The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
May 7, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 March 1-7


Beating Odds of Heart Disease, Stroke in Diabetics

Tuesday, March 4, 2003

TUESDAY, March 4 (HealthScoutNews) -- A major new study in the United States and Canada will test the best ways to lower the risk of stroke and heart disease in adults with Type 2 diabetes.

The U.S. National Institutes of Health (news - web sites) (NIH) study will be conducted in 70 clinics and include 10,000 adults with Type 2 diabetes. It's called the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study.

All participants will be included in the blood sugar control part of the trial. They'll then be randomly assigned to a treatment program involving either aggressive or standard control of blood sugar.

Then, depending on their cholesterol and blood pressure levels, the participants will be placed in either a high blood pressure or high blood fats part of the study.

It's the first large-scale study to test the effects of intensive control of blood sugar along with aggressive control of blood pressure and lipids in people with diabetes.

The ACCORD study is expected to go from February 2003 to June 2009. Most people who take part in the study will be involved from 5.5 to 8.5 years.

About 17 million Americans have been diagnosed with diabetes and about 90 percent of them have Type 2 diabetes. By 2050, the number of Americans with diagnosed diabetes is expected to increase 165 percent, to 29 million people. About 27 million of them will have Type 2 diabetes.

Cardiovascular disease is the leading cause of death in people with Type 2 diabetes, with cardiovascular disease-related death rates two to four times higher than people who don't have diabetes.

People with Type 2 diabetes also suffer more strokes and nonfatal heart attacks than people who don't have diabetes.

More information

Here's where you can learn more about the ACCORD trial.


Folate May Dampen Alcohol's Effect on Breast Cancer

By Jacqueline Stenson
Reuters Health
Tuesday, March 4, 2003

NEW YORK (Reuters Health) - A diet rich in orange juice, leafy greens, fortified breakfast cereals and other foods high in folate may help lower a woman's risk of breast cancer (news - web sites), particularly if she faces an elevated risk from regular alcohol consumption, new study findings suggest.

Among women who consumed about one alcoholic drink a day or more (at least 15 grams of alcohol), those who had the highest levels of folate in their blood were 89% less likely to go on to develop breast cancer than those who had the lowest levels of the B vitamin.

For women who drank less alcohol, those with the highest levels of folate appeared to be about 28% less likely to develop the disease than those with the lowest levels, according to findings published in the March 5th issue of the Journal of the National Cancer Institute (news - web sites).

Previous studies have linked regular alcohol consumption to an increased risk of breast cancer. Alcohol is known to interfere with the body's absorption of folate and to increase the excretion of the vitamin by the kidneys.

Because folate is involved in the healthy function of DNA, low levels of the vitamin may promote breast cancer by causing damage to genetic material, noted study author Dr. Shumin Zhang, an assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School (news - web sites) in Boston, Massachusetts.

The new findings are in line with previous reports that folate may help counter alcohol's effect on breast cancer, she said.

The study involved women enrolled in the ongoing Nurses' Health Study. Researchers took blood samples from 32,826 of the study participants between 1989 and 1990. The investigators then compared levels of folate and other B vitamins in the blood of 712 women who had developed breast cancer by 1996 to those of another 712 women who did not have breast cancer. Some women in the study took vitamins containing folic acid, the synthetic form of folate.

Zhang told Reuters Health the findings offer more evidence of the importance of getting recommended levels of folate and folic acid.

"Folic acid can reduce birth defects," Zhang said. "It also seems to reduce the risk for cardiovascular disease. And now we have another reason to be sure to get enough folic acid. It may reduce the risk of breast cancer."

Both women and men are advised to get 400 micrograms of folate a day. Pregnant women should consume 600 micrograms daily, the government advises.

In addition to oranges and leafy greens such as spinach, other good sources of folate include dry beans, peas, asparagus, cantaloupe and papaya. Many breakfast cereals and breads are now fortified with folic acid.

The study also found that vitamins B6 and B12 appeared to help lower the risk of breast cancer in women who consumed less than 15 grams of alcohol a day, but not in women who drank more.

Source: Journal of the National Cancer Institute 2003;95:373-380.


Avoiding Amputations in Diabetics

Tuesday, March 4, 2003

TUESDAY, March 4 (HealthScoutNews) -- Aggressive screening for evidence of nerve damage and sensory loss helps doctors identify people with diabetes who are at greatest risk for severe foot problems such as skin ulcers and a deformity called Charcot foot.

Left untreated, these serious foot problems can result in lower-limb amputation, says new research from diabetic foot care experts.

Sensory loss (neuropathy) is the most critical predictor of which diabetic patients will develop severe foot problems, according to experts, several of whom spoke at the recent annual meeting of the American College of Foot and Ankle Surgeons (news - web sites).

Simple neurological testing combined with a thorough patient history are the most useful tools in identifying diabetes patients with neuropathy and at the greatest risk for suffering crippling foot disorders.

Regular check-ups and daily patient inspections for sores, cuts and tiny puncture wounds can prevent or minimize diabetes-related foot and ankle problems. Early detection lets doctors begin treatment to prevent foot deformity and possible amputation.

Charcot foot occurs in about 30 percent of people with diabetes who have peripheral neuropathy. In its early stages, Charcot foot is often misdiagnosed as septic arthritis, gout, or osteomyelitis.

Pain, swelling, redness and heat are among the first symptoms of Charcot foot. Balance is affected and bones become soft and fracture-prone. Many people with Charcot foot aren't able to wear shoes.

In more advanced stages, Charcot foot causes loss of sensation in the foot and an inability to feel pain. Muscles are unable to provide proper support to the ankle joint, the foot becomes unstable and a reverse arch develops.

Walking makes the condition worse. Inflammation from the pressure of walking results in further instability, ulcers and dislocation. Eventually, the foot may collapse.

More information

Here's where you can learn more about foot care for people with diabetes.


Green Tea Doesn't Treat Advanced Prostate Cancer

By Alison McCook
Reuters Health
Tuesday, March 4, 2003

NEW YORK (Reuters Health) - Despite previous research touting the promise of green tea for prostate cancer (news - web sites) treatment, a new study shows it does little to help men with advanced disease.

Among 42 men with advanced prostate cancer who ingested highly concentrated forms of green tea, only one showed fleeting signs of improvement.

And the majority of patients developed side effects such as nausea, vomiting, insomnia and confusion, which the study authors suggested may stem from the caffeine contained in green tea.

Green tea "didn't work," study author Dr. Aminah Jatoi of the Mayo Clinic in Rochester, Minnesota told Reuters Health.

But she cautioned that these results only apply to men with advanced prostate cancer that has become resistant to hormonal therapies. The current study should not discourage investigators from studying the benefits of green tea for other forms of the disease, she noted.

"I wouldn't want anybody to think that just because it didn't work in this setting, there are not other possibilities for testing it in the future," Jatoi said.

Researchers became inspired to study green tea's effects in humans after laboratory experiments and investigations in animals suggested the drink could suppress prostate cancer.

Green tea contains substances known as polyphenols, which laboratory research has shown can suppress the growth of tumors and destroy prostate cancer cells that do not respond to hormones, generally considered an advanced form of the disease.

Previous research has also shown that green tea treats prostate cancer in mice, and that the disease is slightly less likely to appear among men who regularly consume green tea.

During the current study, published in the journal Cancer, Jatoi and her colleagues at the Mayo Clinic and the North Central Cancer Treatment Group asked 42 men with advanced disease to drink six concentrated doses of green tea every day. Jatoi estimated that this amount was roughly equivalent to between six and 12 daily glasses of store-bought green tea.

Each month, doctors checked patients' blood for levels of a protein called prostate specific antigen (PSA), which is over-produced by cancerous prostate cells. In general, a rise in PSA is considered an indication that prostate cancer is progressing, and not responding well to treatment.

During the study, only one patient had at least a 50% decrease in his blood levels of PSA, an improvement that only lasted two months. At the end of one month of treatment, half of the men included in this study had experienced an increase in their PSA levels of at least 43%.

