and Gynecology 2003;188:45-48.

Back to the Top

Boys Lean at Birth May Have Hypertension Risk

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, February 10, 2003

MONDAY, Feb. 10 (HealthScoutNews) -- How well a woman eats during her pregnancy might affect her son's risk of cardiovascular disease later in life, researchers say.

Some boys who are unusually thin at birth have an increased risk of high blood pressure when they grow up if they have an unusual growth spurt between ages 8 and 15, says a study in the Feb. 11 issue of Hypertension. And as-yet unpublished data from the same study shows the same relationship for cholesterol levels, says study author Linda S. Adair, professor of nutrition at the University of North Carolina.

However, the study contains a couple of mysteries, Adair says. The risk was not found for boys who had rapid growth in the first two years of life, and the relationship between body proportions at birth and elevated blood pressure at adolescence did not hold true for girls. Large weight gains for girls aged 8 to 15 was associated with high blood pressure, but the risk was not related to weight at birth.

"The sex difference is a big question that we cannot answer," Adair acknowledges.

The data came from the Cebu Longitudinal Health and Nutrition Survey, which is following more than 2,000 persons born in 1983 and 1984 in and near that Philippines city. They fit well with a fetal programming theory propounded by Dr. David J. P. Barker of the University of Southampton in England, she says -- that a malnourished fetus will adjust its metabolism to survive in the womb, but that adjustment might cause trouble later.

This not the first study to relate life in the womb to health later in life. Last month, British researchers reported that girls who were above average weight at birth were more likely to develop breast cancer (news - web sites) before the menopause than girls of average weight.

The analysis of the Cebu data took into account all the factors that might affect blood pressure, and birth weight remained important, Adair says.

"The main point is that there is an interaction between being underweight at birth, rapid growth during childhood and adolescence, and cardiovascular risk factors later in life," Adair says. "It turns out that growth during infancy, in this study at least, was not a risk factor, but more rapid weight gain later in life was."

The lesson for parents of both boys and girls is "to optimize nutrition of the mother during pregnancy," Adair says. For boys who are putting on a lot of weight as they grow up, parents "should be more careful about their diet and exercise and other risk factors," she says.

"Unhappily, we don't know enough about how to prevent hypertension and obesity," she says.

However, we do know some basic measures, says Dr. Rae-Ellen Kavey, chief of cardiology at Children's Memorial Hospital of Northwestern University in Chicago and a spokeswoman for the American Heart Association (news - web sites). She agrees with Adair that the starting point is "good maternal-fetal care," including an adequate diet.

At any age, "excessive weight gain is no good," Kavey adds, and one obvious measure to avoid that is "control of overall food intake."

While the study has some limitations -- for example, it never defines high blood pressure -- it gives important information, Kavey says. "The boys who had the highest blood pressure weighed most at birth and put on the most weight later," she says, and they are the ones who need the most attention.

More information

Learn about obesity, its dangers and how to avoid it from the American Heart Association. If you're pregnant, get lessons on taking care of yourself and your baby from the March of Dimes.

Back to the Top

Cholesterol-Lowering Drug Eases Arthritis in Mice

 

By Alison McCook

Reuters Health

Monday, February 10, 2003

NEW YORK (Reuters Health) - Cholesterol-lowering drugs usually prescribed to prevent heart disease and stroke may also help rheumatoid arthritis, new animal research suggests.

Using a statin, a type of cholesterol-lowering drug, UK researchers prevented or delayed the onset of rheumatoid arthritis in mice primed to develop the condition.

In rheumatoid arthritis, the immune system attacks the tissues that line the joints, leading to pain, inflammation and deformity.

These results suggest that statins do a lot more than just reduce levels of cholesterol in the body, study author Dr. Naveed Sattar of the University of Glasgow told Reuters Health.

"We believe (statins) have effects beyond lipid lowering," Sattar said. "They seem to influence a range of molecular pathways regulating the inflammatory response."

But he cautioned that success in mice does not mean success in humans, and further research is needed to confirm that statins can fight rheumatoid arthritis in people.

Recent research has shown that statins may help mice with a condition that resembles multiple sclerosis, reversing the paralysis caused by the illness and preventing relapses. Investigators have also suggested that statins may quiet inflammation set off by the immune system.

In the current study, Sattar and colleagues used the statin simvastatin (Zocor) to prevent and treat an inflammatory condition in mice that resembles rheumatoid arthritis. To prime the mice to develop the disease, the researchers injected them with collagen, which, over time, would cause them to develop symptoms of rheumatoid arthritis.

Some mice received simvastatin before developing arthritis symptoms, another group received the drug after showing signs of the disease, and others were given an inactive-- placebo--treatment.

Reporting in the February 1st issue of the Journal of Immunology, Sattar and colleagues discovered that simvastatin helped prevent or delay the onset of symptoms of arthritis in mice that received the drug.

In an interview, Sattar explained that the ability of statins to ease inflammation may help explain why the drugs also benefit patients with heart disease, since heart attacks can stem from inflammation in blood vessels as well as the amount of fat and cholesterol present in people's bodies.

The researcher added that people with rheumatoid arthritis appear to have an increased risk of heart disease relative to people without the condition. "Thus, statins may have multiple benefits in such patients," Sattar said, but added that further research in humans is needed to confirm that idea.

Sattar noted that other statins likely have similar effects on inflammation to those seen with simvastatin.

The current study was funded by the Arthritis Research Campaign, the Wellcome Trust and the Medical Research Council.

Source: The Journal of Immunology 2003;170:1524-1530.

