FRIDAY,
AUGUST 2, 2002
Louisiana
Declares W. Nile Emergency
By Anita Chang
Associated Press
Writer
The Associated
Press
Friday, August
2, 2002
SLIDELL, La. (AP) - An outbreak of West Nile virus ( news
- web
sites) has infected 58 Louisiana residents and killed four,
prompting the governor to declare an emergency Friday and ask for
federal aid for more mosquito spraying across this hot, humid and
swampy state.
The West Nile deaths are the first in the country this year
and raise the national toll to 22 since 1999, when the mosquito-borne
virus was first detected in the United States.
The Louisiana victims were three men, ages 53 to 75, and an
83-year-old woman, all of whom died in the past few weeks, state
health officials said. Twelve people remained hospitalized, four
in intensive care.
"This is only the beginning," said Dr. Raoult Ratard,
the state epidemiologist.
Gov. Mike Foster declared a statewide emergency, hoping to
get $3 million to $5 million in federal money for parishes that
are rapidly using up their mosquito spraying budgets.
"There ought to be some kind of relief. This is an emergency
situation," Foster said Thursday on his weekly "Live Mike"
radio show.
The virus is carried by mosquitoes that feed on infected birds
and other animals. Most people bitten by the infected insects do
not get sick, but the virus can cause flu-like symptoms and encephalitis,
a potentially fatal swelling of the brain, in the weak and elderly.
Until June, Louisiana's only human West Nile case was last
year, in a homeless man in suburban New Orleans. He survived.
Experts said the virus has now spread to virtually every part
of watery Louisiana, where mosquitoes are jokingly called the state
bird. The outbreak here is the deadliest since the virus killed
seven people and hospitalized 55 others in the New York City area
in 1999.
Across southeastern Louisiana, people have been putting fresh
water in birdbaths and dumping water out of flowerpot saucers to
deprive mosquitos of the standing water they need to breed. St.
Tammany Parish north of New Orleans has sprayed for mosquitoes every
night for the past month, three to four times more often than typical
during the summer.
Sales of mosquito traps and insect repellents have been brisk.
Lois Murphy, 76, said her boss at an antiques shop in St. Tammany
Parish has made all employees apply insect repellent. "He makes
us spray ourselves twice a day," Murphy said.
In Baton Rouge, where police are investigating a string of
three slayings, Louisiana State University employee Patty Scuotto
said: "The joke around here is, if the serial killer doesn't
kill you, the mosquitoes will."
Dr. Roy Campbell, an epidemiologist at the Centers for Disease
Control and Prevention ( news
- web
sites), said Louisiana residents are not necessarily at greater
risk because of the state's bayous and other mosquito-breeding terrain.
The severity of the outbreak depends on the species of mosquito,
the climate and other factors, he said.
Wayne Machado, owner of Mosquito Control Inc., said the species
that carries the disease usually breeds near homes instead of in
swamps.
Since 1999, the virus has been found in more than 30 states
and it is spreading south and west, reaching Texas, Nebraska, Oklahoma,
North Dakota, South Dakota, Minnesota and West Virginia this year.
Eight people in Texas and 22 in Mississippi are sick with West
Nile encephalitis.
"It will eventually get to all the Western states over
time," Campbell said.
Overall, the number of human cases this year has already surpassed
the 64 reported last year; 43 were reported in Louisiana and Mississippi
on Friday alone.
On the Net:
CDC: http://www.cdc.gov/ncidod/dvbid/westnile/index.htm
State mosquito control association: http://homepages.xspedius.net/cpmc
Louisiana arbovirus database: http://arbonet.caeph.tulane.edu
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Grouchy? Type A? It Won't Affect Breast Cancer
Risk
By Michelle Rabil
Reuters Health
Friday, August
2, 2002
NEW YORK (Reuters Health) - Personality has no effect on breast
cancer ( news
- web
sites) risk, according to a large study of twins published in
the International Journal of Cancer.
While it has been suggested that there may be a cancer-prone
personality, study authors report that being extroverted, neurotic
or hostile or having a type A personality do not, individually or
in combination, increase a woman's risk of developing the disease,
which should help ease women's concerns.
"This study is quite consistent with the majority opinion
among behavioral scientists at this time, and should be seen as
reassuring related to someone's personality 'causing' cancer,"
Michael Stefanek of the National Cancer Institute ( news
- web
sites) told Reuters Health.
Kirsi Lillberg of the Department of Public Health ( news
- web
sites), University of Helsinki, Finland and colleagues studied
12,499 Finnish twins aged 18 and older from 1976 to 1996. The women
answered health questionnaires in 1975 and 1981, which included
questions about personality traits. Other potential breast cancer
risk factors, including age, weight, social class, age at birth
of first child, number of children, physical activity and alcohol
or tobacco use, were also reported.
A total of 253 cases of breast cancer were identified between
1975 and 1996. No discernible difference was found in breast cancer
between women considered to be moderately or highly extroverted
and those who did not have an outgoing personality.
Similarly, having a type A personality (characterized by ambitiousness,
competitiveness and aggressiveness) and having a hostile personality
(marked by irritability, ease of getting angry and argumentativeness)
were not related to breast cancer risk.
The researchers also studied combinations of personality traits,
such as extroversion plus hostility and extroversion combined with
neuroticism. Again, there was no difference in breast cancer risk
for women with these combinations of traits.
Within twin pairs in which one twin had breast cancer and the
other did not, personality was not found to be related to risk.
Previous research has tended to support these findings, including
a Dutch study that found no substantial link, with the exception
of a very small risk increase for women with anti-emotionality (a
lack of trust in one's true feelings). An analysis of 46 studies
reported between 1970 and 1996, conducted at Roswell Park Cancer
Institute, Buffalo, New York, also failed to find a connection between
variables such as stress and depression and breast cancer.
The possible connection of personality to the development of
cancer has a long history, dating back to ancient Rome, according
to Stefanek. "It's a complex issue given the multitude of cancer
sites and different risk factors involved in each," he said.
Source: International Journal of Cancer 2002;100:361-366.
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EPA
on Track in Pesticide Study
By John Heilprin
Associated Press
Writer
The Associated
Press
Friday, August
2, 2002
WASHINGTON (AP) - The Environmental Protection Agency ( news
- web
sites) said Friday it has met two major deadlines for safeguarding
the nation's food supply from potentially harmful pesticide residues.
But an environmental group that sued the agency to enforce
one of the deadlines said Friday that EPA didn't meet all its obligations
and violated a court agreement on the pesticides review reached
last year.
Congress ordered a comprehensive 10-year safety review of pesticide
levels in food in August 1996. The review was to be done in three
stages, with the first deadline in 1999, the second this year and
the third in 2006.
Stephen L. Johnson, EPA's assistant administrator in charge
of the office handling the pesticides review, said EPA has now looked
at more than 6,400 tolerances for hundreds of pesticides on food.
Tolerances are the maximum amount of a pesticide that regulators
feel is safe to remain in or on food.
The agency was charged with reviewing 9,700 tolerances in 10
years: the first set of 3,200 by August 1999, the second set of
3,200 by now and the third set by four years from now.
The EPA's pesticide review "continues to strengthen our
confidence in the overall safety of the nation's food supply and
underscores the benefits of eating a varied diet rich in fruits
and vegetables," he said.
EPA said it gave first priority to pesticide classes that pose
the greatest risk, including organophosphates, carbamates and organochlorines.
But the agency also said it had completed reassessments for
only about half to three-quarters of the individual pesticides in
each of the various classes. EPA said it also has reassessed almost
two-thirds of the tolerances for foods commonly eaten by children,
and decided that 1,900 tolerances needed to be changed.
As part of the review, EPA said it complied with a settlement
agreement with Natural Resources Defense Council to evaluate four
pesticides: benomyl, diazinon, endosulfan, and lindane.
But the environmental group wrote the agency on Friday alleging
EPA had violated the settlement agreement. Erik Olson, a senior
attorney for the group, said EPA had not, for example, reassessed
the worst of the organophosphates or the carbamates.
He said EPA still has not fully complied with either the 1999
deadline or this latest one.
"They're taking credit for what they themselves say are
interim actions, when the law says they must be final actions,"
Olson said. "To us the biggest problem is they really have
not addressed some of the most outstanding risks."
On the Net:
EPA: http://www.epa.gov/pesticides/tolerance
National Resources Defense Council:
http://www.nrdc.org/health/pesticides/default.asp
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Hairdressers
at Risk for Underweight Babies: Study
Reuters Health
Friday, August
2, 2002
NEW YORK (Reuters Health) - Women who work as hairdressers
may have a slightly increased risk for having an underweight baby
or an infant with a birth defect, according to a study conducted
by Swedish researchers.
The findings are published in the August issue of the journal
Occupational and Environmental Medicine.
In the study, Lars Rylander of University Hospital in Lund,
Sweden, and colleagues compared 2,410 women who worked as hairdressers
and had given birth to 3,462 women from the general population.
The hairdressers "more often gave birth to infants that
were small" for their gestational age (4.5% vs. 4.1%) compared
with non-hairdressers, the authors report. In addition, they found
that 2.8% of the hairdressers gave birth to a baby with a "major
malformation" compared with 2.1% of non-hairdressers.
While frequent hair spraying and permanent waving tended to
be associated with small infants, no such link between exposure
to common hair-care chemicals was seen for birth defects, the study
indicates.
Rylander and colleagues recommend that hairdressers regularly
wear protective gloves, especially during pregnancy, and that hair
salons do all they can to increase ventilation of chemical fumes.