Almost seven out of 10 men also reported side effects from the treatment, a number of which were potentially serious.

Jatoi explained in an interview that she did not believe that the disease worsened as a result of green tea, for all patients in the current study had advanced forms of prostate cancer, which, without effective treatment, can progress quickly in the body.

"I think what we were seeing was the natural history of the disease," Jatoi said.

Source: Cancer 2003;97:1442-1446.


Surgery or Medication Both Work Against Angina

By Jennifer Thomas
HealthScoutNews Reporter
Tuesday, March 4, 2003

TUESDAY, March 4 (HealthScoutNews) -- If you're elderly and suffering from angina (news - web sites), what's the best treatment?

Should you stick with medications, such as aspirin, beta blockers, ace inhibitors and nitrates?

Or should you look to an invasive procedure, such as coronary bypass surgery, for relief?

A new study by researchers in Switzerland found both strategies significantly improve quality of life and help prevent further heart problems, including fatal heart attacks.

However, both strategies have drawbacks and neither is clearly better than the other for treating angina, a recurring pain or discomfort in the chest that occurs when a part of your heart isn't getting enough blood.

"After one year, quality of life outcome and survival will be similar," the authors write.

The study appears in the March 5 issue of the Journal of the American Medical Association (news - web sites).

Previous research has shown younger angina patients do well when treated with an invasive procedure, according to the study. Invasive procedures include bypass surgery, in which a blood vessel is grafted onto a blocked artery to bypass the diseased section so blood can get to the heart muscle. Another procedure is called percutaneous coronary intervention, in which the blocked area is opened with a balloon or stent.

However, few studies have looked specifically at angina patients aged 75 and older, the authors write.

Doctors tend to avoid invasive procedures in the elderly because of fears that their advanced age could put them at higher risk of death, explains Dr. Stephen Siegel, a cardiologist at New York University Medical Center.

The Swiss researchers divided 282 angina patients, aged 75 to 91, into two groups: one group was treated with medications and the other had an invasive procedure.

The patients in the study had "class 2" or worse angina. Angina symptoms are rated on a scale of one to four, with four being the most severe, explains Dr. John Reilly, an interventional cardiologist at the Ochsner Clinic Foundation in New Orleans. Class 2 angina symptoms include a dull ache in the chest during physical exertion. People with class 4 angina have chest pain even during rest.

Participants were also asked to fill out a questionnaire about their quality of life, including the severity of their angina symptoms and whether the condition affected their ability to work or take part in social and family activities.

The study found that both those treated by medications alone and those who underwent an invasive procedure had an improved quality of life one year later.

However, each strategy had shortcomings.

After six months, the group that had the invasive procedure had a slightly higher death rate, about 8.5 percent compared to 4 percent for the group on medications. At one year, however, the death rate was nearly identical.

Members of the medication-only group had their own problems, including an increased likelihood that they'd be hospitalized for recurring angina symptoms.

Between six months and one year, about 49 percent of patients treated with medications alone had a "major adverse cardiac event," including death, nonfatal heart attack or hospitalization for angina symptoms, compared to only 19 percent of those who underwent an invasive procedure.

Most of those "cardiac events" in the medication-only group were due to people going into the hospital for an invasive procedure.

About 46 percent of patients treated with medications only eventually had an invasive treatment for angina, while only 10 percent of those who were treated with an invasive procedure needed an additional invasive treatment.

Cardiologists who treat angina are generally divided into two camps: those who favor "aggressive" invasive treatments, and those who favor a more conservative, "wait-and-see" approach.

Siegel, who describes himself as on the conservative side, says the Swiss study provides new evidence that older patients can be treated safely and successfully with invasive procedures.

"The most important thing I can distill out of this is, 'Gee, these people did damn good with surgery,'" he says. "This study is helpful in that it will give me some information that I can give to patients to reassure them that if they end up in invasive therapy, they are likely to do well."

Reilly, an expert in invasive angina treatments, says it's important to remember the two strategies aren't mutually exclusive. Angina patients treated with an invasive procedure should also be prescribed medicines to keep their angina at bay.

Both doctors say the bottom line is that each patient has to be evaluated individually. A patient's age, medical history and angina severity all have to be taken into consideration.

"Nothing replaces common sense and individualized treatment for each patient," Siegel says.

More information

To learn more about angina, check with the National Heart, Lung, and Blood Institute or the American Heart Association.


Proteins Weaken Tamoxifen's Breast Cancer Fight

By Merritt McKinney
Reuters Health
Tuesday, March 4, 2003

NEW YORK (Reuters Health) - Results of a new study may help explain why the breast cancer (news - web sites) drug tamoxifen is more effective in some women than in others.

Researchers in Texas have found that high levels of two proteins in breast tumors can reduce the drug's effectiveness. About 10% to 15% of women who have estrogen-sensitive breast cancer have high levels of both proteins, they said.

Doctors already routinely measure levels of one of the proteins, HER-2/neu, but measuring levels of the other one, AIB1, may turn out to be a useful way of identifying women with breast cancer who are less likely to benefit from tamoxifen, researchers report in Wednesday's issue of the Journal of the National Cancer Institute (news - web sites).

The findings also suggest that the AIB1 protein may be a useful target for new cancer drugs.

Tamoxifen, which has been shown to prevent and treat breast cancer that is sensitive to estrogen's effects, attaches to the same receptor as the hormone estrogen. About two-thirds of breast tumors have estrogen receptors and will grow in response to the female hormone.

In the breast, tamoxifen acts as an "anti-estrogen" to fight cancer. The cancer drug can prolong survival and prevent breast cancer from recurring, but some women on the drug do experience recurrences and the drug can lose its effectiveness.

Dr. C. Kent Osborne said some studies have suggested that breast tumors with high levels of HER-2 are somewhat resistant to tamoxifen, but the results have been mixed.

Separately, laboratory research hints that AIB1 (also known as SRC-3), which helps the estrogen receptor function, may influence the effectiveness of tamoxifen, said Osborne, who is at Baylor College of Medicine in Houston, Texas.

"What we did was to put those two together," Osborne said.

Osborne and his team studied breast tumors from 316 women, all of whom had estrogen-sensitive breast cancer.

Among women who had been treated with tamoxifen, those who had high levels of both proteins were less likely to survive and remain cancer free, the investigators report.

Measuring levels of AIB1 may identify women who may not benefit from tamoxifen, he said. And women who have high levels of AIB1 may actually do better without tamoxifen, he noted. Among women in the study who underwent cancer surgery but did not receive tamoxifen or another cancer drug, those with high levels of AIB1 were most likely to survive and to remain free from cancer.

Osborne cautioned that the results come from just one study and need to be confirmed before doctors start using AIB1 levels to guide treatment choices. If the association between high AIB1 levels and poor results with tamoxifen is confirmed, however, it may be possible to develop a new drug to treat tumors with high levels of both AIB1 and HER-2, Osborne said.

Within breast cancer cells, a "triumvirate" made up of the estrogen receptor, HER-2 and AIB1 appear to control the development of resistance to tamoxifen, according to Dr. V. Craig Jordan, of Northwestern University Medical School in Chicago, Illinois.

Even without knowing more about how the three work together, it may be possible to interrupt their activity--and improve the effectiveness of tamoxifen--with medications, Jordan suggests in an editorial that accompanies the study.

Source: Journal of the National Cancer Institute 2003;95:338-340,353-361.


Children With Immune Problems at Greater Bioterror Risk

By Gary Gately
HealthScoutNews Reporter
Tuesday, March 4, 2003

TUESDAY, March 4 (HealthScoutNews) -- Smallpox, anthrax, plague, botulism. The words spark considerable anxiety among Americans amid all the warnings about possible bioterrorism attacks.

For those with primary immunodeficiency (PI), a genetic immune system disorder that afflicts more children than leukemia and lymphoma combined, the potential danger looms much larger.

"Regardless of the agent we're talking about, these kids are more vulnerable," says Dr. Allan Lock, director of the developmental immunology program at the National Institute of Child Health and Human Development. "We're talking about an at-risk population."