Back to the Top

Keeping Cavities Out of Your Child's Mouth

HealthScoutNews

Monday, February 10, 2003

MONDAY, Jan. 10 (HealthScoutNews) -- Parents can play a key role in ensuring their children's smiles stay healthy and cavity-free.

That's the good news in a report in the January/February issue of General Dentistry.

First, some background. Cavities are caused by acid-forming bacteria found in dental plaque. Children aged 1 to 6 are more susceptible to cavities because their primary teeth have thinner, weaker enamel.

Primary teeth also have more spaces between them, which means it's more likely that food will linger in those spaces and provide a perfect breeding ground for cavity-causing bacteria.

However, parents can help protect their children from cavities by following this advice:

·         Increase your child's daily intake of fluoride, which strengthens young teeth and protects them from cavities. Fluoride can be obtained in toothpaste, fluoridated water, rinses and with professional applications.

  • Ensure your child eats a healthy, balanced diet with plenty of fruits and vegetables. Limit their sugar intake.
  • Help promote and implement dental health and education in the schools and community.
  • Prevent baby bottle tooth decay, which is caused by frequent and long-term exposure of a child's teeth to liquids that contain sugars. These liquids include milk, formula, fruit juice, sodas and other sweetened drinks. The sugars in these drinks pool around the infant's teeth and gums. Never allow an infant to fall asleep with a bottle containing any of these liquids.
  • Wrap a moistened gauze square or washcloth around a finger and clean and massage your baby's gums to help establish healthy teeth and to aid in teething. Do it once a day.
  • Your child should visit a dentist within six months of eruption of the first tooth.

More information

The American Dental Association has more information about children's dental health.

Back to the Top

Hot Tub Cause of Man's Serious Lung Infection

 

Reuters Health

Monday, February 10, 2003

NEW YORK (Reuters Health) - A severe lung infection caused by bacteria growing in a patient's hot tub highlights the importance of following guidelines for maintaining the tubs, according to Wisconsin researchers.

The 40-year-old man went to the emergency room after developing symptoms including fever, chills and a cough that produced blood. Although they initially feared the man had tuberculosis, doctors found that he had pneumonia caused by a bacterium known as Pseudomonas aeruginosa.

Doctors were initially stumped as to the cause of the infection, but when the man was interviewed further they learned that he owned a hot tub and had been using it daily for several weeks preceding his illness.

A laboratory test of the hot tub's filter later identified a strain of Pseudomonas aeruginosa identical to that present in the man's lungs.

The man was released from the hospital after 12 days and successfully treated with a six-week course of antibiotics, Christopher J. Crnich of the University of Wisconsin Hospital and Clinics in Madison and colleagues report in the February 1st issue of journal Clinical Infectious Diseases.

Although most healthy adults can fend off an infection with the bug, experts say that Pseudomonas aeruginosa infections can occur in people with immunodeficiency or chronic lung disease. The patient may have been more susceptible to the infection because he was an alcoholic and a smoker.

The bacterium is found naturally in soil, water, animals and plants. It can be released from water droplets, or from the steam in hot tubs, and then inhaled into the lungs.

The US Centers for Disease Control and Prevention (news - web sites) suggests that hot tubs contain 1-3 milligrams of chlorine per liter of water and be kept at a pH of 7.2-7.8, according to the report.

Many users may not realize that chlorine quickly dissipates at water temperatures above 84 degrees Fahrenheit, and that bacteria can multiply if chlorine levels drop and pH rises for as little as 24 hours, according to the researchers.

"Therefore it is necessary to monitor these levels on a frequent basis, in order to make adjustments necessary to maintain the appropriate level of disinfection, and to change the water regularly, especially after heavy use," they conclude.

Source: Clinical Infectious Diseases 2003;36:55-57.

Back to the Top

Poor Sleep Can Be Deadly for Elderly

By Nancy Deutsch
HealthScoutNews Reporter

HealthScoutNews

Monday, February 10, 2003

MONDAY, Feb. 10 (HealthScoutNews) -- Elderly people who don't sleep well may have more than mental alertness to worry about: They are also more likely to die sooner than their sound-slumbering counterparts, a new study suggests.

Sleep difficulties, such as having trouble falling asleep or middle-of-the-night waking, significantly increased the risk of death in seemingly healthy older individuals, say the authors of a study in the current issue of Psychosomatic Medicine.

"We were surprised because the people we studied were so healthy at the time we looked at them," says study author Mary Amanda Dew, a professor of psychiatry, psychology and endocrinology at the University of Pittsburgh School of Medicine.

Of 185 people primarily in their 60s to 80s who began the study, 66 had died in the follow-up period that averaged about 12 years.

None of the participants had major health problems when they entered the study and none thought they had sleep problems, Dew says. People with sleep apnea or serious medical problems were excluded from the study. The volunteers each spent three nights in the sleep laboratory where their quality of sleep was recorded.

Taking a long time to fall asleep was found to be the deadliest sleep-related problem. Those who required more than 30 minutes to nod off had a 2.14 greater risk of death than those who needed less time to do so. People who slept for less than 80 percent of the time they spent in bed were also almost twice as likely to die as sound sleepers. Participants with too much or too little rapid eye movement (REM), which is the dream portion of sleep, also faced greater risk for death, although to a lesser degree.

There were a variety of causes for the deaths, Dew says. "We thought maybe they'd die of brain-related problems," but this was not necessarily so, she notes.

Although the connection between the numerous deaths and poor sleepers could be chance, she doesn't think that's the case. "The sleep was a very subtle indicator that they were on the verge of developing other medical problems not yet evident," she believes. "This could be reflecting degenerative diseases that didn't become obvious until later."