Commenting on the study, Dr. Gerald McEwen of the Cosmetic,
Toiletry and Fragrance Association in Washington, DC noted that
the study did not take into account other factors that can affect
pregnancy, including alcohol consumption or physical strain and/or
work-related stress.
Each of these factors can affect birth outcomes like the ones
noted in the paper, he explained, and since they were not properly
controlled for it is not possible to rule these factors out as a
possible cause for the birth outcomes reported.
"Overall, there is no link between the products used in
the salon and the effects that were reported, he said.
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Tighter
Biotech Crop Rules Proposed
By John Heilprin
Associated Press
Writer
The Associated
Press
Friday, August
2, 2002
WASHINGTON (AP) - The Bush administration on Friday proposed
new safety reviews for genetically engineered crops.
Under the proposals, the Agriculture Department, the Food and
Drug Administration (news
- web
sites) and the Environmental Protection Agency (news
- web
sites) will update their field test requirements. The FDA and
EPA will oversee early food safety assessments for new proteins
produced by biotech crops that are intended for human food and animal
feed use.
The safety reviews by the FDA would be voluntary, but the ones
by the Agriculture Department and the EPA would be mandatory, said
Cliff Gabriel, deputy associate director for science for the White
House Office of Science and Technology Policy.
"While the consultations are voluntary, compliance with
the Food, Drug and Cosmetic Act is mandatory," Gabriel said.
"What's voluntary here is how the developers comply — but they
have to comply."
Michael J. Phillips, a spokesman for the Biotechnology Industry
Organization, said its members would treat the White House proposals
as mandatory, regardless of a specific agency's authority.
"For consumers, this enhancement adds yet another layer
of assurance to the existing regulatory review of agricultural crops
intended for both food and feed," Phillips said.
Existing rules for commercial products require the Agriculture
Department to check that crops won't harm other crops or the environment.
The EPA reviews whether crops with pesticides are safe for people
and the environment. Companies voluntarily consult with the FDA
when they have a new commercial product.
The new assessments would extend the FDA voluntary consultations
to selected field trials for previously unreviewed proteins. Such
consultations are conducted well before a product is ready for market.
The FDA is not currently involved in field trial oversight; the
Agriculture Department has that role for crops, and the EPA has
it for pesticides.
The overall aim is to reduce the likelihood that any potentially
harmful biotech crops in the field testing stage will show up in
commercial seed lots, bulk commodities or processed food before
all the safety standards are met.
Jane Rissler, a senior staff scientist with the Union of Concerned
Scientists, said her organization was among several environmental
and consumer groups that met with White House and agency officials
to discuss the proposal Friday.
Such groups have been urging stricter oversight of field trials
for years, but Rissler said the best way to do that would be through
mandatory measures.
"If most of the changes lead to only voluntary actions
then I think we will not have significant improvement in protection
against the risks of these crops," she said. "I fear that
these changes are designed to protect industry rather than people
and the environment. Some potentially dangerous proteins could fall
through the cracks."
Public comment on the plan is being sought until Sept. 30.
On the Net:
Office of Science and Technology Policy: http://www.ostp.gov
Biotechnology Industry Organization: http://www.bio.org
Union of Concerned Scientists: http://www.ucsusa.org
Source: Occupation
and Environmental Medicine 2002;59:517-522.
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Antibiotics
Not Tied to Childhood Asthma, Allergies
Reuters Health
Friday, August
2, 2002
NEW YORK (Reuters Health) - Contrary to earlier findings, there
appears to be no link between the use of antibiotics in babies and
the development of asthma and allergies later in childhood, according
to Boston-based researchers.
"Since five retrospective studies had reported an association
between antibiotic use in early life and asthma in childhood,"
Dr. Juan C. Celedón told Reuters Health, "we were interested
in studying the relation between the use of oral antibiotics in
the first year of life and allergic diseases."
Celedón, of the Channing Laboratory, and colleagues examined
antibiotic use in babies under 1 year old and the development of
asthma, allergic rhinitis and eczema at the age of 5. They studied
448 children with one or both parents who had allergies, and followed
them from birth. The findings appeared in the July 1st issue of
the American Journal of Respiratory and Critical Care Medicine.
The investigators found no significant connection between antibiotic
use in the first year of life and asthma, recurrent wheezing, allergic
rhinitis, or eczema at age 5 years.
Celedón pointed out that "this does not mean, however,
that antibiotics should be unnecessarily used in early childhood,
as this practice is known to be associated, among other things,
with the development of microbial resistance to antibiotics."
Source: American
Journal of Respiratory and Critical Care Medicine 2002;166:72-75.
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Gene
May Change Behavior of Abused
By Paul Recer
AP Science Writer
The Associated
Press
Friday, August
2, 2002
WASHINGTON (AP) - Abused children who become violent criminals
as adults may be influenced by a gene that fails to make enough
of an essential brain chemical, a study says.
Based on a 26-year analysis of the lives of 442 males in New
Zealand, the study found those men who had a combination of abuse
and a less active brain chemical gene were about nine times more
likely to commit criminal or anti-social acts as adults than others
in the group.
Experts say the finding, appearing this week in the journal
Science, could lead to new ways of helping abused children become
responsible, nonabusing adults.
The men in the study group were tested for the activity of
a gene, called monoamine oxidase A, or MAOA. It produces an enzyme
that regulates chemicals in the brain which transmit signals between
neurons. Among those studied, 279 were found to have normally active
MAOA genes, while 163 showed a low level of action from the gene.
The study found that 64 percent of the men were not abused
in childhood, while the balance experienced either "severe"
or "probable" maltreatment — defined as rejection by the
mother, frequent changes in primary caregivers and physical or sexual
abuse.
At the conclusion of the research, the researchers found that
the abused children with low MAOA gene activity — 12 percent of
the study group — accounted for 44 percent of the violent crime
convictions among all of those in the group, said Terrie E. Moffitt,
a psychologist at the University of Wisconsin, Madison, and a co-author
of the study.
"As adults, 85 percent of the severely maltreated children
who also had the gene for low MAOA activity developed anti-social
outcomes, such as violent criminal behavior," Moffitt said
in a statement. The abused children with normal MAOA genes were
no more likely to be anti-social than those who were not abused,
the study found.
The findings provide evidence that genetic characteristics
"can moderate children's sensitivity to environmental insults"
such as abuse, Moffitt said in an e-mail. "These findings may
partly explain why not all victims of maltreatment grow up to victimize
others."
She said the findings also suggest a new tool for evaluating
the risk that a person may become a problem for society.
"The combination of the low-activity MAOA genotype and
maltreatment predicts anti-social behaviors about as well as high
cholesterol predicts heart disease," Moffitt said.
Dr. John M. Leventhal, professor of pediatrics at Yale University
School of Medicine and medical director of the child abuse program
at the Yale-New Haven Children's Hospital, said the study was interesting
and important because it suggests a biological factor may play a
role in causing some abused children to become abusive adults.
"If this paper is confirmed by other studies and we have
a better understanding about what the biology means, then this may
play a role in clinical evaluations in the future," he said.
"We know that not all abused children grow up to be violent.
This study supports that observation," said Sid Johnson, president
of Prevent Child Abuse American, a Chicago-based group that conducts
child abuse research and has chapters in 39 states. "This finding
could to lead to a very effective prevention approach."
On the Net:
Science: http://www.sciencemag.org
Prevent Child Abuse America: http://www.preventchildabuse.org
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FDA
OKs Generic Versions of Tylenol with Codeine
Reuters Health
Friday, August
2, 2002
WASHINGTON (Reuters Health) - Generic drugmaker Able Laboratories
Inc. said on Friday it has received approval from the US Food and
Drug Administration ( news
- web
sites) (FDA) to market generic versions of Johnson & Johnson's
Tylenol (acetaminophen) with codeine #3 and codeine #4.
South Plainfield, New Jersey-based Able said it received FDA
approval to market the 300mg/30mg and 300mg/60mg acetaminophen and
codeine phosphate tablets.
Citing data from the pharmaceutical market research firm IMS
Health, the generic drugmaker estimated the combined generic and
branded market for the newly approved drugs at about $200 million.
Able further noted that with these approvals it has now received
16 approvals from the FDA for generic drugs since March 2001. The
company said these approvals have served to complete its conversion
to a generic drug manufacturer.
Formerly part of the biotechnology concern DynaGen, Able Laboratories
was acquired by the now defunct company in 1996 as part of a plan
aimed at converting the failing concern into a manufacturer of generic
drugs. DynaGen subsequently changed its name to Able Laboratories
as part of the restructuring plan.
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Pharmacies,
Mass. Make Funding Deal
By Jennifer Peter
Associated Press
Writer
The Associated
Press
Friday, August
2, 2002
BOSTON (AP) - Massachusetts' three largest drug store chains
will temporarily continue to fill Medicaid prescriptions in exchange
for the state's reconsidering a planned cut in reimbursement rates.
Gov. Jane Swift announced the agreement Thursday, for now resolving
a dispute with CVS, Walgreens and Brooks Pharmacy. The chains had
threatened to withdraw from the state's Medicaid program because
of an 11 percent reduction in prescription reimbursement rates.
Altogether, the companies operate more than half of Massachusetts'
1,014 drug stores and fill 60 percent of the state's Medicaid prescriptions.
Under the agreement, the state will continue repaying pharmacies
for Medicaid prescriptions at the current rate until Oct. 2. In
the meantime, the state will hold a public hearing and set an appropriate
reimbursement rate.