PI afflicts at least 500,000 Americans, many of them children, but often goes undiagnosed or is diagnosed only after patients become extremely ill or chronically debilitated, sometimes with life-threatening conditions, experts say.

Proper diagnosis is all the more critical in the face of the threat of bioterrorism, according to experts who gathered in Washington, D.C., on March 3 for a conference titled "Primary Immune Deficiency Disorders: New Research and the Threat of Bioterrorism."

The conference, part of an ongoing effort to increase awareness of PI, featured physicians, immunologists, infectious disease specialists and bioterrorism experts.

"We thought it was very important in the context of world events to bring these people together," says Dr. Philip J. Landrigan, the conference director.

"My strong suspicion is most doctors haven't thought about this intersection of bioterrorism and immune deficiency," adds Landrigan, director of the Center for Children's Health and the Environment at Mount Sinai School of Medicine in New York City.

The conference addressed such key topics as ensuring that PI patients are diagnosed and don't receive live-virus vaccines such as the smallpox vaccine. (The smallpox vaccine has been given to health-care workers, but widespread public vaccinations have not begun.)

"The thing we've been concerned about is how many people out there who might not be aware that they have primary immunodeficiency and might go ahead and get the [smallpox] vaccine and could get very sick or even die from it," says Dr. Lisa Kobrynski, a pediatric immunologist at the Emory University School of Medicine in Atlanta.

PI patients also could be threatened by the live vaccine that was given to, say, family members or day-care workers. Patients could be infected by the pustules that form on people who have received the vaccination, Kobrynski adds.

The Immune Deficiency Foundation recommends that any smallpox vaccine programs include questionnaires at vaccination locations designed to identify undiagnosed PI patients and instructions to recently vaccinated people informing them of the potential for the virus to spread to others.

Kobrynski also says anthrax vaccines, which have been given to some military personnel, would not be effective in most PI patients because they don't produce antibodies.

PI patients' parents must exercise vigilance to shield their children from bioterrorism and take steps such as keeping them indoors in sealed rooms if an attack occurs, Landrigan says.

"Parents of children with immune deficiency disorders will need to keep those children under very close cover," he says. "Those children are really going to need very careful protection."

PI includes more than 70 conditions that can be traced to a genetically faulty immune system. Those conditions can range from chronic sinusitis to "Bubble Boy Disease," which leaves the immune system with little or no defenses against infections.

Each type of primary immunodeficiency has somewhat different characteristics and symptoms, depending on the parts of the immune defense system that are compromised. Some deficiencies are deadly; others are mild. But they all share a common trait, experts say: They may pave the way to multiple infections.

Most types of primary immunodeficiency can be diagnosed with a simple blood test, according to the National Institutes of Health (news - web sites).

A child should be tested for PI if two or more of these warning signs are evident: eight or more new ear infections within a year; two or more serious sinus infections within a year; two or more months on antibiotics with little effect; two or more cases of pneumonia within a year; failure of an infant to gain weight or grow normally; recurrent deep skin or organ abscesses; persistent thrush in the mouth or elsewhere on the skin after age 1; a need for intravenous antibiotics to clear infections; two or more deep-seated infections such as meningitis, cellulitis or sepsis; or a family history of immunodeficiency.

The sponsors of the Washington conference included the Center for Children's Health and the Environment of Mount Sinai School of Medicine and the Jeffrey Modell Foundation.

More information

For more on primary immunodeficiency, visit the National Institute of Child Health and Human Development or the National Primary Immunodeficiency Resource Center.


Group Blasts Dental Academy's Deal with Coca-Cola

By Amy Norton
Reuters Health
Tuesday, March 4, 2003

NEW YORK (Reuters Health) - A US interest group on Tuesday sharply criticized the American Academy of Pediatric Dentistry's new partnership with soft-drink giant Coca-Cola, saying the deal will make the dental group a "captive" of Coke.

The partnership, which the AAPD announced Monday, involves a $1-million research grant to the academy from Coca-Cola, the world's largest soft-drink manufacturer.

The deal quickly drew fire from the non-profit group Center for Science in the Public Interest (CSPI).

On Tuesday Washington-based CSPI issued a statement urging the AAPD to abandon its partnership with "a company whose products cause tooth decay, obesity and other health problems in children."

But AAPD President Dr. David K. Curtis described the Coke partnership as an "appropriate arms' length relationship."

He told Reuters Health that research money from Coca-Cola will go through the AAPD to independent, university researchers, and that Coke--like all other AAPD corporate sponsors--"will have no say-so" into the specifics of that research.

Coca-Cola will also help the AAPD "create public and educational programs, based on science, that promote improved dental health for children," according to the academy.

But the CSPI blasted the idea of Coke's involvement in any educational efforts aimed at children's oral health.

"It's hard to imagine a professional association of dentists choosing a more inappropriate partner to fund educational programs," CSPI Director Dr. Michael F. Jacobson said in the group's statement.

"Coke's idea of education is spending billions 'educating' kids to consume caffeine- and sugar-laden soda," he added.

And, the CSPI contends, no matter how Coca-Cola's money is used, the deal makes it "extremely unlikely" that the AAPD will take stands that aren't in the soda giant's interests--such as opposing soft-drink machines in schools.

But according to Curtis, it would be "impossible" for Coke to hold such sway over the academy.

"Our corporate sponsors have absolutely no say in our positions," he said.

This is not the first time the CSPI has taken aim at Coca-Cola. In 2001, it accused the company of using its marketing rights for the movie "Harry Potter (news - web sites) and the Sorcerer's Stone" to push junk food on kids.


Light Therapy Prevents Damage from Methanol Poisoning

By Serena Gordon
HealthScoutNews Reporter
Tuesday, March 4, 2003

TUESDAY, March 4 (HealthScoutNews) -- A simple light therapy can seemingly prevent blindness from methanol poisoning, a new study says.

Using a red light operating at near infrared levels, researchers from the Medical College of Wisconsin have shown that cell damage to the eyes from methanol poisoning can be prevented, at least in rats.

Results of the study appear in the March issue of the Proceedings of the National Academy of Sciences (news - web sites).

Methanol is a chemical used in antifreeze, windshield wiper fluid and other liquids. While methanol poisoning isn't a big problem in the United States -- probably happening about 5,000 times a year -- it can be serious. Poisonings typical occur among children who drink it accidentally, or adults trying to commit suicide, says study author Janis Eells, an associate professor of pharmacology at the Medical College of Wisconsin.

Without treatment, methanol poisoning can cause blindness, even death. It's difficult for doctors to diagnose because symptoms don't appear for several days after ingestion and they mimic other disorders. With prompt treatment -- say within a day -- most people recover without lingering effects, Eells says.

"Animals treated with LED (light emitting diode) light were protected, not 100 percent, but they did much better than the animals not treated with LED light," she says.

Because methanol poisoning is rare, Eells says the real benefit from this work may be in treating other diseases, like macular degeneration or glaucoma, that cause damage to the cells in the eyes similar to that done by methanol poisoning.

Methanol causes blindness by attacking the mitochondria in the retina and optic nerve and disrupting their ability to supply cells with power. Mitochondria provide cells with the energy they need to function. The LED light treatment works by stimulating the mitochondria, Eells explains.

In an earlier study, one of Eells' colleagues showed that LED light could boost energy production in cells by stimulating the mitochondria. Eells noticed the cells that were stimulated were the same ones that were damaged by methanol poisoning and thought LED light treatment might help prevent that damage.

To test her theory, Eells randomly assigned rats to one of four groups: a control group that got no methanol; LED-treated controls that also got no methanol; a group given methanol; and one given methanol that received LED treatment. The treated rats were all given brief treatment with the LED light once a day for three days. The treatments lasted for 2 minutes and 24 seconds, Eells says.

The researchers then tested the retinal function of the rats.

"The LED light had protected the rats. It appears to be preventing damage," says Eells, adding that subsequent studies have also shown the LED light can reverse damage that's already been done.

The researchers saw no adverse side effects from the LED treatment. Eells says she expects that results would be similar in humans because the changes that occur in rats with methanol poisoning are similar to the changes that happen in humans.