The researchers did not look at the amount of sleep the volunteers received each night, although they reported sleeping an average of seven to eight and a half hours.

Many people don't know how well or poorly they sleep, Dew says. She suggests people who think they are having sleep problems see their doctor, but thinks even people who seem to sleep well should work on improving their sleep habits. "Don't do work in bed for example, and no napping during the day," she says. Dew also suggests limiting caffeine intake and avoiding the use of sleeping pills.

Being elderly is not a prescription for sleeping poorly, Dew stresses: "There's this myth that older people need less sleep or shouldn't be concerned if they have sleep problems. That's incorrect."

Timothy Roehrs, director of research at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit, thinks this study is important. Other studies looking at sleep and health have included people in poor health, and many rely on self-reported sleep. Some other studies have also included people who took medication for sleep, which subjects in this study were not permitted to do.

There are some limitations, however. "These were volunteers and there may be some bias. These are possibly people concerned about their sleep," Roehrs says. Furthermore, the researchers "were unable to look at duration of sleep as a critical variable."

Roehrs believes poor sleep leads to health problems, rather than signifying underlying health problems that already exist. "Sleep serves some vital function," he explains.

Either way, "obtaining inadequate sleep affects mortality."

More information

Learn about the importance of sleep from the National Sleep Foundation and the National Institute on Aging.

Back to the Top

Zoloft Gets FDA OK for Social Phobia, Pfizer Says

 

Reuters

Monday, February 10, 2003

NEW YORK (Reuters) - Pfizer Inc. on Monday said it had won permission from US regulators to market its blockbuster depression drug Zoloft for additional use as a treatment for "social anxiety disorder."

People with the condition, also known as social phobia, often fear public speaking, acting in plays, playing musical instruments in public and eating in front of others, according to the Merck Manual of medical information--situations that in an earlier era might have been characterized as shyness.

The New York-based company said Zoloft is the first member in its popular class of depression drugs, known as selective serotonin reuptake inhibitors (SSRIs), to win approval for long-term treatment of patients with the anxiety disorder. It was also approved for acute, or short-term, treatment for the disorder.

Pfizer said people with the disorder experience "anxiety, fear and avoidance behaviors" in certain social situations.

Analysts have said its approved use for social-phobia could help sustain or boost sales of Zoloft, which boasted fourth-quarter global revenues of $775 million. Pfizer said Zoloft is the most-prescribed SSRI in the United States. Other members of the class include GlaxoSmithKline's Paxil and Eli Lilly's Prozac.

Back to the Top

Which Blood-Thinning Drug Works Best?

HealthScoutNews

Monday, February 10, 2003

MONDAY, Feb. 10 (HealthScoutNews) -- A new study of the blood-thinning drug Angiomax is being conducted at the Virginia Commonwealth University Health System.

The researchers are comparing the effectiveness of Angiomax to the drug heparin during cardiac surgery. Heparin is the most commonly used blood thinner.

Blood thinners, or anti-coagulants, are used during cardiac surgery to prevent blood from clotting during critical stages of the operation.

In this study, the researchers will evaluate the side effects and blood behavior of both drugs during and following surgery.

Angiomax is a short-acting drug that clears the body without the need for any additional medication. Heparin is a longer-acting drug that requires a second drug to reverse its blood-thinning effects. Heparin is given as an injection, while Angiomax is given to the patient as a constant infusion.

Since the study, funded by the maker of Angiomax, began in November, four people have received Angiomax and all have done well.

Angiomax has U.S. Food and Drug Administration (news - web sites) approval for use during coronary balloon angioplasty procedures on people with unstable angina (news - web sites).

More information

Here's where you can learn more about blood thinners.

Back to the Top

Some Boys' Fast Weight Gain May Up Blood Pressure

 

Reuters Health

Monday, February 10, 2003

NEW YORK (Reuters Health) - Small baby boys who gain weight rapidly in childhood and adolescence appear to be at a higher risk for elevated blood pressure, a new study shows. These higher blood pressure levels may contribute to heart disease later in life.

The findings, announced Monday, are based on a study of 2,026 Filipino children who were followed from birth until their teen years. The study is published in the online edition of Hypertension: Journal of the American Heart Association (news - web sites).

"The boys who were thinnest at birth and who gained the most weight during childhood and adolescence were the ones who had the greatest risk of having elevated blood pressure," lead author Dr. Linda S. Adair of the University of North Carolina in Chapel Hill said in a prepared statement.

Past studies have identified low birth weight alone as a risk factor for high blood pressure later in life, leading many experts to suggest that a person's adult blood pressure is, at least in part, determined during life in the womb.

The new study found that low birthweight infant boys who gained weight rapidly between the ages of 8 and 16 had the highest blood pressure. Weight gain in the first two years of life actually reduced the risk of high blood pressure.

"Faster growth in infancy did not represent a risk for increased blood pressure in adolescence for either sex," said Adair. "This period of weight gain may even be slightly protective against high blood pressure later.

"This is an important finding because pediatricians want to see improved growth in babies born small," the researcher added.

Adair and co-author Tim J. Cole did not find the same relationship in girls.

"The sex difference is a big question that we can not answer," said Adair. "We thought that the reason might be related to sexual maturity but when we controlled for that in our analysis, it didn't make a difference."

The findings underscore the need for pregnant women to obtain the best nutrition possible for their developing fetus and newborn, according to the report.

"Future research should seek to identify specific modifiable factors that influence fetal growth patterns and disease development in the postnatal period," the authors conclude.

Source: Hypertension 2003;41.