The new rate will be announced Oct. 2 and will be applied retroactively
to any prescriptions filled after Thursday, Swift said.
CVS, the state's largest drug store chain and leader of the
pharmacy revolt, issued a statement welcoming Swift's action and
saying it has suspended its decision to stop filling Medicaid prescriptions
Aug. 19.
Walgreens confirmed the agreement, but had no further comment.
A Brooks spokesman did not immediately return calls.
Starting Friday, the state will also require pharmacies to
give 30 days notice before withdrawing from the state's Medicaid
program. Previously, pharmacies were not required to give any notice.
State officials decided to reduce the reimbursement rate to
help keep down spiraling Medicaid costs.
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Imported
Fruit Drink Behind 1998 Florida Outbreak
Reuters Health
Friday, August
2, 2002
NEW YORK (Reuters Health) - Health officials have linked a
1998 outbreak of typhoid fever in the US to consumption of shakes
made with a tropical fruit imported from Guatemala.
The outbreak, which occurred in the winter of 1998-1999 and
involved at least 16 people in Miami-Dade County, Florida, was traced
to mamey, a commercially processed frozen fruit.
Typhoid fever is caused by bacteria transmitted in food and
water contaminated with urine or feces. The infection causes high
fever, headache, coughing and rose-colored spots on the skin.
This is the first report of an outbreak of typhoid fever in
the US caused by commercially imported food, Dr. Dolores J. Katz,
of the Florida Department of Health, and colleagues note in The
Journal of Infectious Diseases. In previous outbreaks, infected
food handlers and contaminated water have been implicated.
No further illnesses occurred once the product was recalled.
This outbreak highlights the need for new strategies to ensure
the safety of commercially imported food, Katz told Reuters Health.
"We are part of a global food network; we import food
from all over the world. And with that food, we may also import
foodborne organisms that are very rare or unknown in the United
States, such as the organism that causes typhoid fever. We [need]
to work with developing nations to help them improve their food
processing practices."
Irradiating selected imported foods is another option, according
to the report.
"This outbreak was identified because local doctors and
hospitals did their job of reporting cases to the Miami-Dade County
Health Department," Katz emphasized. "Without their help,
we would not have identified the outbreak; more people might have
gotten ill and the problems at the processing plants would not have
been corrected."
Source: The
Journal of Infectious Diseases 2002;186:234-239.
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Controlling
Your Asthma
HealthScoutNews
Friday, August 2, 2002
(HealthScoutNews) --
If you find yourself using your quick-relief inhaler to stop an
asthma attack more than twice a week, it may be time for a different
medication.
So recommends the University of Texas Southwestern Medical
Center in Dallas. In fact, if you have to refill your inhaler more
than two times a year or are awakened by asthma symptoms two nights
or more per week, you also probably need a change, the medical center
says.
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Antiretroviral
Use May Stamp Out HIV Epidemic
Reuters Health
Friday, August
2, 2002
NEW YORK (Reuters Health) - Widespread use of antiretroviral
drug combinations together with a decrease in risky sexual behaviors
could eradicate an HIV ( news
- web
sites) epidemic, even in locations where as many as 30% of the
population is infected, according to researchers who created a mathematical
model. However, it would likely take 100 years.
"We wanted to calculate the overall impact of antiretroviral
drugs on the HIV epidemic, because most people look at only one
part of the picture; increasing drug resistance, for example,"
lead researcher Dr. Sally M. Blower from the University of California
at Los Angeles, told Reuters Health.
Antiretroviral drugs work by inhibiting the ability of the
human immunodeficiency virus (HIV) to replicate. There are several
types of these drugs and they are generally used in various combinations
with one another. Antiretrovirals don't completely eliminate the
virus, but their use has prolonged the lives of many HIV-infected
people.
One potential drawback of these drugs is the possibility for
drug resistance. Drug resistance occurs when the virus mutates into
a form that is not affected by the drug.
Blower and colleagues developed a mathematical model for an
HIV epidemic scenario, which accounted for the number of new HIV
cases that each infected person generates in a lifetime. They assumed
that antiretroviral drugs were available and drug-resistant mutations
would develop and be transmitted. They considered the possibilities
that risky sexual behavior would decrease, increase or stay the
same.
The model was tested using HIV epidemic data from a gay community
in San Francisco. Their findings appear in the August issue of The
Lancet Infectious Diseases.
Even in the presence of strains of drug-resistant HIV, if there
was a decrease in high-risk sex and high levels of antiretroviral
drug use, the probability that the HIV epidemic would be eradicated
was high.
If risky sexual behavior remained unchanged, the probability
of eradication was moderate, and eradication would be unlikely if
sexual risk behaviors increased, the researchers found.
"Antiretroviral drugs have a very beneficial impact. If
you can gets lots of people on treatment you can even get eradication,"
Blower said.
"This shows that drugs that don't eradicate virus or cure
a single individual can lead to eradication of HIV at the epidemic
level. The message is to get more and more people on treatment,
and definitely treatment in developing countries, as well as reducing
risky sexual behavior," she added.
"The public health community is polarized on this issue,
some believing that treating more people will lead to more drug
resistance," Blower said. "But you have to look at the
big picture--treating more people will have a beneficial impact.
It will benefit the infected people and it will also benefit uninfected
people, by preventing transmission--and it will gradually reduce
the epidemic."
Source: Lancet
Infectious Diseases 2002;2:487-493.
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Producing
a Healthy Diet
HealthScoutNews
Friday, August 2, 2002
(HealthScoutNews) -- Ever wonder whether you need vitamin supplements
to stay healthy?
The Duke University Medical Center says you can get almost
all the vitamins you need from a diet rich in fruits, vegetables
and grains. However, if you don't eat well, vitamins are important
-- especially if you also smoke or drink alcohol.
Women who are pregnant or thinking about getting pregnant should
get at least 600 micrograms of folic acid every day. The medical
center notes that taking smaller doses throughout the day can improve
how much your body absorbs.
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Many
Seniors Unaware of Drug Company Discount Cards
By Karen Pallarito
Reuters Health
Friday, August
2, 2002
NEW YORK (Reuters Health) - With the Senate failing this week
to agree on a Medicare drug benefit, pharmaceutical companies say
they are focusing attention on boosting sluggish enrollment in their
own drug-discount card programs.
However, critics say there is little incentive for drug companies
to sign seniors up for manufacturer-sponsored discount programs.
Although millions of older Americans potentially could qualify
for a price break on prescription medications, sponsors of the discount
cards have enrolled just thousands.
Jane Woods, Secretary of Health and Human Services ( news
- web
sites) for the Commonwealth of Virginia, frets that some of
the cards have been available for months, yet in her state "the
numbers are just not reflective of great public awareness."
"Our guesstimate is that there's about 7 million low-income
Medicare enrollees who don't have prescription drug coverage,"
said Pfizer spokesman Andy McCormick. Pfizer's "Share Card"
program offers eligible seniors the opportunity to purchase a 30-day
supply of any company drug for a flat fee of $15. Since the program's
rollout in March, about 200,000 people have enrolled.
"The trick here is to get the word out," he told
Reuters Health.
Making seniors aware of the manufacturer-sponsored discount
programs seems to be one of the most difficult hurdles the companies
face. Increasingly, drugmakers are engaging local political leaders
and senior housing organizations in events aimed at reaching eligible
low-income seniors.
Pfizer, for one, is tackling the publicity challenge by involving
political leaders in company-sponsored enrollment events in selected
states. Texas Gov. Rick Perry joined with the Texas Association
of Homes and Services for the Aging (TAHSA) and Pfizer executives
in kicking off a statewide enrollment event in March involving some
20 state legislators.
Sponsors of Together Rx, a discount card program backed by
seven major drugmakers, are pursuing a similar marketing strategy.
A five-city enrollment event involving local government officials
and senior centers is planned for the fall. Although the list is
still being finalized, likely sites include Cleveland, Phoenix,
and Memphis, Tennessee.
"We're looking for places where there's a good percentage
of our target audience," offered Together Rx spokesman Doug
Arbesfeld.
In a little over a month of actual operation, Together Rx enrolled
118,000 people. As of August 1, the count was 140,000, with thousands
being added each week.
Sponsors are "pleased so far" with enrollment, says
Arbesfeld, who also serves as executive director for global pharmaceutical
communications at Johnson & Johnson. But a team of marketing,
government relations and public relations specialists continues
to work on ways to boost awareness.
While he wouldn't disclose the sponsors' marketing budget,
he did say that the companies "really are committed to making
this program work and signing up as many people as possible."
GlaxoSmithKline, for example, has its own card program, with
more than 100,000 enrollees, but "it's fair to say most of
our efforts are in Together Rx," Glaxo spokeswoman Patty Seif
told Reuters Health.
Critics, though, say the latest buzz about reaching more seniors
is little more than a public relations ploy.
"I think they're trying to mitigate some of the public
relations damage they've experienced in the wake of rising drug
prices," said Ron Pollack, executive director of Families USA.
He doesn't believe the discounts will mean much, in the long run,
given that companies may raise the prices of their drugs they sell
to seniors. "We have been saying all along, the underlying
price increases will dwarf the discounts."
What the drug companies offer are "charades of discounts,"
charged Dr. Sidney Wolfe, director of Public Citizen's Health Research
Group.