Other eye experts aren't convinced, however.

"This is a very preliminary study," says Dr. Robert Cykiert, an ophthalmologist at New York University Medical Center. "It's hard to say if it would mean anything to humans."

Cykiert says it would be great to have a way to treat methanol-induced blindness because there are no other treatments for it. He's also skeptical that a simple light therapy could have a meaningful effect on diseases such as macular degeneration or glaucoma.

More information

Visit the National Capital Poison Center for a list of common household poisons, including those that contain methanol. And check the center's tips on what to do if a poisoning has occurred.


Smokers Cut Baby's Risk by Stepping Outside Room

By Alison McCook
Reuters Health
Tuesday, March 4, 2003

NEW YORK (Reuters Health) - Infants of mothers who light up in the same room with them are more likely to be hospitalized with a respiratory infection during their first year of life than offspring of smoking mothers who took it outside, according to a new study.

These findings indicate that mothers who haven't been able to kick the habit should step out of the room in order to protect their children from the dangers of secondhand smoke, according to the Australian researchers.

"We found that the safest option for your infant is for you to stop smoking," study author Dr. Leigh Blizzard of the University of Tasmania in Australia told Reuters Health.

"If you cannot stop, you can at least reduce the harm to your infant by never smoking in the same room as the child," Blizzard added. "It is particularly important for you not to smoke when you are holding or feeding the infant, or at other times that you are very close to the child."

Experts have long known that exposure to secondhand smoke puts infants at risk of a number of respiratory health problems, including pneumonia, impaired lung function and asthma.

Previous reports have also suggested that the distance between a baby and cigarette smoke can matter, showing that babies whose parents smoke in another room have lower urine levels of cotinine, a nicotine byproduct.

In order to test the effect of nearness of cigarette smoke on infants' symptoms, Blizzard and colleagues followed 4,486 newborns until they reached 12 months of age.

During the infants' first weeks of life, the researchers interviewed their mothers about their smoking habits, both while pregnant and after childbirth. Blizzard and colleagues then tracked hospital records to determine how many infants were hospitalized as a result of respiratory infections.

During their first 12 months of life, approximately 8% of the infants included in the study were hospitalized for a respiratory infection, such as pneumonia, bronchitis or a case of the flu accompanied by breathing problems.

The authors discovered that babies born to mothers who smoked in close proximity to them were at higher risk of these and other respiratory infections.

Specifically, babies whose mothers smoked in the same room were 56% more likely to be hospitalized than babies whose mothers took their habit into another room.

Holding infants or feeding them while smoking increased their chances of hospitalization from respiratory infections by 73% and 95%, respectively, Blizzard and colleagues report in the American Journal of Public Health.

Babies whose mothers smoked close to them remained at higher risk of respiratory infections even when the authors removed the influence of smoking during pregnancy.

Among mothers who smoked while caring for their infants, the majority--almost 72%-- said they did so either sometimes or usually in the same room as their babies.

In an interview, Blizzard noted that even mothers who are able to take their habit into another room may be putting their infants at risk of health effects from secondhand smoke, for infants of smoking mothers who puffed in another room still had an increased risk of breathing problems.

Source: American Journal of Public Health 2003;93:482-488.


Splitting Pills

Tuesday, March 4, 2003

(HealthScoutNews) -- Are you in the habit of splitting pills to get the correct dosage?

According to the Mayo Clinic, you need to make sure your medication is as effective when halved.

Here's how:

  • Ask your pharmacist how the pill is absorbed. If it's an extended-release or coated tablet, it may not do its job when split, or it could be dangerous.
  • Ask your pharmacist about the pill shape and design. Not all medications are scored for easy splitting. Also, the active ingredient may not be spread evenly throughout the pill, so you may not get an accurate dose with half a pill.
  • Use a pill splitter, not a knife, to halve a pill.


Inhaled Gas May Ease Youngsters' Sickle Cell Pain

By Merritt McKinney
Reuters Health
Tuesday, March 4, 2003

NEW YORK (Reuters Health) - Children with the inherited condition sickle cell disease may benefit from treatment with nitric oxide, a naturally-occurring body chemical that can be inhaled in a gas.

The results of a small, preliminary study released on Tuesday suggests that the gas, which widens blood vessels, may curb pain during excruciating flare-ups of the condition known as sickle cells crises.

"We are really very encouraged" by the results of the study, lead researcher Dr. Debra L. Weiner told Reuters Health in an interview.

Although Weiner stressed that the findings need to be confirmed in larger trials, she said that nitric oxide may turn out to be "a long overdue breakthrough" for the treatment of sickle cell disease.

Sickle cell disease is an inherited condition that causes red blood cells to take on a curved "sickle" shape, which makes it difficult for the cells to pass through the bloodstream to deliver oxygen to the body's tissues.

When symptoms of the disease worsen in an episode called a crisis, blood vessels narrow and patients may experience more severe anemia, pain, fever and shortness of breath. The illness is most common in people of African descent as well as people of Mediterranean, Indian and Middle Eastern heritage.

Currently there is no therapy approved specifically to treat sickle cell crises, according to Weiner, who is at Children's Hospital Boston in Massachusetts. The current approach, which usually includes giving fluids and pain medication, only treats symptoms, not the disease itself, she explained.

Recent studies have shown that people with sickle cell disease have low levels of nitric oxide, which promotes blood vessel widening. In a handful of cases, treatment with nitric oxide has been shown to relieve a sickle cell complication called acute chest syndrome, a painful lung condition that makes breathing difficult. Weiner's team set out to see whether the chemical would also help children during sickle cell crises.

In the study, 20 people ages 10 to 21 were randomly assigned to breathe in nitric oxide or normal air through a face mask for four hours during a crisis in addition to standard treatment. Neither doctors nor patients knew which patients were receiving nitric oxide.

Participants in the nitric oxide group reported a greater decrease in pain at each hour than those in the placebo group, although this difference was statistically significant only when pain was considered over the entire four-hour treatment period.

In another sign that nitric oxide relieved pain, children who inhaled the chemical needed less morphine to control their pain. Children in the nitric oxide group also tended to spend less time in the hospital, although this difference was not quite statistically significant.

None of the participants experienced any side effects from the treatment.

A report on the findings is published in the March 5th issue of the Journal of the American Medical Association (news - web sites).

Weiner and her colleagues stress that the study is preliminary and needs to be confirmed in larger trials. Still, the study results are encouraging, Weiner said.

"The disease is devastating," Weiner said. Treatment for sickle cell crises "has been a long time coming."

Weiner said she hopes to begin another nitric oxide trial, and she expects that other researchers will also study its effects in treating sickle cell crises.

Inhaled nitric oxide is already used to treat some medical conditions, including respiratory failure and high pressure in the lungs.

Pulmonox Medical Corporation donated the nitric oxide used in the study, but none of the researchers has a financial interest in the company.

Source: Journal of the American Medical Association 2003;289:1136-1142.


Adventure Travel

Tuesday, March 4, 2003

(HealthScoutNews) -- Adventure travel is big business. Many people are forgoing time at the beach for a week of hiking, rafting, or wilderness camping.

But before you head out, you need to know how to handle common outback emergencies, advises the American College of Emergency Physicians (news - web sites).

Here are some safety tips:

  • Check in advance for potential hazards. Avoid areas rife with natural dangers such as avalanche, rock fall, floods, and hazardous plants and animals.
  • Take a first-aid course before your trip.
  • Learn to recognize and respond to medical emergencies. If you're faced with a serious head, spine, chest or abdominal injury, send for help immediately.
  • Pack a survival kit that includes a medical kit, map, compass, flashlight, knife, waterproof firestarter, personal shelter, whistle, warm clothing, high energy food, water, sun and insect protection.



Timing of Hormone Therapy Could Be Crucial

By Kathleen Doheny
HealthScoutNews Reporter


Monday, March 3, 2003

MONDAY, March 3 (HealthScoutNews) -- The timing of hormone therapy may be the key to whether it can slow down heart disease.