Back to the Top

Office Ergonomics

(HealthScoutNews) -- Office workers' most common aches and pains involve their hands, wrists, necks, shoulders, backs, arms and legs.

The U.S. government's Occupational Safety and Health Administration (news - web sites) offers these tips:

  • Adjust your chair to fit your body.
  • Sit with your shoulders relaxed, thighs parallel to the floor, and feet flat on the floor.
  • Shift your position often and take frequent rest breaks.
  • Exercise by gently stretching your fingers, arms, and shoulders.
  • Use a document holder at eye level.
  • Put the keyboard at elbow level and hold your wrists straight while typing.
  • Place the mouse next to the keyboard and move your whole arm to operate the mouse.
  • Rest your hands in your lap when not typing.
  • Organize your desk so that the items you use most often are within a 14- to 18-inch reach.
  • Place your computer monitor directly in front of you 18-24 inches away, with the top just below eye level.

Back to the Top

New England Journal of Medicine Retracts Study 

Reuters Health

Monday, February 10, 2003

NEW YORK (Reuters Health) - The New England Journal of Medicine (news - web sites) retracted a study on Monday because one of the coauthors falsified signatures of the majority of the researchers named on the study as it was being reviewed.

The study was published in October 2002, and concerned a technique in which alcohol is injected directly into the heart to treat hypertrophic cardiomyopathy, a leading cause of sudden cardiac death in children and adolescents.

According to the journal, there was an "egregious disregard of the principles of authorship."

"Of the eight persons named as authors of the article, some claimed that they had never reviewed the original data and most claimed that they had not seen or approved either the original version or one or more of the three revised versions of the manuscript," according to the notice of retraction that is to be published in the March 6th issue of the journal. "One author claimed that he had seen neither the original data nor any version of the manuscript."

The study's authors, led by Dr. Waqar Shamim of the Imperial College School of Medicine in London, requested the retraction in a letter to the journal.

They note that the technique described in the study may be a "useful procedure in selected patients."

"We also want to make clear that the Cleveland Clinic Foundation was not involved in the study but was mentioned purely as an address for correspondence," they wrote.

To prevent the problem from happening again, the journal plans "to inform all authors of record by e-mail when their manuscript is accepted."

The "unfortunate incident serves as a reminder to the medical community that with the privilege of authorship comes a mandate for personal and professional responsibility that must be taken very seriously," according to the journal's editors.

Source: The New England Journal of Medicine 348;10.

Back to the Top

Body Cast Aids Toddler Hip Defect 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, February 10, 2003

WASHINGTON - For days, Julia would scream and beat her little fists against her cast. A healthy 1-year-old used to running and climbing, she now could only lie propped up on a hill of pillows — plaster encasing her from navel to ankles.

Her legs were frozen apart in a frog-like split.

She no longer fit in her car seat or high chair or stroller. Her diapers wouldn't stuff through the little opening in the cast's middle — how would we keep her dry? And what could she do for entertainment? Yikes.

For four months, this awkward cast was to hold my daughter's hip together and start correcting her hip dysplasia, a mysterious condition in babies that, if not caught early, can lead to excruciating arthritis by the time they're young adults.

Early in life, the ball of Julia's left hip silently slipped out of a socket that was too loose or shallow.

Regular exams designed to catch this defect, called developmental dysplasia of the hip, or DDH, in early infancy when it's easiest to fix never turned up the warning "clunky" sounds. And no one knew she was at risk because no one even knows what causes DDH, which can range from mild loose hips to the full dislocation that occurs in one in 1,000 newborns. The biggest risk is simply gender — for unknown reasons, DDH is at least four times more common in girls, especially the first born.

Then Julia started walking and dragged her left foot a little. Kids do that a lot — let's monitor it, the pediatrician said. Sure enough, the foot drag soon disappeared. But a very subtle limp remained, along with a telltale extra skin fold atop her left thigh that finally had me seeking an X-ray when she was 16 months old.

It could have been far worse. Even when caught so late, DDH is a treatable disorder. And while wearing a special harness often easily cures infants, some babies require multiple surgeries, something Julia hopefully will avoid.

"Coping with it, sometimes I say how did we live through all that?" recalls Kim Phillips of Plainfield, Ill., whose daughter Samantha was in a cast almost continuously from age 2 months to her second birthday.

It took half a dozen surgeries, including bone-cutting operations and metal pins inserted in her thighs, to force both of Samantha's hips back into their sockets. Phillips knew the treatments were necessary because her own brother, at 36, can hardly spread his legs because of DDH-caused arthritis. At 4, Samantha's doing well.

By comparison, Julia seems lucky so far. She was just under the magic 18-month age when hip repair would have required open-pelvic surgery. Instead, while Julia was under general anesthesia, her surgeon manhandled her left hip back into place with only a small incision. The frog-style cast — three of them, actually, replaced as she grew — let it grow into place.

Like most tots, Julia adapted amazingly well to the cast. Within a month, she had built up enough arm strength to pull herself across the floor, delighting in being mobile again. A month after that, she gleefully learned to stand, looking like a midget sumo wrestler.

Creativity is key to helping kids through the ordeal. We learned to replace diapers with adult incontinence pads that fit the cast opening better. Julia's hospital loaned us a special cast-sized carseat. Phillips cut the sides out of Samantha's seat to squeeze her legs through.

Julia's grandmother built her a tall wooden TV tray to fit over the pillows she propped on to eat. Samantha's father built a table around a brace that held his child in place. A harness fashioned from a dog leash held Julia in a stroller. Samantha propped on pillows in a wagon.