Drug manufacturers, one by one, began unveiling discount card
programs last fall, in the wake of President Bush ( news
- web
sites)'s failed attempt to launch a Medicare-sponsored drug
discount card. First came GlaxoSmithKline's "Orange Card,"
followed by Novartis Pharmaceuticals' "CareCard," then
Pfizer Inc.'s "Share Card," and Eli Lilly and Company's
"LillyAnswers."
Then at a splashy press event this past April, seven major
drugmakers, including Glaxo and Novartis, launched Together Rx,
a single card program that features discounts said to range from
20% to 40% on sponsors' medications. By collaborating, drugmakers
hoped to demonstrate a united front in responding to an issue of
great importance to seniors in America while simplifying and expanding
the discounts available to seniors.
Sponsors said the card could benefit as many as 11 million
low-income seniors with no prescription drug coverage. Full-page
ads in 13 major newspapers touted the news. Letters announcing the
program were mailed to 735,000 doctors. And the companies' 35,000
sales representatives began spreading the word, too.
Together Rx is accepted at most of the major pharmacy chains,
including CVS, Rite Aid, Wal-Mart and Walgreen. Rite Aid, the nation's
third largest drugstore chain, accepts all five manufacturer-sponsored
cards. An overwhelming majority of the prescriptions filled through
those programs in April, May, and June came from Pfizer's Share
Card, said Sarah Datz a spokeswoman for the Camp Hill, Pennsylvania-based
retailer.
Some pharmacists, however, see little more than a trickle of
business from the manufacturer-backed discount cards and hear nary
a whisper about the programs from the drug marketers who visit them.
"We're not seeing any great promotion of it," said
Ernest E. Boyd, executive director of the Ohio Pharmacists Association.
And pharmacists are not seeing the cards presented at the pharmacy
counter in any great quantity, he added.
"My perspective is there's no motivation for the sales
reps to do this," offered pharmacist Tom Kelly, owner of a
Forked River, New Jersey-based unit of The Medicine Shoppe franchise.
"The incentive is to move product and make larger bonuses,"
he said.
And while boosting awareness of the discount programs may help,
"there are a lot more obstacles to just knowing about a program,"
added Deane Beebe, a spokeswoman for the Medicare Rights Center
in New York.
Consumers need to be healthy enough to apply for a card, able
to read English well enough to understand the application, able
to read the point size on the back of their pills to know who the
manufacturer is, and comfortable filling out the paperwork, she
said.
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Online
Site Aims to Deter College Suicides
By Robert Preidt
HealthScoutNews Reporter
HealthScoutNews
FRIDAY, Aug. 2, 2002 (HealthScoutNews) -- When Phillip and
Donna Satow saw their son Jed off to college, it seemed to be the
beginning of a wonderful new period of his life.
But in 1998, at age 20, Jed committed suicide in his sophomore
year at the University of Arizona. And his story isn't unique.
Suicide is the second leading cause of death among college
students, according to the National Mental Health Association. It's
estimated that at least 1,000 American college students will commit
suicide this year.
The Satows want to reduce that toll and help all college students
who suffer emotional and mental difficulties.
They've established a new online support system called "Ulifeline"
for college students. It offers anonymous access to mental health
information and support, provides screening tools for depression
and suicide risk, and can link students to their college's mental
health center.
Other features include a drug interaction center, mental health
library and documentary videos.
Ulifeline is a project of the non-profit Jed Foundation, which
the Satows established following their son's suicide. It's dedicated
to reducing the youth suicide rate and improve mental health support
provided to American college students.
Phillip Satow says Ulifeline was inspired by discussions he
had with University of Arizona students after his son killled himself.
"So many students there spoke to me about the development
of a Web site. They felt it would be so valuable for them, in an
anonymous way, to go to one place, have a URL to go to and have
their questions answered or potentially be screened," Satow
says.
"The development of this site and the items on the site
came about really from the students themselves. I have really answered
what are the perceived student needs," he says.
Ulifeline is available to universities through a free subscription.
Each university gets a customized site that provides its students
with information about mental health programs and resources at their
university and in the local community.
Parents need to pay attention to their children's mental health
and not rely on anyone else to do it, says Dr. Monica Michell, attending
psychiatrist and former chief of child and adolescent psychiatry,
Lenox Hill Hospital, New York City.
"What I would say to parents is that the responsibility
may belong to the school and the health care system to a certain
extent, but when push comes to shove, no one is really going to
care about your child as much as you do. So, keep you eyes on your
child," she says.
She says parents who suspect something is wrong should arrange
for their child to see a mental health professional.
"If you're worried, it's always worth seeking a consultation
or evaluation even if the outcome ... is that someone says your
child is homesick and going through an adjustment period in the
first year of college," Michell says.
Satow says there are about 30 universities on the waiting list,
and he expects to have about a dozen online by mid-August. He hopes
to eventually get all universities in the United States to subscribe
to the program.
Ulifeline is only for colleges students. But the Jed Foundation
plans a section at its home Web site to offer information and advice
for parents concerned about the mental and emotional well-being
of their children about to start, or already at college.
The Jed Foundation says parents, college officials and fellow
students should be on the lookout for suicide warning signs. They
include: social withdrawal; dramatic personality changes; drug or
alcohol abuse; notes or poems about death; talk about suicide; giving
away prized possessions; decline in quality of schoolwork; difficulty
concentrating; dramatic change in eating or sleeping habits; extreme
distress about romantic relationships.
And here's information from the Jed Foundation about risk factors.
They include:
·
Mental illness -- 90 percent of adolescents who commit suicide have
at least one diagnosable, active psychiatric illness.
- Previous suicide attempts
-- Among adolescents who commit suicide, between 26 and 33 percent
have made a previous suicide attempt.
- Stressors -- In many cases,
a youth suicide happens after the victim has been in trouble or
had a recent disappointment, rejection or academic pressure.
- Firearms -- 64 percent
of suicide victims between 10 and 24 years old used a gun to kill
themselves.
What To Do
You can get more information about Ulifeline and the Jed Foundation
by clicking here.
More information about suicide prevention can be found at the
Nemours
Foundation.
And the American Foundation for Suicide Prevention is holding
a special overnight walk in Washington, D.C., this month to raise
awareness of the issue. For further information, you can click here.
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Roche
Warns of Shortage of Revolutionary AIDS Drug
By Ben Hirschler
Reuters
Friday, August
2, 2002
LONDON (Reuters) - A revolutionary AIDS ( news
- web
sites) drug could offer new hope to patients, but demand for
it is so great its manufacturer warned Friday it may not be able
to supply the medication, called T-20, to all those who need it.
Patient groups and AIDS activists have been clamoring for access
to the new drug, which will be sold under the brand name Fuzeon,
as an alternative treatment for tens of thousands of people who
have become resistant to existing medicines.
Swiss manufacturer Roche Holding AG said, however, it would
only be able to supply some 3,000 patients by March next year.
"In the short term, we do not have the flexibility to
increase production beyond our current capacity to meet a potentially
higher than initially anticipated demand," said William Burns,
head of Roche Pharmaceuticals.
The injectable drug, which Roche expects to reach the market
in the first quarter of 2003, is the first in a novel class known
as fusion inhibitors that work in a completely new way, by preventing
HIV virus ( news
- web
sites) from entering cells.
All 16 of the currently approved AIDS medicines attack HIV
( news
- web
sites) only after it has entered a human cell.
T-20 is currently undergoing a fast-track review at the US
Food and Drug Administration ( news
- web
sites), and Roche said there was increased likelihood of a speedy
approval in Europe as well.
Data released at the world AIDS conference in Barcelona last
month by Roche and its US partner Trimeris Inc showed T-20 slashed
the amount of virus in the blood of many patients running out of
treatment options.
Furthermore, only 3% of those taking the drug gave up treatment
as a result of injection site reactions.
David Reddy, head of Roche's HIV franchise, said this level
of tolerance to the drug was far better than expected, which would
further increase demand for T-20.
Colorado Plant
Roche and Trimeris are working flat-out to bring on new production
capacity at a plant in Colorado, but increased output will take
time to build up and, in the meantime, the companies have to rely
on a small pilot plant.
"We are going to have to carefully monitor the allocation
of T-20 throughout 2003," Reddy told Reuters.
"Production will continue to ramp up as we proceed through
the year. We expect that by the end of 2003 we will have enough
capacity to supply the drug to around 25,000 patients."
A further expansion of capacity has also been approved but
this will not come on stream before 2004, he added.
Production is constrained by the complexity of the T-20 molecule.
The product is the most complicated drug ever made, with the manufacturing
process requiring 106 steps of chemical synthesis.
Reddy said no supplies of T-20 would be stockpiled ahead of
launch and medicine would be shipped to patients as soon as possible.
As part of this drive, Roche and Trimeris plan to begin an
early access program in late September or early October to supply
T-20 to 1,200 patients around the world at no cost.
Expanded access schemes allow drugs to be given to needy patients
before a product is fully licensed and while clinical studies are
continuing.
Combined with the ongoing clinical program, this will take
the number of patients on T-20 to 3,000.
Roche and Trimeris have yet to disclose how much the drug will
cost--but it will not be cheap.
Industry analysts expect it be sold at a substantial premium
to existing AIDS drugs at some $10,000 to $12,000 per patient a
year.
"We haven't made any firm decisions on pricing at this
time. I think you'd expect those to be announced around the time
of launch," Reddy said.
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Dementia
+ Stroke a Potentially Fatal Combination
By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Friday, August 2, 2002
FRIDAY, Aug. 2 (HealthScout News) -- As if having a stroke
weren't bad enough: A mental disability known as dementia can be
a strong predictor of death if it accompanies a stroke, researchers
have found.