That's the conclusion of researchers who reviewed numerous studies on the cardiovascular effects of hormone replacement therapy (HRT).

If begun during menopause, when the cardiovascular system is still relatively healthy, HRT may be beneficial, the researchers conclude in the new issue of Menopausal Medicine.

"One of the really important messages for people to hear about is, we do not yet have the definitive answer of how HRT affects cardiovascular disease in women," says Dr. Richard H. Karas, co-author of the review and director of the preventive cardiology center at Tufts-New England Medical Center in Boston.

Last year, traditional thinking about HRT -- that it could protect a woman from heart disease and other ailments associated with aging -- was dramatically altered when the Women's Health Initiative (WHI), a large-scale study, was halted early. The reason: it found that women on HRT had more cardiovascular and other health problems than those on a placebo.

And an earlier study, the Heart and Estrogen/progestin Replacement Study (HERS), which looked at hormone therapy's effects in women with heart disease, found an increased risk of cardiovascular problems with the first year of treatment, no affect after 4.1 years of follow-up, and then a trend toward benefits in the fourth and fifth years.

However, other previous studies had found benefits.

One of the largest, the Nurses' Health Study, looked at more than 120,00 women aged 30 to 55 and found the users of HRT were at less risk for cardiovascular problems than those who never took it.

Why the discrepancy?

"We focused on the hypothesis that one of the possible explanations for the differences in the studies is that the more recent studies looked at HRT in elderly or older women, whereas the earlier studies looked at the effects of HRT in younger women," Karas says. "And there may be important differences in those two groups of women."

The crucial issue may be the time at which the therapy begins, say Karas and his co-author, Thomas B. Clarkson, a professor of comparative medicine at Wake Forest University Baptist Medical Center who evaluated numerous human and monkey studies.

In the HERS study, the average age of the participants was 67 and menopause had occurred 18 years before, the authors note in their review. In the WHI, the women averaged 63 years of age, and many were in their 70s before getting hormone therapy for the first time.

In Clarkson's own research on monkeys, hormone therapy begun at the time of menopause inhibited fatty buildup in cardiac arteries by 70 percent. When delayed for a time comparable to six years in women, there was no benefit on the monkey arteries.

Hormone therapy may work best, they conclude, on healthy cardiovascular systems. If begun too late, it may not only not help, but harm.

"Maybe HRT only works if you start when you have healthy tissues," Karas speculates.

Another expert, Dr. Leon Speroff, director of the Women's Health Research Unit at Oregon Health & Science University in Portland, praises the new review as an excellent critical look at the medical literature, especially the WHI.

"Too many organizations have taken a non-critical look at it," he says. "And there are a lot of reasons to criticize it."

The timing of hormone therapy studied in the WHI doesn't mirror clinical practice, he adds, since most women go on hormones when hot flashes and other symptoms of menopause begin.

"It takes healthy tissue to respond to estrogen," Speroff says. "This is true for the cardiovascular system and the brain. The evidence is pretty conclusive over the last 10 years that women with coronary artery disease should not be treated with estrogen in the expectation that it will reduce the risk of another cardiovascular event."

"Whether hormone therapy early in the postmenopausal years will prevent primary coronary heart disease has not been disproven," he adds.

What should women do?

"Talk to your doctor," Karas says. By assessing risks for heart disease and other diseases, you and your doctor should be able to come to a comfortable decision about hormone therapy.

Such discussions should take place annually, Speroff says.

More information

To see frequently asked questions about hormone therapy, visit the American College of Obstetricians and Gynecologists. For a discussion of the benefits and risks of HRT, see The National Women's Health Information Center.


Doctors Seek to Raise Awareness of Clots

By Lauran Neergaard
AP Medical Writer
The Associated Press
Monday, March 3, 2003

WASHINGTON - If you're lying in a hospital bed, chances are doctors didn't check you for a silent killer — one that causes some 60,000 potentially preventable deaths a year.

It's called "deep vein thrombosis," when a dangerous blood clot forms deep in the leg muscles. The clot sometimes floats into the lungs, causing sudden death.

Such clots made headlines a few years ago when seemingly healthy people collapsed after long airplane flights. Take an overseas flight today and you'll probably see a video advising walking around or at least wiggling your legs frequently to keep clots at bay.

While that's good advice, it provides a skewed vision of the clots: Most actually occur when people are hospitalized for surgery, trauma or some other reason. Worse, although simple steps can prevent blood clots in hospitalized patients, troubling new research suggests too many physicians either don't know to check for the risk or they forget.

Now a group of doctors and federal health officials are trying to raise public awareness of DVT, so more physicians will check for it — and so people at risk can take steps to protect themselves, whether they're entering the hospital or taking a long trip.

"There are so many preventable deaths," laments Dr. Samuel Goldhaber of Harvard Medical School (news - web sites). "It's become a crisis."

Goldhaber is conducting the largest study ever done on who gets DVT and why, using a registry of 5,000 DVT patients from 180 hospitals. Findings so far are "quite shocking," he said: More than half of people who developed DVT while hospitalized for other reasons never got the clot-preventing care that doctors should have administered.

There aren't precise counts, but officials estimate up to 2 million Americans suffer DVT each year. In as many as 600,000, the clot moves to the lungs, called a pulmonary embolism. Anywhere from 60,000 to 100,000 of them die. Survivors often must take the blood-thinning drug warfarin for years to prevent recurrence.

Veins have a hard job fighting gravity as they push blood from the legs back up toward the heart. Illness, injury or prolonged inactivity can inhibit that action, allowing blood to temporarily pool where clots can form.

Risk factors include:

  • Hospitalization for a serious illness or surgery.
  • Other immobility, such as paralysis or long-distance travel, by plane, train or car.
  • Obesity.
  • Excess estrogen during pregnancy or from birth control pills or hormone therapy.
  • Smoking.
  • An inherited tendency for sticky, clot-prone blood.
  • Being over age 40.
  • Chronic diseases such as high blood pressure, heart disease or cancer.

But it can strike anybody, warns Miranda Fowler of Clarendon, N.C., who got a DVT at age 22 while competing in the Miss North Carolina pageant. It felt like an excruciating leg cramp, leaving her unable to stand after a long car trip. Paramedics dismissed her complaint; fortunately, a friend called a doctor who sent her to the emergency room.

Fowler unknowingly had three DVT risks: Her grandmother had developed blood clots, and she'd inherited the tendency. Her doctor didn't ask about that family history before prescribing birth control pills. The final straw was sitting motionless in a car for hours.

But patients don't always experience leg pain to know they have a DVT. And if the clot heads for the lungs — symptoms then range from a general sense of anxiety to shortness of breath or passing out — it can be too late. For 20 percent of patients, sudden death is the first symptom, says Dr. John Heit of the Mayo Clinic.

Hence the new focus on preventing clots.

The Centers for Disease Control and Prevention (news - web sites) and the American Public Health Association (news - web sites) brought DVT experts together last week to debate how. They called for hospitals to screen all patients for DVT risk factors and do better preventive care — injections of a blood-thinning drug called "low molecular weight heparin" that cuts clots by two-thirds, and compression stockings to help leg veins pump for those who can't take the drug.

People can protect themselves, too. Goldhaber's advice:

  • Learn the risk factors, and know if you have a family history of blood clots.
  • Ask a doctor about preventive care before any surgery or hospitalization, or during pregnancy.
  • Move around when traveling. If you're at high risk, ask a doctor about wearing compression stockings or getting a blood-thinning injection for super-long travel.
  • Seek immediate care if you have any symptoms of a clot.

On the Net:

American Heart Association (news - web sites) information:

Editor’s Note: Lauran Neergaard covers health and medical issues for The Associated Press in Washington.


A Touchy Subject

Monday, March 3, 2003

MONDAY, March 3 (HealthScoutNews) -- Most men aren't taught how to do testicular self-exams and they also don't bother performing them.

So says an American study in the March issue of Pediatrics.

The electronic survey of 129 pediatric or pediatric/internal medicine residents at two teaching programs found that only 29 percent of the male residents performed monthly testicular self-exams, which take only about a minute to complete.