Everyday coping aside, how normally do these children grow once the cast comes off?

Pushing the hip into place doesn't solve the whole problem. The socket — cartilage that gradually will turn to bone — remains poorly formed, the wrong shape, until friction helps it remodel. Some children later need bone-cutting surgery to help that happen, and surgeons are becoming more aggressive in fixing even subtle remaining abnormalities thanks largely to the work of Dr. Stuart Weinstein of the University of Iowa.

He tracked how children treated at various ages fared 30 years later, and found the hip socket must turn out almost perfect to avoid DDH-spurred arthritis in middle age.

And while the American Academy of Pediatrics updated guidelines in 2000 to stress catching DDH in infancy, missed cases still trickle through. Chicago's Dr. Ken Kuo just saw a 20- and 30-year-old in the same week who need hip socket reconstruction.

As for Julia, it will be another year before we know if she'll need more treatment. But six weeks after the cast came off, her prognosis is good.

Editor’s Note — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Back to the Top

Estrogen May Affect Embryo's Ability to 'Stick' 

By Merritt McKinney
Reuters Health
Monday, February 10, 2003

NEW YORK (Reuters Health) - The "window of opportunity" during which an embryo can implant in the uterus depends on just the right estrogen levels, new research in mice suggests.

The mouse research does not prove that estrogen has the same effect in humans, said Dr. Sudhansu K. Dey, who is at Vanderbilt University Medical School in Nashville, Tennessee.

But if the hormone does help regulate the ability of an embryo to implant in the uterus in humans, Dey said that tinkering with a woman's estrogen levels may improve the odds that assisted reproduction techniques such as in vitro fertilization (IVF) will succeed.

According to the report, too much estrogen seems to close the "implantation window," reducing the chances that an embryo will take hold in the uterus. But low levels of the hormone seem to prolong the time in which an embryo can implant in the uterus.

"Estrogen within a very narrow range can determine the duration of the window of uterine receptivity for implantation," Dey told Reuters Health in an interview.

Dey noted that a technique used in IVF may actually work to close the "window of opportunity" for implantation in the uterus.

During IVF, a woman's eggs are harvested and then fertilized with a man's sperm in the laboratory. The resulting embryos are then transferred into the uterus.

Women undergoing such procedures are often given hormones to stimulate the release of eggs from the ovaries. This approach may raise estrogen levels, Dey said, which in turn could affect the uterus. When estrogen levels rise, embryos may be less likely to take hold in the uterus, he said.

In the study, the researchers gave various doses of estrogen to female mice to stimulate the uterus. They then implanted embryos one to five days later.

In mice that had received a low initial dose of estrogen, the uterus was receptive to embryos for several days. In contrast, after a high dose of the hormone, the window of opportunity for embryos to take hold in the uterus was much shorter.

What's more, Dey and his colleagues found that the activity of several genes related to embryo implantation was abnormal when they gave the mice higher levels of estrogen.

The jury is still out on whether stimulating ovaries to release more eggs makes it less likely that an embryo will implant in the uterus, Dey's team points out in a report on the findings in the advance online edition of the journal Proceedings of the National Academy of Sciences (news - web sites).

Still, the researchers suggest that it may be possible to improve the success rate of assisted reproduction techniques by paying close attention to estrogen levels. By keeping estrogen levels low, thus prolonging the window of opportunity for embryos to take hold in the uterus, it may be possible to reduce the need for transferring more than one embryo, according to the report.

When performing IVF, doctors often transfer more than one embryo with the expectation that most will not take hold in the uterus. When several embryos do implant and begin to develop, it can be hazardous for the fetuses and the mother. A pregnancy with twins, triplets or more fetuses can result in premature birth, greatly increasing the risk of complications.

SOURCE: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.0530162100.

Back to the Top

SUNDAY, FEBRUARY 9, 2003

Paperwork Irks Patients Most

HealthScoutNews

Sunday, February 9, 2003

SUNDAY, Feb. 9 (HealthScoutNews) -- Paperwork and billing concerns cause more patient complaints than the quality of their health care, despite the fact that problems with health-care quality are as common as administrative problems.

Surprising as that may sound, it's the conclusion of a recent study in Milbank Quarterly.

The study found many people don't complain even when they have serious problems with the quality of their health care. Such complaints haven't increased, even though recent government regulations make it easier to file grievances about health-care quality.

The study says people who did complain about health-care quality were five times as likely to have their concerns resolved in a successful manner. People were most likely to complain about simple problems, rather than complex problems, and about repeated and costly problems.

People were more likely to complain and have their problem resolved when a third party, such as a family member, doctor or outside mediator, was involved.

The study used data from the 1999 Kaiser Family Foundation's National Survey on Consumer Experiences with Health Plans.

About half of the survey respondents reported at least one problem linked to their health-care plan in the previous year. Of those who said they had a problem, 59 percent complained directly to their health plan and 13 percent made their complaint to their employer.

Blacks and Asian Americans were half as likely to complain about problems as whites, but their complaints were just as effective as complaints made by whites.

More information

Here's where to learn more about patient rights.

Back to the Top

Saving Face

By Colette Bouchez
HealthScoutNews Reporter

HealthScoutNews

Sunday, February 9, 2003

SUNDAY, Feb. 9 (HealthScoutNews) -- If you're one of millions of women who use skin-care treatments and cosmetics containing the popular anti-aging ingredients known as alpha hydroxy acids, you may soon find a warning on the product labels.

The U.S. Food and Drug Administration (news - web sites) (FDA) is proposing that manufacturers be required to print the alert. It would indicate that the very ingredients used to reduce the signs of skin aging may well be causing your skin to age, primarily by increasing your risk of sunburn.