People with symptoms of dementia before or after a stroke have
a much greater risk of dying within the next two years, reports
a study in the August issue of Stroke: Journal of the American
Heart Association ( news
- web
sites).
In fact, dementia turned out to be one of the most important
determinants of death in people who had had strokes.
Individuals who developed dementia after their stroke had a
more than eight-fold increase in their risk of dying within two
years. Those who had symptoms of dementia before the stroke had
a risk of death twice as high as those with no dementia before or
after. When the dementia was related to the stroke, the risk for
death increased more than six times. This was true even after adjusting
for other risk factors such as age, gender and heart disease.
The authors of the study speculate that this may be because
stroke survivors with no dementia receive better care than those
who do suffer from dementia. The study found that patients with
dementia were less likely to receive oral anticoagulants, for example.
People with dementia have declining mental abilities, including
memory loss, some motor skill degradation, confusion and often,
the inability to find the right words to express a thought or idea.
Although the idea that individuals with stroke and dementia
fare worse than their non-demented counterparts is not new, there
may be some implications for prevention and care strategies.
"It is true, when a person has dementia, there is unfortunately
a trend towards easing up on the care that they get," says
Dr. Keith A. Siller, assistant professor of neurology at New York
University School of Medicine in New York City.
"One thing you should take away from the study is that
you should be just as concerned at modifying risking factors --
treating blood pressure, lowering cholesterol, giving anticoagulants
and antiplatelets -- to those who have dementia," he adds.
It's a message the authors are also highlighting.
"We can say that cognitive impairment has prognostic implications
in stroke patients," says Dr. Raquel Barba, lead author of
the study and a clinical investigator in the department of medicine
at Fundacion Hospital Alcoron in Madrid, Spain.
"Both pre- and post-stroke dementia determine a significant
reduction in survival and are among the most important risk factors
of mortality in these patients," she adds. "On the other
hand, we must try to control other risk factors even in demented
patients, because this can improve their prognosis."
Vascular dementia is caused by a narrowing of the blood vessels
in the brain. Stroke is the most common acute neurological illness
in the country, the leading cause of disability for adults and the
third cause of mortality in developed countries. Post-stroke dementia
can be found in some 20 to 30 percent of stroke patients.
Barba and her colleagues analyzed information on 324 patients
who were admitted to a hospital in Madrid for stroke treatment in
1994 and 1995. Information from a questionnaire on cognitive decline
(filled out by a patient's relative or caregiver) as well as a medical
history and neurological evaluation identified pre-stroke dementia
in 49 patients or about 15 percent of the patients.
Evaluations conducted three months later identified 75 people
with post-stroke dementia, including 50 cases in which the dementia
was related to the stroke.
After two years, only 58.3 percent of patients with stroke-related
dementia had survived compared with 95.4 percent of patients without
it.
"I think this reinforces the connection between dementia
and stroke," Siller says. "What happens with dementia
after stroke is a big topic in my field. Patients get through the
stroke, but they may now be cognitively very poor. This is often
more disabling than paralysis. This is a big health concern."
Ironically, the most severely disabled stroke patients may
actually get the best care because they're often in a hospital or
other facility and are totally supervised.
"It's the people in between who you may not even know
are demented," Siller says. They may miss appointments, miss
taking their pills, or take too many pills at one time.
"Some of these people may not get best medical care because
the thinking process of the doctor changes when they don't know
if the patient is reliable," Siller says. "It's wrong
and unethical to withhold care even in an unconscious way."
What To Do
For more information on dementia, visit the American
Geriatrics Society.
For a range of information on strokes, visit the National
Stroke Association or the American
Heart Association.
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Life
Expectancy in Japan Now Longer Than Ever
By Hanna Kite
Reuters Health
Friday, August 2, 2002
YOKOHAMA (Reuters Health) - The life expectancy of Japanese
men jumped by over four months to 78.07 years, the first time the
expected life span for Japanese men has exceeded 78 years, according
to new data released by the Japanese Health and Welfare Ministry.
The Ministry released new figures from 2001 this week.
Life expectancy for Japanese females increased from 84.60 years
to 84.93 years, the highest life expectancy in the world. The difference
between the sexes decreased by 0.02 years in the past year.
Officials said a decrease in cancer-related deaths in men and
a drop in deaths due to stroke in women contributed to the lengthened
lifespans.
In comparison to figures from 1990, life expectancy for females
increased 3.03 years over the past decade, while the life expectancy
for males increased by one year.
According to Ministry figures, the closest country to Japan
is Hong Kong, where life expectancy is 78.0 years for males and
83.9 years for females.
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Nearly
Half of Elderly Angina Patients Don't Feel Chest Pain
HealthScoutNews
Friday, August 2, 2002
FRIDAY, Aug. 2 (HealthScoutNews) -- To paraphrase the old classic
song "Love and Marriage": Angina ( news
- web
sites) and chest pain go together like a horse and carriage.
But do they?
Apparently they don't in many elderly. Latest research from
the University of Alabama at Birmingham indicates that nearly half
the angina sufferers studied who were over age 65 felt no chest
pain at all. That's a two-edged sword, because earlier findings
indicated that those with angina who don't have chest pain were
twice as likely to die while in the hospital.
Now, scientists are trying to confirm the earlier data.
Here's how the researchers, led by UAB cardiologist Dr. John
Canto, describe typical and atypical symptoms of angina:
·
Typical: "Chest pain located substernally in the left or right
chest; or chest pain characterized as squeezing, tightness, aching,
crushing, arm discomfort, dullness, fullness, heaviness, pressure
or pain aggravated by exercise or relieved with rest or nitroglycerin."
- Atypical: "Confirmed
cases of unstable angina without the presence of the typical symptoms
listed above."
Canto and his team had done an earlier study in 2000, examining
the records of more than 450,000 angina patients.
The follow-up study involved about 4,100 Alabama Medicare patients
and was designed to determine whether those who suffered no chest
pain received different hospital treatment that could have ignored
their condition.
More research is needed to make that determination, Canto says,
but researchers did find that patients without chest pain received
aspirin, heparin and beta-blocker therapy less aggressively; there
appeared to be no difference in mortality rates.
They also found that among patients with confirmed angina,
51.7 percent had atypical presentations and 45 percent had no chest
pain at all.
The research team's findings are published today in the August
issue of The Journal of American Cardiology.
More information
A news release from the University of Alabama at Birmingham
describes angina this way: "Unstable angina is caused by lack
of oxygen to the heart muscle -- usually from blocked or narrowed
and clogged arteries -- and if left untreated, it can develop into
a full-blown heart attack, when portions of the heart muscle begin
to die from the lack of oxygen."
This information from the National Heart, Lung, and Blood Institute
explains the symptoms,
treatment and effects of angina.
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New
Test Helps Predict Outcome for Cancer Children
Reuters
Friday, August
2, 2002
LONDON (Reuters) - A new test that lights a tumor's DNA is
helping doctors monitor and predict the progress of children suffering
from cancer.
Scientists at Britain's Institute of Cancer Research have developed
the technique that uses a fluorescent red dye to spot highly active
cancer genes in tumors that can increase the odds of a relapse.
"The genetic picture that marks out a tumor for relapse
is there on day one," Dr. Kathy Pritchard-Jones, team leader
of the study, said on Friday.
Knowing which children are most likely to relapse when the
cancer is first diagnosed will allow doctors to tailor treatment
to individual patients. Children with a more aggressive cancer can
be given stronger treatments that could reduce the chances of the
disease returning.
So far the scientists have tested the technique on children
suffering from Wilms' tumor, a type of kidney cancer that affects
children.
But Pritchard-Jones said it could be used for other cancers.
"It is applicable for any type of cancer," she said,
adding that researchers are already testing its impact on prostate
cancer ( news
- web
sites) and muscle tumors in children.
In research reported in The Lancet medical journal, the scientists
analyzed samples of tumors from 18 children with Wilms' tumor. Ten
of the children had suffered a relapse.
Scientists believe certain combinations of cancer genes affect
a child's odds of relapsing. They used a computer program to compare
the red areas in the tumor sample to green areas that signified
active genes in normal tissue.
In all of the children who had a relapse, genes in a region
on chromosome 1 produced a pattern of red fluorescence that was
not seen in the children who remained healthy.
"This is preliminary work with a very new technique, but
we believe it will have real clinical value in the future,"
said Pritchard-Jones.
Wilms' tumor develops from cells that are involved in the development
of the kidney when the child is in the womb. Usually the cells disappear
at birth. In most children the cause of the disease is unknown.
Up to 90% of youngsters with the illness are cured.
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Cardiology
Groups Tout Safety, Benefits of Statins
By Alicia Ault
Reuters Health
Friday, August 2, 2002
NEW YORK (Reuters Health) - Cholesterol-lowering drugs called
statins are one of the most effective weapons in the battle against
heart disease and they are safe, according to a consensus statement
by the American Heart Association ( news
- web
sites) (AHA), the American College of Cardiology (ACC), and
the National Heart, Lung and Blood Institute (NHLBI). The consensus
statement, which is a reiteration of these organizations' prior
positions, will be published in several medical journals in August.
The groups are also jointly issuing new guidelines for health
professionals to address concerns about statins that came up after
last August's recall of Baycol, a statin that was made and sold
by Bayer.