The survey also found that only 40 percent of the residents taught the testicular self-exam to their 12- to 21-year-old patients.

The most common reason offered by male residents for not doing testicular self-exams on themselves was that they simply forgot. Lack of time and not thinking about it were the reasons they cited for not teaching the self-exam to their patients.

While 41 percent of the residents said they'd been instructed on how to teach testicular self-exam, 88 percent said they'd received instruction on how to teach breast self-exam to patients.

Testicular cancer cases have increased 42 percent in the past 25 years. They accounts for 20 percent of the cancers diagnosed in males aged 15 to 35. That makes it the most common cancer in that age group.

Along with the target age group, risk factors for testicular cancer include being white, family history and an undescended testes. Monthly self-exams are recommended for men with one or more of the risk factors.

Testicular cancer has a 5-year survival rate of 96 percent. As with all cancers, late detection significantly lowers the chances of survival.

More information

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


Vitamins May Help Prevent Infections in Diabetics

By Merritt McKinney
Reuters Health
Monday, March 3, 2003

NEW YORK (Reuters Health) - People with diabetes may be able to ward off colds and other minor infections by taking a daily multivitamin, according to a study released Monday.

Taking a vitamin and mineral supplement did not prevent infections in people without diabetes, but the study's lead author did not rule out that some people without diabetes might see a drop in infections if they take a supplement.

"If the benefit seen in diabetics (news - web sites) is due to the fact that their nutrition was more marginal, then any population at risk of having marginally inadequate nutrition, such as the elderly in general, might also benefit," Dr. Thomas A. Barringer, of Carolinas Medical Center in Charlotte, North Carolina, told Reuters Health.

Noting that most of the people in the study were overweight or obese, Barringer said that "if obesity was a factor in why they benefited, then all obese people might benefit."

Forty percent of US adults take some sort of vitamin or mineral supplement on a regular basis, but there is little scientific evidence showing that supplements actually boost health.

But some research does suggest that a multivitamin enhances immune function, Barringer noted. The elderly and people with diabetes often do not consume adequate amounts of nutrients and they also have a slightly higher risk of infection, so Barringer's team studied whether a vitamin and mineral supplement would prevent minor infections.

A multivitamin did seem to ward off infections, at least in people with diabetes, the researchers report in the March 4th issue of the journal Annals of Internal Medicine. All the diabetic patients had type 2 diabetes, the most common form of the disease.

Only 17% of diabetics taking a multivitamin reported having an infection, such as an upper respiratory infection, the flu or a gastrointestinal infection, compared with 93% of diabetics who were taking a dummy pill. In addition, 89% of people with diabetes who took a placebo pill reported missing at least one day of work during the one-year study compared with none of the diabetics taking a multivitamin.

The reduction in infections was found almost exclusively in people with diabetes, according to the report. Participants with diabetes were more likely to be deficient in at least one vitamin or mineral at the start of the study, which could explain the beneficial effect of a multivitamin, Barringer's team points out. The researchers are uncertain, however, whether these small differences fully explain the effect.

The study included 130 adults ages 45 and older. Roughly two out of three participants were overweight or obese and about 30% had type 2 diabetes. Although the researchers originally wanted to measure the effect of multivitamins in the elderly, too few older people enrolled in the study for them to make a conclusion. Only 33 patients were over 65.

Since most participants in the study were overweight, Barringer said it is uncertain whether people who are overweight but who do not have diabetes, or who only have diabetes but are not overweight would also benefit.

Even though Barringer cautioned that the study is not the final word on the effect of multivitamins on the immune system, he pointed out that supplements are safe and relatively inexpensive, so taking a daily multivitamin is "a reasonable option" for people who are overweight, who have any type of diabetes, who may not receive adequate nutrition or whose immune system is weak.

The study represents a step toward understanding the effects of supplements, but it has several limitations, including its small size, according to Drs. Wafaie Fawzi and Meir J. Stampfer at Harvard School of Public Health in Boston, Massachusetts.

They note that two out of three similar studies found no beneficial effect of a multivitamin when it came to preventing infections. However, those two studies were conducted in people who already had an adequate intake of nutrients before taking the supplement.

"The potential impact of supplements merits further rigorous study, especially among diabetic persons and other vulnerable populations," they conclude in an editorial that accompanies the study.

The study was funded by an independent, charitable organization known as the Charlotte-Mecklenburg Health Services Foundation.

Source: Annals of Internal Medicine 2003;138:365-371,430-431.


Study Examines Sugar in the Diet

By Emma Ross
AP Medical Writer
The Associated Press
Monday, March 3, 2003

LONDON - People should get no more than 10 percent of their calories from sugar, experts say in a major new report Monday on how to stem the global epidemic of obesity-linked diseases.

The study is the most significant in more than a decade on what the world should be doing about its diet. Although concerns about sugar intake are not new, very few experts have recommended a specific limit.

The food industry immediately decried the document, insisting more exercise is the key to ending obesity.

The report was commissioned by two U.N. agencies, the World Health Organization (news - web sites) and the Food and Agriculture Organization (news - web sites), and compiled by a panel of 30 international experts.

The experts say heart disease, diabetes and other diseases that can be caused by poor diet and lack of exercise are no longer just the preserve of the Western world.

The report underlines what doctors have been saying for years — that along with regular exercise, a diet low in fatty, sugary and salty food is key to staying healthy.

The experts recommend one hour of daily exercise, double the amount recommended by the U.S. government but the same as that endorsed by other establishments.

And their recommendations on how much fat, grains, protein, salt and fruits and vegetables people should eat also were in line with prevailing opinion.

But when it came to sugar, their advice was some of the boldest yet.

The experts said people should restrict their consumption of added sugar — including sugar from honey, syrups and fruit juices — to below 10 percent of calories.

In the United States, which leads the world in obesity, the government's Dietary Guidelines for Americans advise only that sugar should be used in moderation. The Institute of Medicine (news - web sites), part of the U.S. National Academy of Sciences (news - web sites), recommended in September that sugar could make up to 25 percent of calories.

"There are very few international recommendations on sugar. There are countries that are trying to develop recommendations on sugar, but every time they introduce them, the pressure from industry-led groups is very high," said Derek Yach, chief of non-communicable diseases at the World Health Organization.

Philip James, chairman of the International Obesity Task Force and one of the scientists on the panel, said the report presents the food industry with one of its biggest challenges.

"Despite all the attempts so far to increase the provision of healthier choices over the last 10 or more years, obesity rates have accelerated," he said. "The food industry must now sit down with WHO and others to work out how to seriously address this issue and become part of the solution rather than remaining part of the problem."

Rapid changes in diets and lifestyles resulting from industrialization, urbanization, economic development and global food trade have accelerated during the last decade, the report said.

That has meant improved standards of living in poorer countries, but also has led to inappropriate shifts in eating and exercise patterns and a corresponding increase in diet-related chronic diseases, the experts found.

Scientists predict that heart disease will be the leading cause of death in developing countries by the end of the decade. Obesity rates are also increasing more rapidly in developing countries than in rich nations, and two-thirds of the people with type 2 diabetes — the type related to bad eating and exercise habits — live in the developing world.

The U.S. National Soft Drink Association said that a 10 percent limit on sugar should not be part of the plan.

"A thorough review of scientific literature on the subject of obesity shows there is no association between sugar consumption and obesity," said Richard Adamson, the association's vice president of scientific and technical affairs.

"Study after study shows that restricting foods or food ingredients won't work. In fact, it can create a 'forbidden fruit syndrome' that causes individuals to gain weight," Adamson said. "Together, we need to educate people about consuming all foods and beverages in moderation and getting more active."

The Grocery Manufacturers of America, the world's largest association of food, beverage and consumer product companies, also objected to the targeting of sugar. It maintained that all foods can be part of a healthy diet when eaten in moderation and combined with the right amount of physical activity.

Starting next week, WHO officials will be meeting health authorities from around the world to discuss how governments plan to respond to the recommendations. A similar meeting is planned with food industry officials in May.