The warning may be particularly important because sunburn increases your risk of skin cancer. However, some dermatologists are downplaying the threat posed by alpha hydroxy acids.

According to a "draft guidance" published in the December 2002 Federal Register, the FDA has proposed a labeling change that would read as follows: "Sunburn Alert: This product contains an alpha hydroxy acid (AHA) that may increase your skin's sensitivity to sunburn. Use a sunscreen and limit sun exposure while using this product and for a week afterwards."

Alpha hydroxy acids -- or fruit acids as they're sometimes called -- help the skin maintain a more youthful appearance by increasing the rate of cell turnover. This can be beneficial because, as we age, the rate at which we shed dead skin cells slows down -- a fact that contributes to an older, more wrinkled-looking skin.

Currently, there are some 1,500 different products containing AHAs, comprising a $6 billion market in the United States alone.

However, the other factor that increases skin aging is sun damage. And the FDA says AHAs contribute to that damage by increasing the rate at which skin burns.

And sunburns are one of the leading causes of skin cancer, the most common form of cancer in the United States, with more than 1 million new cases diagnosed in 2002, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

FDA officials say the proposed label change was prompted by studies conducted by the Cosmetic, Toiletry and Fragrance Association on the safety of topically applied AHAs.

Those studies -- co-sponsored by the FDA's Office of Women's Health -- confirmed that applying an AHA to the skin increased ultra violet (UV) sensitivity by up to 18 percent, following four weeks of use. Similarly, the study found that skin sensitivity to UV-induced cellular damage doubled on average.

As worrisome as these results might seem, not all dermatologists think the findings are that significant -- or warrant a label warning.

"We in dermatology have been using AHAs -- in prescription strength -- for decades, with no increased risk of skin cancer and no dramatically increased risk of sunburn," says Dr. Ted Daly, an assistant professor of dermatology at Nassau University Medical Center in New York.

"To put this kind of warning on a label seems to me to be alarming women for no reason. I don't really see it as necessary," he says.

Adds Dr. Darrell Rigel, a professor of dermatology at the New York University School of Medicine and past president of the American Academy of Dermatology: "I don't think that AHAs are dangerous, and the new label, while an important reminder to use sunscreen, could be very misleading."

Rigel says that while an AHA may, in fact, increase your risk of sunburn, that risk is small.

"Even though an AHA may increase your risk of sunburn by 18 percent, a sunscreen with a protection factor as low as 2 decreases your risk by 50 percent," says Rigel, who says it's important to keep the study findings in the proper perspective.

Both doctors concur, however, that any time you can draw attention to the need for using sunscreen, the outcome is positive. In this respect, the proposed label change may offer an important public service.

 

 

"I think reminding people to protect their skin from the sun is a good thing, and if a label is going to remind women to use a sunscreen, then it can be helpful," Rigel says.

According to the Cosmetic Ingredient Review Panel -- the industry's self-regulating body for reviewing scientific information about cosmetic ingredients -- products containing AHAs are safe for use by consumers under the following circumstances:

·         The concentration of AHA does not exceed 10 percent;

  • The acid content, or pH, of the product is listed at 3.5 or greater (the higher the pH the lower the acid level);
  • The product either contains ingredients that protect the skin from sun damage, or directions recommending the use of sunscreens following applications of products containing AHAs.

More information

To read more about the proposed label changes and the studies that led to those recommendations, visit the U.S. Food and Drug Administration. You can also learn more about how sun ages the skin by visiting The American Academy of Dermatology.

Back to the Top

Cold Weather, Cold Hearts

HealthScoutNews

Sunday, February 9, 2003

SUNDAY, Feb. 9 (HealthScoutNews) -- If you have heart disease, be careful that the cold weather doesn't put a chill in your heart.

Winter temperatures and conditions can be dangerous for people with cardiovascular disease, says the American Heart Association (news - web sites) (AHA).

They may be more prone to hypothermia, a condition where the body temperature falls below normal. It's the result of the body not being able to produce enough energy to maintain internal body temperature. Hypothermia can be fatal, and heart failure is the cause of most deaths in such cases.

Hypothermia symptoms include coordination difficulties, slowed reaction, shivering, sleepiness and mental confusion.

It's not just cold temperatures that can snatch away your body heat: Wind, snow and rain are also factors. The AHA advises you to protect yourself by wearing layers of warm clothing that trap insulating air between layers.

Don't forget to wear a hat or head scarf to prevent body heat from escaping through your head. Wear mittens and boots that will keep your hands and feet warm.

Avoid alcohol. It expands blood vessels in the skin, causing heat to be drawn away from your body's vital organs.

Cold weather combined with shoveling or walking through heavy, wet snow or snow drifts can put strain on your heart, the AHA says. Some studies indicate severe winter weather may also increase heart attack risk because of overexertion.

More information

To learn more, go to the American Heart Association.

Back to the Top

SATURDAY, FEBRUARY 8, 2003

FDA Urges More Blood Scrutiny

By Lauran Neergaard

AP Medical Writer

The Associated Press

Saturday, February 9, 2003

WASHINGTON - The government is investigating whether blood quarantined because it contained mysterious white particles may have played a role in health problems suffered by half a dozen people, including one who died, after recent transfusions.

The Food and Drug Administration (news - web sites) stressed Friday that it had no evidence yet linking the blood mystery to any harm. The person who died, for instance, was already severely ill long before receiving a transfusion, and some of the other reports included allergic reactions and infections that are fairly routine transfusion side effects.