"The principal reason for the AHA, ACC, and NHLBI getting
together to make this statement was to counter the growing concern
that these drugs are dangerous and have lots of side effects,"
said Dr. Richard Pasternak, director of preventive cardiology at
Massachusetts General Hospital, and an ACC spokesman.
The guidelines "lay out how people should be monitored,
and the kinds of groups more likely to have trouble," Pasternak
told Reuters Health.
"For the vast majority of people," he said, statins
"are risk-free."
Dr. Claude Lenfant, NHLBI director, said, "We hope this
joint advisory will give physicians a good appreciation of appropriate
usage of statins and how to monitor for side effects."
The Food and Drug Administration ( news
- web
sites) (FDA) found that Baycol was associated with several dozen
deaths, as well as hundreds of adverse events related to muscle
weakness and a more severe condition called rhabdomyolysis, in which
the muscle breaks down. The FDA said all statins have muscle weakness
listed as a potential side effect, but that there was no indication
that any other drug in the class caused severe problems.
The advocacy group Public Citizen disagreed and petitioned
the FDA to add a large warning to all statins about the potential
for severe muscle weakness and wasting. Nothing has come of the
request.
The ACC and the AHA initially said they believed the severe
muscle side effects were limited to Baycol.
After a more in-depth review of existing and on-going research
and the FDA's adverse reaction database, the two groups, along with
the NHLBI, said they still believe statins are safe, and they developed
new guidelines to make sure patients are closely monitored for side
effects.
The guidelines help identify patients most at risk for muscle
soreness and weakness, which includes people who are extremely old,
those who have a small body frame and are frail, those who have
more than one severe chronic disease (such as kidney disease and
heart disease), and those taking other medications that statins
might interact with.
With Baycol, people who also took the cholesterol-lowering
drug Lopid (gemfibrozil), a member of the fibrate class of drugs,
seemed to have a higher rate of fatal muscle breakdown.
Pasternak said that muscle weakness and rhabdomyolysis was
much higher with Baycol than with other statins. Only one in 1,000
patients taking statins will have some muscle soreness, but fatal
rhabdomyolysis has been detected in less than one in 1 million people,
he said.
General aches and pains that occur in the course of normal,
daily living should not concern people taking statins, said Pasternak.
But, people "should be reporting any serious muscle problems
to their physician, as well as any new and unexpected weakness,
or the presence of brown urine."
"The bottom line is that when statins are given properly
and monitored appropriately, they can do a tremendous amount to
reduce cardiac risk," Pasternak said.
The guidelines are published on the ACC, AHA, and NHLBI Web
Sites, and will appear in the August 7 issue of the Journal of the
American College of Cardiology and the August 20 issue of Circulation.
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Failure
to Lose Weight After Birth May Be Lasting
By Melissa Schorr
Reuters Health
Friday, August 2, 2002
NEW YORK (Reuters Health) - Women who gain excess weight during
pregnancy or fail to shed the pounds after birth are at increased
risk of having those extra pounds stick around for many years, researchers
report.
"Excessive weight gain and failure to lose weight six
months after pregnancy were identifiable predictors of long-term
obesity," study co-author Dr. Charles W. Schauberger, an obstetrician/gynecologist
at the Gundersen Lutheran Medical Center in La Crosse, Wisconsin,
told Reuters Health.
Schauberger and colleague Dr. Brenda Rooney, studied factors
linked to long-term obesity after pregnancy. In an initial study,
the doctors followed 795 women from their first prenatal visit until
6 months after giving birth. All the pregnancies were uncomplicated.
In the follow-up study, the researchers tracked down 540 of
the women an average of 8.5 years later to assess factors associated
with weight gain.
The findings were reported in the August issue of the journal
Obstetrics & Gynecology.
The researchers found that women gained an average of 3.7 pounds
from pre-pregnancy to 6 months after pregnancy and an average of
13.8 pounds at long-term follow-up.
The researchers found that women who did not lose their pregnancy
weight at their 6-month checkup or who had gained more than the
recommended amount during pregnancy were more likely to gain the
most weight in the long term. The Institute of Medicine ( news
- web
sites) advises women of average weight to gain 25 to 35 pounds
during pregnancy, while those who are overweight should gain 15
to 25 pounds.
Those who lost their pregnancy weight after 6 months were heavier
by about 5 pounds at the point of long-term follow-up, while women
who did not lose their pregnancy weight gain by 6 months were 18
pounds heavier, on average, at long-term follow-up.
"This is a controversial subject that has gone on within
the field of obstetrics-gynecology for decades--the issue of how
much weight a woman gains in pregnancy and whether that will adversely
affect her long term prognosis," Schauberger said. "The
concern is that pregnancy weight will never be lost and lead to
morbidity associated with that."
Women who worked out aerobically and who breast-fed more than
three months were more likely in the long term to have the smallest
weight gain, although this effect was not seen in the short term.
However, Schauberger said it was not demonstrated that breastfeeding
alone was responsible for the long-term weight loss.
Schauberger advised women to generally heed the weight-gain
guidelines and attempt to lose pregnancy weight gradually, rather
than immediately after pregnancy.
"Whatever the weight gain during pregnancy, it should
be matched with weight loss afterwards," Schauberger advised.
"Women should have a long-term perspective--they have time
to lose it, but it is a good idea to continue to work to get that
weight off."
Source: Obstetrics
& Gynecology, 2002;100:245-252.
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Better
Collar for Dogs May Cut Kid's Infection
Reuters Health
Friday, August
2, 2002
NEW YORK (Reuters Health) - Fitting dogs with insecticide-saturated
collars may help reduce the risk of a potentially life-threatening
parasitic disease in children, according to a study conducted in
Iran.
The condition, called visceral leishmaniasis, is caused by
a parasite that can be transmitted from dogs to humans via biting
sandflies. Because children like to play with dogs, they can be
particularly vulnerable to the sandfly bites.
Although exceedingly rare in the US, about 500,000 visceral
leishmaniasis cases occur worldwide every year and the disease is
endemic in 70 countries in Latin America, Africa, Europe and Asia.
Symptoms include fever, anemia, and swollen liver and spleen,
and it is "generally fatal if untreated," according to
the report published in the August 3rd issue of The Lancet.
In the current study, Dr. Clive Davies, of the London School
of Hygiene and Tropical Medicine, and colleagues looked at 18 villages
in Iran during the season when transmission occurs. In nine villages,
researchers gave insecticide-saturated collars to dog owners. One
year later the researchers tested dogs and children in all 18 villages
for the parasite, known as Leishmania infantum.
Clive and colleagues estimate that infection rate was reduced
by 54% in dogs and 43% in children in those villages given the dog
collars.
The "protective effect of dog collars against leishmania
transmission was as good as, or better" than, that shown with
more traditional methods, according to the report.
Typical control methods involve spraying of homes with insecticide
and killing stray and pet dogs. But these methods may not be very
effective, in part because owners refuse to kill their dogs or may
quickly acquire puppies, which also become infected, the authors
note.
"In Brazil, for example...visceral leishmaniasis has increased
steadily during the past 10 to 20 years despite the spraying of
200,000 houses and killing 20,000 dogs per year," the authors
write.
"These dog collars could have a role in control of visceral
leishmaniasis and replace controversial dog culling programs in
some countries," they conclude.
Source: The
Lancet 2002;360:374-379.
THURSDAY,
AUGUST 1, 2002
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Fewer
Calories May Lengthen Lives
By Paul Recer
AP Science Writer
The Associated
Press
Thursday, August
1, 2002
WASHINGTON (AP) - For the first time, researchers have found
evidence suggesting people may live longer by eating fewer calories
each day, a dietary restriction that already has shown in experiments
to extend the lives of laboratory animals by up to 40 percent.
Even if the evidence proves to be correct, it's unknown how
much extra time people might live.
Laboratory studies for decades have shown that reducing the
calories fed to lab mice and rats enabled the animals to live much
longer, but the same effect has not been positively demonstrated
in monkeys or in humans.
Now, George S. Roth and his colleagues at the National Institute
on Aging say they have preliminary evidence that biological changes
that help create superaged rodents may also work in humans.
The biological markers — lower temperature, lower insulin levels
and a steady level of a steroid hormone called DHEAS — all occur
in restricted-diet rodents that live about 40 percent longer than
fellow rodents on a normal diet, said Roth. The same biological
markers have now been found in men who are living longest in a continuing
study in Baltimore on aging.
"This means that the biological characteristics of animals
that are on calorie-restricted diets seem to apply to longevity
in people," Roth said.
But Roth, co-author of a study appearing Friday in the journal
Science, said the results should be considered "preliminary"
and he cautions that nobody should start starving in hopes of living
longer. Instead, he said, the study gives only tantalizing hints
that are worthy of further investigation about helping people to
extend life.
Other experts said the study offers new hope about science
some day finding ways to slow aging and extend life.
"The study doesn't absolutely prove anything, but it suggests
that the same mechanisms that operate in calorie-restricted animals
can operate in humans," said Stephen R. Spindler, a human lifespan
researcher at the University of California, Riverside. "It
increases the likelihood that we will find pharmaceuticals that
will mimic this effect."
Roth and his co-authors drew their preliminary conclusions
from the combination of studies on aging rodents, a 15-year-old
study on aging monkeys, and the continuing project called the Baltimore
Longitudinal Study of Aging, which follows the lifespan of people.
The monkey study, conducted at the National Institute of Aging,
is designed to test the longevity effects of calories restriction.
It started in 1987, but Roth said that since Rhesus monkeys can
live for 25 years, it may take another four or five years before
the results are final. Statistically, at least half of the monkeys
will have to complete their normal lifespan before the data is considered
significant, said Roth.