On the Net:

World Health Organization:


Losing Weight-Or Even Just Trying-Boosts Survival

By Merritt McKinney
Reuters Health
Monday, March 3, 2003

NEW YORK (Reuters Health) - Overweight and obese people who try to lose weight may live longer than people who do not try to shed excess pounds, according to a new study, which also found that people who tried but failed to trim down were less likely to die than those who made no attempt.

It may seem like a no-brainer that people who are carrying around extra pounds can prolong their lives by slimming down, but the scientific evidence is not so straightforward, according to the lead author of the study.

"There is a widespread assumption that weight loss is good," Dr. Edward W. Gregg told Reuters Health in an interview. Weight loss is proven to have beneficial effects on several risk factors for disease, including high blood pressure, cholesterol levels and blood sugar, explained Gregg, who is at the Centers for Disease Control and Prevention (news - web sites) in Atlanta, Georgia.

But the evidence linking weight loss to these improvements comes from relatively short-term studies, Gregg said. There is not really any very convincing evidence that losing weight decreases the risk of dying, according to Gregg.

In fact, the CDC researcher pointed out that a large number of studies have suggested that people who lose weight may actually be at greater risk of premature death.

The problem with most of these studies, Gregg said, is that they did not separate intentional weight loss from weight loss that occurred because of disease.

"We were able to move a little bit beyond that data," Gregg said.

In a study of more than 6,000 obese and overweight people 35 and older who were followed for up to nine years, the death rate was 24% lower in people who lost weight intentionally than in people who did not try to shed pounds and whose weight stayed steady. But the death rate was 31% higher in people who lost weight unintentionally, the researchers report in the March 4th issue of the journal Annals of Internal Medicine.

For people who were trying to trim down, those who actually lost weight had the lowest death rate. In a somewhat surprising finding, however, even people who were trying to lose weight but did not succeed had a lower death rate.

"How to interpret that finding is a little tricky," Gregg said in the interview.

People who are trying to lose weight may take steps to make their lifestyle healthier, such as increasing physical activity and eating a better diet, Gregg said. These lifestyle changes may be beneficial even if they do not lead to weight loss, he said. Gregg added that people who are trying to lose weight may be getting better medical care.

More research is needed to determine why people who try but do not succeed to lose weight live longer, Gregg said. Until that question is answered, the CDC scientist encouraged people "to talk to your doctor about whether you are at an ideal weight."

For people who are overweight or obese, Gregg recommended gradual weight loss by making healthy lifestyle changes in moderation. Besides exercising more and eating less, other healthful steps include eating more fruits and vegetables and adding more fiber to the diet, Gregg said.

Source: Annals of Internal Medicine 2003;138:383-389.


Knapweed May Be Key to Natural Herbicide

By Katherine Vogt
Associated Press Writer
The Associated Press
Monday, March 3, 2003

DENVER - An invasive weed that has taken over vast swaths of grazing land in the West may hold the key to creating an effective, natural herbicide.

A Colorado State University study found that a chemical compound secreted from the roots of spotted knapweed is toxic to surrounding plants and has potential to wipe out other unwanted weeds.

"This is a herbicide that is as potent as a commercial chemical but it comes from a natural plant," said study author Jorge Vivanco, an assistant professor of horticulture biotechnology at CSU. "It's considered an environmentally friendly herbicide."

Vivanco's research — and a separate study at the University of Colorado in which bugs stopped the spread of diffuse knapweed — are among the latest efforts to find natural ways of controlling invasive plants that have bedeviled farmers and ranchers for centuries.

Eric Lane, who carries the unlikely title of "state weed coordinator," says there is a growing emphasis on nonchemical ways to fend off weeds. He called the knapweed study exciting because it would encourage others to try similar efforts.

At least three knapweed species are found in Colorado, and forms of the invasive weed have taken over millions of acres in the West. The plant is capable of wiping out all other surrounding plants, effectively ruining grazing lands. Because they are not native to Colorado, they have few predators.

Originally from eastern Europe and western Asia, the most common knapweed species in the West are believed to have arrived in the late 1800s in contaminated crop seed or possibly discarded soil from ships.

Common forms feature tiny white or purple flowers on spindly, leafed green stalks.

Two years ago, Vivanco read about a knapweed species that invades and colonizes by secreting a toxic compound into the soil through its roots.

His team tried to become the first to isolate the chemical from spotted knapweed — a feat complicated by the complex jumble of contaminants, microbes and chemicals found in soil.

The team grew spotted knapweed plants in flasks in the lab. The roots were submerged in a water-based solution while the plant floated on top.

The plants secreted the toxic chemical compound into the liquid, making it easier for the researchers to isolate each compound in it.

They found nearly 30 compounds, including two forms of catechin. One type had antibacterial properties and the other had a toxic effect on other plants.

The researchers found that spraying toxic catechin on plants or adding it to soil was as effective against some weeds as common synthetic herbicides, typically killing the plants within a week.

Vivanco said no one previously knew about catechin's toxic effect on plants.

His findings were published in last year in the journal Plant Physiology.

Because there is no evidence that catechin is toxic to humans or animals, Vivanco hopes it will eventually be fast-tracked for approval by the Environmental Protection Agency.

CSU has licensed the catechin technology patent to a company, and Vivanco hopes to see it on the market in two or three years.

Ragan Callaway, an associate professor of biology at the University of Montana and a plant ecologist who specializes in invasive weeds, said Vivanco's research is exciting but should be carefully studied.

"Just because it's produced organically doesn't mean it won't kill you. On the other hand, I think that because Jorge is trying to use natural processes to control how plants interact with each other is fantastic," Callaway said.

Vivanco said the discovery has several potential applications as a herbicide. In reduced concentrations the chemical only kills select plants while sparing others. That could allow farmers to protect a crop while killing a weed. Or it could be used as a preventive agent by mixing it with soil before weeds emerge.

On the Net:

Vivanco lab:

Colorado Agriculture Department:


Partners Play Key Role in Breast Surgery Aftermath

By Jacqueline Stenson
Reuters Health
Monday, March 3, 2003

LOS ANGELES (Reuters Health) - How a husband reacts to his wife's breast cancer (news - web sites) scars can have a big impact on her sense of femininity and the overall health of the couple's relationship, a new study finds.

The less breast cancer patients felt their partners were bothered by their surgical scars, the more likely they were to report feeling feminine and attractive, results showed.

And the higher women rated the quality of their first sexual experience after surgery, the greater their feelings of femininity and attractiveness, the less emotional distress they experienced and the more satisfied they were with their relationship.

The study, presented here at a recent meeting of the Society for Personality and Social Psychology, involved 240 women with breast cancer who had undergone either mastectomies to remove an entire breast or lumpectomies to remove part of a breast. All were married or in a long-term relationship. They were followed for up to a year after their surgeries.

Overall, the more the women saw their partners as affectionate and emotionally involved after the surgery, the more satisfied they were with the relationship.

"The findings indicate that having the perception that her partner is emotionally invested and involved in the relationship relates to the woman having less distress, stronger feelings of femininity and desirability and greater marital satisfaction," said study author Dr. Charles Carver, a professor of psychology at the University of Miami in Florida.

"The same pattern also derives from the perception that her partner has sexual interest in her, in the form of initiating sex, and in the actual frequency of sex," he told Reuters Health.

Carver said partners of breast cancer patients need to take a proactive role in making sure the relationship is on track after the surgery, which can be a very trying time.

"It is important for the man to actively convey the fact that he is emotionally involved in the relationship and his wife," he said. "He should not take for granted that she knows that, but do small things repeatedly that convey that message to her. Her perceptions are what matter here, and he needs to provide a good basis for those perceptions."


Study Warns of Preemies' Sleep Positions

By Lindsey Tanner
AP Medical Writer
The Associated Press
Monday, March 3, 2003

CHICAGO - Stomach-sleeping is more common among babies born extremely prematurely, even though they face a much higher risk of sudden infant death syndrome than larger babies, a study suggests.

The American Academy of Pediatrics recommends that infants sleep on their backs to reduce the risk of SIDS and was involved in a 1990s "Back-to-Sleep" campaign that helped reduce the nationwide SIDS rate by more than 40 percent.