But as a precaution, the FDA urged blood banks Friday to more closely visually inspect bags of donated blood for those mysterious white clumps as it continues to investigate just what they are and what prompted their appearance a week ago.

"For patients who need blood, the benefits of transfusion continue to outweigh the risks," stressed Dr. Jesse Goodman, the FDA's chief of biological products.

Some preliminary testing suggests at least some of the particles might just be normal blood cells or other natural components that for some reason clumped up, but no possible cause has yet been ruled out, he said.

Even if initial reports that they're just clumps of blood cells called platelets prove true, such excess clumping could be risky to certain patients because they could encourage, for example, too much blood clotting. Also, scientists would be concerned about what prompted a sudden change in blood quality as well, Goodman explained.

"We want to have blood as pure a product as possible," he said. "We are certainly hoping this is not a significant safety problem, but we are also acting as though it could be."

The mysterious contamination came to light Jan. 30, when the American Red Cross (news - web sites) asked hospitals in Georgia and northern Florida to stop using recently collected blood because some contained white particles visible inside the bags. Eventually, additional blood was quarantined in areas stretching from Illinois and Missouri to Kentucky and Tennessee.

Government testing so far suggests the particles are not any infectious substance.

The investigation so far is focusing mostly on the bags storing the blood in question, because the initially quarantined pints had been stored in a particular type of bag made by Baxter International Inc.

But the FDA revealed Friday that in recent days it has learned of possible particles spotted in blood in other parts of the country and stored in different bags.

Friday, the FDA asked all blood banks to add an extra step to their normal safety tests: Lay each blood bag on a flat counter for 10 minutes and then see if particles are visible to the naked eye. If there are, quarantine that blood and immediately call or e-mail FDA blood officials, the agency ordered.

Back to the Top

Giving Birth Against the Odds

By Lisa Girard
HealthScoutNews Reporter

HealthScoutNews

Saturday, February 9, 2003

SATURDAY, Feb. 8 (HealthScoutNews) -- When Kim LaSalvia cradles her infant twin sons, she doesn't think of herself as a medical pioneer.

Perhaps she should.

"Pretty much up until recently, I didn't think I'd be able to have children," says LaSalvia, one of thousands of Americans who have received organ transplants -- in her case, a kidney. "I was diagnosed with lupus at 16 and between that and the transplant, I didn't think it would happen for me."

At one time, the medical community might have advised LaSalvia against becoming pregnant. Until recently, it was thought the anti-rejection drugs taken after transplant surgeries might harm a fetus, and the pregnancy itself might lead to problems with the transplanted organ.

"In a case like Kim's, the conventional wisdom would have been, she had a kidney transplant several years ago and it might cause problems," says Dr. Vincent Armenti, a transplant surgeon at Thomas Jefferson University Hospital in Philadelphia. "Not that it was discouraged, but there was a high level of concern and the issue was approached carefully."

Armenti is familiar with LaSalvia's case because she works as the kidney transplant coordinator at Jefferson. Also unique about her situation is that her husband, James, has been the recipient of three different kidneys in the past 10 years. They met on a blind date two years ago, and it wasn't until they decided to get married that LaSalvia started thinking about having children and began seeking information.

Her greatest resource was the National Transplant Pregnancy Registry (NTPR), which since 1991 has been recording pregnancy outcomes of transplant recipients (both mothers and fathers) in more than 200 centers across the United States. Although some records have been kept since 1958, this is a national database and the most comprehensive source available, with information on 1,300 pregnancy outcomes for women and about 2,000 people altogether. Kidney transplant patients make up the majority of patients in the registry.

"We still feel it's a higher risk situation, but we're encouraged by the results," says Armenti, director of the NTPR. "You have to have an assessment of risks for each patient instead of putting them all together. We're starting to look at each patient on a more individual basis."

Kidney transplant recipients are three times more likely to run into problems during their pregnancies than women in the general population. In pregnancies where the father is the organ recipient, the results are consistent with those in the general population.

Some of the most common problems observed in the female transplant recipients are high blood pressure and preeclampsia, which is a combination of high blood pressure, edema and protein in the urine. Preeclampsia affects about 7 percent of the general population during pregnancy and 25 percent to 35 percent of kidney transplant patients, says Armenti.

Infection is another problem for kidney patients, affecting about one quarter of the pregnancies. Most of these are minor, such as a urinary tract infection, but there can be an occasional serious infection that needs more aggressive treatment.

About 5 percent of kidney patients run into rejection problems during pregnancy, a number that is higher in those who have had pancreas transplants (8 percent) and liver transplants (5 percent to 10 percent).

It is recommended that female recipients wait at least two years after their operation to try to become pregnant, letting their bodies adjust to immunosuppressive medications, to make sure graft function is good and there's no sign of infection or rejection of the organ.

"These medical conditions are inherent problems in the transplant population, not just in those who are pregnant," Armenti says.

Other problems that have been identified through the NTPR are a higher incidence of prematurity in transplant recipients -- the average gestation period is 36 weeks, compared to 40 weeks for the general population -- and smaller birth weights. Cesarean section rates are higher as well because, Armenti says, "there is extra concern about these pregnancies, and many doctors don't want them to progress too far."

On the other hand, the database has shown no pattern for increases in birth defects, and the survival rate seems to be in line with the general population of premature babies. Once a pregnancy outcome is entered into the database, the child born to the transplant recipient is followed up to the age of 18. There have been no particular difficulties observed in these children.

"It's hard to find all the necessary information, so you have to make certain assumptions," Armenti says. "Further study needs to be made. This is an ongoing situation."