The same is true of the Baltimore study on aging people.
But Roth said he and his team gathered preliminary conclusions
by looking at early trends in the deaths of both the monkeys and
the men. The researchers also divided men in the Baltimore study
into two groups based on measurements of the key biomarkers — temperature,
insulin and DHEAS levels — that were characteristic of the superaged
lab rodents.
Roth said the men whose biomarkers were similar to those of
the calorie-resticted, long-lived rodents were dying at a much slower
rate than were men with other biomarker measurements. Roth said
none of the Baltimore study's men are known to be on restricted
diets, but clearly some are enjoying the same lifespan benefit that
calorie restriction gave the laboratory animals and researchers
are not sure why.
"Whatever it is, they have those biological characteristics
and they seem to live longer," said Roth. "It looks like
that if you have any one of those markers, it is good for a couple
of extra years."
In the monkeys, Roth said those on reduced feeding since the
study started are dying at a rate that is about half that of the
monkeys receiving a full food ration. He said all of the animals
are fed the same nutritionally balanced chow, but the longer-lived
group gets 30 percent less.
Although the findings suggested that a diet restriction of
30 percent or 40 percent could extend life, Roth said, "This
is not practical for most people" and could be unhealthy.
Instead, he said the aging studies may lead to finding drugs
that could mimic the effects and lifespan benefits of calorie restriction.
Spindler agreed, saying the study by Roth and his colleagues
"gives us reason to hope."
On the Net:
Science: http://www.sciencemag.org
National
Institute on Aging: http://www.nih.gov/nia
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Natural
'Fat Burner' Found in Mouse Study
By Merritt McKinney
Reuters Health
Thursday, August 1, 2002
NEW YORK (Reuters Health) - Many scientists have suspected
the body tries to prevent weight gain by heating up the calorie-burning
furnace when we eat too much, but proving this hunch has been difficult.
Now, a new study in mice provides the first proof that this weight-control
mechanism, known as diet-induced thermogenesis, does exist.
The research does not prove that the same phenomenon exists
in people. But if the findings are confirmed, they could point the
way to new targets for anti-obesity drugs, according to the study's
senior author, Dr. Bradford B. Lowell, of Beth Israel Deaconess
Medical Center and Harvard Medical School ( news
- web
sites) in Boston, Massachusetts.
When Lowell's team fed a high-fat diet to normal mice and to
mice that lacked three receptors thought to be involved in diet-induced
thermogenesis, both groups gained weight, but the genetically altered
mice nearly doubled in size.
"They got enormously obese," Lowell told Reuters
Health in an interview. All of the extra weight gained was fat,
according to Lowell. He noted that both groups of mice ate the same
number of calories, but the normal mice gained an average of 6 grams
compared with 27 grams in the altered mice.
"This entire defect is due to an abnormality in energy
expenditure," Lowell said.
The Boston researcher explained that how much we weigh depends
on a balance between how many calories we eat and how many we burn.
He noted that physical activity burns calories as do the body's
normal functions, such as the beating of the heart.
But in certain situations, such as when the body is exposed
to cold or takes in too many calories, Lowell said that the body
is thought to try to prevent weight gain by changing the rate at
which calories are burned. Until now, there has been no proven explanation
of how the process of diet-induced thermogenesis occurs.
The body's sympathetic nervous system, which comes into play
during stressful situations, is thought to be involved in burning
extra calories, so Lowell's team focused on three molecules known
as beta-adrenergic receptors that are involved in this part of the
nervous system and are believed to initiate the process of diet-induced
thermogenesis. They tinkered with the mice's genes to make them
lack active beta receptors.
The findings are published in the August 2nd issue of the journal
Science.
The study is a "definite demonstration" that diet
can have an effect on thermogenesis and that this process involves
beta receptors, Lowell said.
According to Lowell, the research raises several questions,
including what happens "upstream" of the beta receptors.
He noted that the receptors are located in tissues throughout the
body, but one of the major questions is how the brain is involved
in regulating diet-induced thermogenesis.
If future research uncovers how diet-induced calorie-burning
takes place on a molecular level in tissues, it "may reveal
new targets for drug therapy" for obesity, Lowell speculated.
Of course, what occurs in mice does not necessarily occur in
people, but Lowell said there is a "good chance" that
a similar mechanism exists in people. He noted that the same direct
evidence for the existence of diet-induced thermogenesis, which
has now been confirmed, also exists in people.
The study was funded by the National Institutes of Health (
news
- web
sites) and Eli Lilly and Company.
The study is "something of a triumph," according
to Dr. Abdul G. Dulloo, of the University of Fribourg in Switzerland.
He notes in an accompanying editorial that several attempts to trigger
obesity by switching off genes in the sympathetic nervous system
have not succeeded.
As to whether defects in the diet-induced thermogenesis that
eventually lead to obesity are caused by variations in the sympathetic
nervous system "remains to be firmly established in humans,"
according to Dulloo.
Source: Science 2002;297:843-845.
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Nevada
Lawmakers OK Malpractice Cap
By Brendan Riley
Associated Press
Writer
The Associated Press
Thursday, August 1, 2002
CARSON CITY, Nev. (AP) - Trying to end a health-care crisis
triggered by soaring malpractice insurance rates, lawmakers on Thursday
capped pain-and-suffering awards at $350,000 in most lawsuits.
The vote ended after 4 a.m., following several hours of negotiations
to resolve differences between rival Assembly and Senate measures
that developed after the collapse of an early deal announced at
the start of a special legislative session Monday.
The crisis has led some doctors to limit their practices or
even leave the state. Nevada's top trauma center, located in Las
Vegas, shut down for 10 days last month, while Las Vegas obstetrician
Dr. Gloria Martin closed shop rather than absorb a bump in premiums
last month from $23,000 to $80,000 a year.
Republican Gov. Kenny Guinn said the approved plan will help
keep doctors in the state because rates would be expected to fall
in a few years.
"I believe what the doctors were looking for, what they
really wanted, was the ability to see the light at the end of the
tunnel," he said.
At the Senate's insistence, the agreement allowed the $350,000
cap to be waived only when a jury finds gross negligence or when
a judge finds "clear and convincing" evidence warranting
a higher award.
The first plan would have allowed automatic exceptions in the
most serious cases, such as death, brain damage or blindness. In
such cases, lawsuits would have been allowed up to the maximum on
a doctor's policy, typically $1 million.
Bill Bradley ( news
- web
sites) of the Nevada Trial Lawyers Association decried the legislation,
saying special interests got "the upper hand at the expense
of society in general."
But Dr. Ikram Khan, a Las Vegas general surgeon who led the
effort to get the cap, called the new law "a major, significant
accomplishment" that would help lower premiums and stabilize
the insurance market.
Insurance industry lobbyist Jim Wadhams said insurers will
want to see whether the plan can survive court challenges. But,
he said, "it's a positive change. It will just take time."
Nevada's problems began in December, when the company that
had insured 60 percent of the state's doctors began canceling its
malpractice policies.
Facing losses of nearly $1 billion, Minnesota-based St. Paul
Cos. said it was getting out of the malpractice insurance business
worldwide. Other companies also pulled out of Nevada, citing the
high cost of settling malpractice claims in a state with no cap
on jury awards.
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Children
Get Chemotherapy Overdose
By Brian Witte
Associated Press
Writer
The Associated Press
Thursday, August 1, 2002
BALTIMORE (AP) - Two cancer-stricken children were mistakenly
given chemotherapy overdoses by a doctor at Johns Hopkins Children's
Center, and one of them may have gone deaf as a result, health officials
said.
The child who lost his hearing, a critically ill 2-year-old
boy, received twice the correct dose of the cancer drug carboplatin
on three successive days in late May, the state health department
said.
A 3-year-old girl also was given an overdose around the same
time, but the dose was corrected after one treatment and no harm
was done, the agency said.
Carol Benner, director of the state Office of Health Care Quality,
said Thursday the overdoses were the doctor's error. She would not
identify the doctor or the children.
"You would have hoped that a nurse would have picked it
up or the pharmacy would have picked it up and it didn't happen,
so this is a clear example of a system's breakdown," Benner
said.
Benner said hearing loss is a known risk of the medication,
so it was not certain whether the boy's deafness was a result of
receiving too much. But the overdose significantly increased the
risk, she said.
Hospital spokesman Gary Stephenson issued a statement acknowledging
the error.
"Hopkins deeply regrets the accidental dosing error with
an anticancer drug being used to prepare a critically ill ... child
for a bone marrow transplant," the statement said.
He said the hospital had systems in place to make sure doses
are correct. The hospital discovered the overdose during a routine
check, he said.
The discovery of the boy's overdose prompted hospital officials
to review dosages for five other patients, and that turned up the
second overdose.
The state agency could fine the hospital up to $10,000 and
impose restrictions if Hopkins does not take steps to prevent another
such accident. But Benner said the children's facility has cooperated
fully.
"This does not appear to be a pattern," she said.
The boy who became deaf suffered from neuroblastoma, the third
most common cancer in children and one that typically attacks the
adrenal glands or nerves in the back of the abdomen. Benner said
the child may be regaining some hearing, but it remains unclear
how much.
She said the boy eventually did receive the bone marrow transplant
and seems to be recovering.
The health department began an investigation last month after
receiving an inquiry from The (Baltimore) Sun, the newspaper reported.