While stomach sleeping decreased during that time, SIDS still kills nearly 3,000 infants each year — and premature babies face a disproportionate risk.

Some parents and doctors may mistakenly believe "that the `back to sleep' message perhaps doesn't apply to low-birthweight or preterm infants," said the lead researcher, Dr. Louis Vernacchio of Boston University.

The study found that stomach-sleeping among very small premature babies has declined. Still, in 1998, 17.5 percent of mothers reported putting very small preemies to sleep on their stomachs one month after leaving the hospital, compared with 12.8 percent of mothers of the largest babies studied.

Rates of stomach sleeping increased at three months, which is also when rates of SIDS peak.

The study appears in the March edition of Pediatrics, published Monday. Doctors from the National Institutes of Health also were involved in the report.

The researchers surveyed mothers of 907 low-birthweight babies in Massachusetts and Ohio from 1995 to 1998. Vernacchio said similar results likely would be found nationwide. Babies' birth weights ranged from less than 3.4 pounds to about 5 1/2 pounds.

The overall rate of infant stomach-sleeping reported by mothers dropped from 20 percent to 11.4 percent during the study. Among the smallest babies, it dropped from 34 percent to 17.5 percent.

Parents who placed very small premature infants on their stomachs often said that their babies and their doctors seemed to prefer that sleep position, the study found.

Vernacchio said the risks of SIDS outweigh any medical problem that might prompt a doctor to recommend stomach-sleeping for premature babies.

University of Virginia pediatrician Dr. John Kattwinkel said many doctors who care for very small premature babies prefer stomach-sleeping while infants are in the intensive care unit, where they are constantly monitored. Such infants often have lung problems, and doctors think they can breathe easier on their stomachs, Kattwinkel said.

Doctors should — but often don't — switch premature babies to back-sleeping toward the end of their hospital stays, said Kattwinkel, who chairs an American Academy of Pediatrics task force on SIDS.

Parents who see their hospitalized babies sleeping on their stomachs may assume that's the correct position at home, Kattwinkel said.

On the Net:



Analysis Shows More Study Needed for Homeopathy

By Alison McCook
Reuters Health
Monday, March 3, 2003

NEW YORK (Reuters Health) - A review of the scientific literature reveals that the jury is still out regarding the benefits of the alternative medicine homeopathy, researchers said Monday.

Developed by a German scientist at the end of the 18th century, homeopathy is a practice that uses extremely dilute drug solutions--some so dilute they contain few or no molecules of the original drug--to stimulate or provoke the body's immune system to defend itself.

Future studies of homeopathy need "open minded, but also skeptical" investigators at the helm, said Dr. Wayne B. Jonas of the Samueli Institute in Alexandria, Virginia, a nonprofit medical research organization founded in 2001. A lack of evidence does not necessarily represent a lack of effect, he told Reuters Health.

Jonas and his colleagues recommend that patients opt for therapies that have more convincing data on their side.

Homeopathy, if practiced correctly, is likely safe, Jonas said. But the dangers of the use of this technique come if patients choose homeopathy over other treatments that research has shown may work better, he added.

Simple coughs and colds, which could clear up on their own, are fine to treat using homeopathy, Jonas noted; but for more serious conditions, he suggested patients consult their physicians to make sure they don't ignore other options before trying homeopathy.

Homeopathy makes sense for patients "only if they've exhausted known, effective cures, and they're not ignoring those cures," Jonas said.

Jonas and his colleagues Dr. Ted Kaptchuk of Harvard Medical School (news - web sites) in Boston, Massachusetts and Dr. Klaus Linde of Technische Universitat in Munchen, Germany base their conclusions on a review of previous studies that have themselves attempted to review the existing data on the effectiveness of homeopathy.

While some well-designed studies suggest the practice may be better than a placebo at helping certain ills, "there's just not enough information, enough research in any one area" to declare homeopathy works, Jonas noted.

Other studies suggest the practice holds no benefit for patients with migraines, muscle soreness, and those who wish to prevent the flu, the authors note in the Annals of Internal Medicine.

The amount of research is only a "spit in the bucket" of what is needed to truly understand homeopathy, Jonas added.

Jonas said that studies of homeopathy may have produced mixed results because of biases the researchers brought to their studies. Many investigators have likely set out to either prove or disprove the benefits of the practice, he noted, and may have discarded any work that did not fit their theory.

Source: Annals of Internal Medicine 2003;138:393-399.


Folic Acid

Monday, March 3, 2003

(HealthScoutNews) -- If you're pregnant or thinking of getting pregnant, you should take at least 600 micrograms of folic acid per day, advises Duke University Medical Center.

Folic acid helps prevent neural tube birth defects, such as spinal bifida. While you may get enough folic acid through the foods you eat, you should ask your doctor about taking vitamins as extra nutritional insurance for you and your baby.


Exposure to Violence Linked to Teen Drug Use

Reuters Health
Monday, March 3, 2003

NEW YORK (Reuters Health) - Among 14- to 17-year-olds living in three countries, those who experience more violence in their communities are also more likely to smoke, drink alcohol and do drugs, researchers said Monday.

The results are based on a survey of 3,380 teens living in urban regions in Belgium, Russia and the US.

Given that violence was linked to substance use among teens in three parts of globe, Dr. Robert Vermeiren of Middelheimhospital in Antwerp, Belgium and his colleagues suggest this trend may be a "worldwide urban phenomenon."

This is an important trend to investigate, the authors note in the journal Pediatrics; reports have suggested that almost all inner-city youth living in the US have been exposed to violence.

During the study, Vermeiren and his team asked teens if they had ever experienced or been directly threatened with violence or if they had ever witnessed threats or acts of violence between others. Incidents included being mugged or beaten up, attacked with a knife or gun, chased or wounded.

Teens were also asked if they smoked cigarettes, drank alcohol or did drugs and, if so, how often.

The adolescents included in the study hailed from Antwerp, Belgium; Arkangelsk, Russia; or New Haven, Connecticut.

Despite their youth, the teens had already witnessed a significant amount of violence, the authors note. For instance, 54% of the US adolescents had witnessed more than two violent events, while 29% and 18% had themselves been victims of moderate and severe violence, respectively.

In Belgium and Russia, approximately 38% of inner-city teens said they had witnessed one or two violent events in their lives, and slightly less than 30% reported they had been victims of moderate violence.

Vermeiren and his colleagues report that the more violence teens witnessed, the more likely they were to smoke, drink, smoke marijuana or do hard drugs.

For instance, Russian adolescents who had witnessed more than two acts of violence in their communities were between three and five times more likely to report substance use than those who did not report having seen any violence, Vermeiren and his team note.

The risk of substance use also rose among adolescents who had been victims of severe violence or moderate violence, relative to those who had not.

Teens in Belgium, for example, who had been victims of severe violence were almost twice as likely as those who had not been abused to smoke cigarettes, and around three times as likely to smoke marijuana or do hard drugs, including LSD, cocaine and heroin.

Similar trends were noted among teens living in Russia and the US, the authors note.

"Prevention and treatment initiatives that target substance use and dependence should focus on the role of community violence as part of their intervention," the authors recommend.

Source: Pediatrics 2003;111:535-540.


Weight-Loss Wisdom

Monday, March 3, 2003

(HealthScoutNews) -- If you'd like to lose weight, it's a good idea to first draw up a "how-to" weight-loss plan, rather than impulsively jumping into a new diet. This way, if the pounds don't drop, you're more likely to understand the reasons, according to Harvard Medical School (news - web sites).

Here are some tips:

  • Write down your reasons for wanting to lose weight. Knowing why you want to shed some pounds will help you stay focused.
  • Tell people close to you about your intentions. Support can make the job easier.
  • Make changes gradually. Dramatic changes tend to be short-lived.
  • Schedule regular activity. Exercise burns calories and makes you feel good. It can also stem your appetite.
  • Eat smaller, more frequent meals. This will stave off feelings of starvation, which can lead to overeating.