Kim LaSalvia says she's up every two hours during the night feeding her babies, born in November, and wouldn't have it any other way.

"I'm feeling really very grateful that everything worked out as well as it did," LaSalvia says. "The whole process wasn't without its risks, but if I had looked too much at those risks and chickened out, look what I would have missed out on. I still can't believe they're mine."

More information

Here's more on pregnancy and transplants. You can also check out the latest research on the risks of pregnancy among transplant recipients.

Back to the Top

Playground Equipment May Pose Cancer Risk

By David Ho

Associated Press Writer

The Associated Press

Saturday, February 9, 2003 

WASHINGTON - Children could face an increased lifetime risk of developing lung or bladder cancer from using playground equipment made of wood treated with arsenic, the nation's top product safety official said Friday.

Almost all wood playground equipment now in use has been treated with a pesticide called chromated copper arsenate, said Hal Stratton, chairman of the Consumer Product Safety Commission (news - web sites). He said children can get arsenic residue from the treated wood on their hands and then put their hands in their mouths.

Stratton said the agency's scientists recommend that parents and caregivers thoroughly wash children's hands with soap and water immediately after youngsters play on playground equipment made of the treated wood. Children also should not eat while on the equipment, he said.

The safety agency will hold a public meeting next month to consider a proposed ban on the arsenic-based preservative in playground equipment. Advocacy groups petitioned for a ban in 2001.

Last year, preservative manufacturers agreed with the Environmental Protection Agency (news - web sites) to stop using the chemical in new wood playsets and other consumer products by December 2003. An EPA report on the risks of the pressure-treated wood is expected later this year.

To figure a child's cancer risk from treated playground equipment, researchers considered factors including how much arsenic is released from wood, the amount picked up on hands and transferred to the mouth and the time a child spends with the equipment. Researchers said an average child visits playgrounds three times each week.

The study found that for every 1 million kids exposed to the treated wood that frequently during early childhood, two to 100 of them might develop lung or bladder cancer later in life because of that exposure. This increase is in addition to other risks of getting cancer.

The range of risk is large because of differing estimates of how likely arsenic is to cause cancer, agency spokesman Ken Giles said. Some of the data came from studies in Taiwan, where there are higher levels of arsenic in drinking water.

Lung cancer is the most common form of cancer; bladder cancer is more rare. The greatest risk factor for both is smoking.

Mike Casey, a spokesman for the Environmental Working Group, one of the groups seeking a ban, said the study supports their position that the treated wood is dangerous.

Wood preservatives containing arsenic and dioxin have been increasingly targeted as unsafe by advocacy groups. Those preservatives have been commonly used in utility poles, wood decks and playgrounds.

The safety commission did not study other products because the ban petition only involved playgrounds, Stratton said.

Arsenic, both manufactured and naturally occurring, is known to cause cancer, but the preservative industry has said the arsenic-based preservative has never been linked to skin disease or cancer in children and its wood is safe when used properly.

The safety commission and the EPA are studying ways to coat treated wood with a sealant to prevent arsenic from coming through.

EPA began requiring consumer warning labels on treated lumber containing arsenic in 2001.

On the Net:

Consumer Product Safety Commission: http://www.cpsc.gov

Environmental Protection Agency: http://www.epa.gov

Back to the Top

Nurse Your Nose in the Cold

HealthScoutNews

Saturday, February 9, 2003

SATURDAY, Feb. 8 (HealthScoutNews) -- The nose knows when it's cold. And it can suffer, both indoors and out.

"Wintertime causes us to spend more time indoors and therefore individuals have additional exposure to indoor allergens, including pet dander, dust mites, mold spores, feathers and cockroach allergen," says Dr. Clifford Bassett, an allergist at Long Island College Hospital.

More allergens means more exasperating allergies.

To cut down on the number of allergens in your home, use a hygrometer in conjunction with a humidifier. The hygrometer measures how much moisture the humidifier is adding to the air. Shoot for a humidity level of 45 percent to 50 percent, Bassett says. Anything above that will turn your abode into a greenhouse, resulting in more growths to aggravate your respiratory system.

Outside, the problem is a little different but equally annoying.

"Individuals may find cold weather causes the nose to run when outdoors for a prolonged period," Bassett says. This is sometimes referred to as "skier's nose." Try wearing a cold-weather face mask if you're outdoors for prolonged periods. You can also talk to your doctor about prescription nasal sprays.

More information

The American Academy of Allergy, Asthma and Immunology has some tips on getting rid of mold.

Back to the Top

Smallpox Info on Internet

HealthScoutNews

Saturday, February 9, 2003

SATURDAY, Feb. 8 (HealthScoutNews) -- If you have questions or concerns about smallpox and the smallpox vaccine, there's a new Web site that can provide you with answers.

University of Florida experts have created the Web site to assist anyone who's concerned about smallpox bioterrorism to better understand and evaluate the risks posed by smallpox and the vaccine to protect against it.

Here's where you can find the smallpox Web site.

Currently, smallpox vaccinations in the United States are available only to medical workers, people in the military, and law enforcement officials. However, a voluntary program for the general public could be implemented in the United States in 2004.

The smallpox vaccine was once routinely given to children but hasn't been used in the United States since 1972. That's because measures to control the disease were so successful the vaccine was no longer necessary.

The Web site provides examples of the relative risks of smallpox, along with the risks associated with receiving the vaccine.

The odds of dying from a first-time smallpox vaccination are about one in 500,000. However, the risk is much greater for people with weakened immune systems. Those people should consult a doctor before making a decision about getting a smallpox vaccination.

More information

Here's where you can learn more about smallpox.

Back to the Top