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Three
Longevity Factors Found in Mice and Men
Reuters
Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - Men who have three "longevity
factors" seen in animals on calorie-restricted diets appear
to enjoy a longer life span--even without cutting back on calories.
The factors--a low body temperature, low blood levels of insulin,
and slower decline in the hormone DHEAS--were found in rhesus monkeys
fed a diet with 30% fewer calories than normal.
Although most of the animals are still living, it seems that
the restricted-calorie diet is boosting the monkey's life span,
according to the report issued Thursday in the journal Science.
The mortality rate is about 15% in the calorie-restricted monkeys
compared with 24% in monkeys allowed to eat as much food as they
want.
Many studies in rats and other animals have suggested that
fewer calories equal a longer life, and the three factors have been
seen in those species on a reduced-calorie diet.
However, it has not been clear if the three factors are important
in monkeys or humans, according to the researchers from the National
Institute on Aging, a division of the National Institutes of Health
( news
- web
sites) in Baltimore, Maryland.
In the new study, Dr. George S. Roth and colleagues looked
at these factors in the rhesus monkeys, as well as 700 men enrolled
in the Baltimore Longitudinal Study of Aging.
The men were split into two groups--those with higher body
temperature and insulin levels and low levels of DHEAS, and a group
with lower body temperature, insulin levels and higher DHEAS. The
men reported consuming about 2,300 calories a day and were not necessarily
on a calorie-restricted diet.
Men with lower levels of insulin, lower body temperature and
higher levels of DHEAS tended to live longer, as did the calorie-restricted
monkeys that showed a similar trend in those three factors.
"The fact that these men apparently weren't practicing
caloric restriction is important because it means that there may
be other ways to achieve biological hallmarks without having to
undergo drastic dietary changes," Roth said in a statement
issued by the NIH.
"Although we don't yet know what these pathways are, this
finding suggests it may be possible to develop compounds that offer
the benefits of caloric restriction without having to resort to
it," he added.
While it is not clear exactly what environmental or genetic
factors cause the men to have factors that mimic calorie restriction,
it appears that those factors are related to longevity and are "therefore
worthy of further investigation," the authors conclude.
Source: Science 2002;297:811.
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Preventing
that Aching Back
Health Scout News
Thursday, August
1, 2002
(HealthScoutNews) -- What can you do to prevent those nagging
back aches?
The Presbyterian Hospitals of Hunt County, Tex., offers some
tips. All involve being aware of your posture and ensuring that
your back gets proper support:
- Sit all the way back in
chairs and be sure to sit up straight.
- If you must stand for
a long time, be sure to switch positions often.
- When sleeping, be sure
your pillow supports your neck and shoulders as well as your head.
- When lifting an object,
bend your knees, keep your back straight and always keep your
head up.
- Never twist your body
to place an object on the ground next to you. Instead, move your
feet to keep the object in front of you.
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Impact
of US Childhood Vaccine Shortage Substantial
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - Last year's shortage of a routine
childhood vaccine has left many children in Puerto Rico vulnerable,
with similar findings in the United States possible, according to
a survey by the Centers for Disease Control and Prevention ( news
- web
sites) (CDC) in Atlanta, Georgia.
In March 2001, there was a temporary shortage of the diphtheria
and tetanus toxoids and acellular pertussis (DTaP) vaccine, which
is given in four separate doses to children between the ages of
2 months and 4 to 6 years. At the time, the CDC recommended that
doctors defer administration of the fourth dose of the vaccine if
their supplies were low.
According to a new survey of 990 2-year-olds in Puerto Rico,
the shortfall led to a major drop in the number of children receiving
the fourth dose of the vaccine on the island in 2002 compared with
2001 (32% versus 96%).
"Our findings in Puerto Rico may herald similar findings
in the United States but this may not be evident until later this
year or perhaps early calendar year 2003," Dr. Francisco Alvarado-Ramy,
of the Puerto Rico Department of Health, told Reuters Health.
Coverage levels for the first three doses of the vaccine remained
well above 90%, the researcher said.
Now that DTaP supplies have returned to normal, the CDC recommends
resuming the routine DTaP schedule. All children who did not receive
the fourth dose of vaccine should now get it. "The CDC will
monitor post-shortage vaccination coverage levels," Alvarado-Ramy
added.
Source: Morbidity and Mortality Weekly Report 2002;51:667-668.
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Morphine
Fuels Tumors in Mice
By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Thursday, August
1, 2002
THURSDAY, Aug. 1 (HealthScoutNews) -- The well-known painkiller
morphine may actually stimulate the growth of blood vessels, causing
tumors to grow, new research contends.
The animal-study findings, by University of Minnesota Cancer
Center researchers, are preliminary and have yet to be proven in
humans, and some experts feel they never will be.
"It was a tissue study in mice of a human cell line, and
the biology and pharmacology and pharmacodynamics of medication
in other species are very different from what can be expected in
humans," says Dr. Sean O'Mahony, the medical director of the
palliative care service at Montefiore Medical Center in New York
City, who adds that he has had cancer patients on morphine for months
and years who have experienced no ill effects.
But even if the results are duplicated in other species, the
news is not all negative.
"Blood vessel growth can be good and bad," says Kalpna
Gupta, lead author of the study, which appears in today's issue
of Cancer Research. Stimulating blood vessel growth can actually
be beneficial for cardiovascular health and for wound repair, she
says.
And even cancer patients, who are often given morphine for
pain, need not despair. First of all, morphine is usually not given
in early-stage cancer patients. Second of all, the lead author stresses
that the results are just too preliminary to draw any firm conclusions.
"This is an animal study in a laboratory and until a human
study is done, I really don't think there is any need to agonize,"
says Gupta, who is an assistant professor in the University of Minnesota
Medical School's department of medicine. "One should not get
worried with these results; it's purely an experimental study in
mice, and we don't know if it will be similar in humans."
In the experiment, doses of morphine proportional to the doses
given to human cancer patients caused a human tumor model in mice
to grow. The effect did not take place right after the tumor was
implanted, but at a later stage of development.
"What happens is the blood vessels do not initiate growth,
but they make it grow faster," Gupta explains. "Once the
blood vessels have grown to a certain extent, then they take the
cells from the tumor and spread them to other parts of the body."
The morphine appeared to work through a particular signaling
pathway -- the mitogen-activated protein kinase (MAPK) signaling
pathway, which plays a key role in the formation of new blood vessels.
And the morphine also contributed to the survival of endothelial
cells, which form blood vessels.
Knowing the mechanism at work here may enable researchers to
develop pain-killing compounds that don't have the effect of stimulating
blood-vessel growth. Or it may enable researchers to find alternative
ways of administering morphine.
Alternatively, the findings, if confirmed, could be used to
help with wound healing or cardiovascular medicine.
"We might find a compound to make blood vessels grow faster
in wound healing," Gupta says.
"It has a brighter side to it. That's the importance of
our basic findings," she adds.
"Blood vessels play a central role in so many diseases,
and all these patients receive morphine. So we are working on several
aspects so that we can make better use of it when we want its beneficial
effects or when we want preventive effects," she says.
What To Do
For more information on the role of angiogenesis in cancer,
visit the National
Cancer Institute, which also has more on opioids
for cancer.
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Linoleic
Acid Intake May Cut Stroke
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - Consuming foods rich in linoleic
acid--a fatty acid found in corn, sunflower and safflower oils and
soybeans--may protect a person from the most common type of stroke,
new study findings suggest.
Ischemic strokes, which occur when a clot or narrowed artery
cuts off the blood supply to part of the brain, account for about
80% of all strokes. The other 20% are due to broken blood vessels
in the brain and are called hemorrhagic strokes.
Lead author Dr. Hiroyasu Iso of the University of Tsukuba in
Ibaraki-ken, Japan, and colleagues followed 7,450 men and women
aged 40 to 85 for a period of 6 to 14 years. At the start of the
study each person answered questions about their daily food intake
and gave a blood sample that was later evaluated for levels of linoleic
acid.
At the end of the study period, 122 people had an ischemic
stroke and 75 had hemorrhagic strokes, according to the report published
in the August issue of Stroke: Journal of the American Heart Association
( news
- web
sites).
"The major finding of the present study was that (levels
of blood) linoleic acid was inversely associated with the risk of
total stroke, ischemic stroke and more specifically lacunar infarction"--a
type of stroke that involves small arteries deep in the brain, according
to Iso and colleagues.
The investigators report that a 5% increase in consumption
of linoleic acid was associated with a 28% decrease in total stroke
risk, a 34% decrease in ischemic stroke, a 37% reduction in lacunar
stroke and a 19% reduction in hemorrhagic stroke.
Iso's team notes that linoleic acid may decrease blood pressure
and reduce the blood's ability to "stick" together, or
form clots.
"This finding implies the potential importance of dietary
intake of linoleic acid for the prevention of ischemic stroke. A
clinical trial is necessary to confirm the causality between linoleic
acid intake and risk of ischemic stroke," the authors conclude.
Source: Stroke 2002;33.
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HRT
Protects Against Endometrial Cancer
HealthScoutNews
Thursday, August
1, 2002
THURSDAY, Aug.1 (HealthScoutNews) -- Hormone replacement therapy
(HRT) does not increase the risk of endometrial cancer and may even
help prevent the disease by protecting the lining of the uterus,
says a study in this week's British Medical Journal.
The study by researchers across the United Kingdom is one of
the largest of its kind and included 534 postmenopausal women.
Prior to the study, 364 of the women had taken estrogen and
progestin HRT, 164 hadn't used any HRT, and 10 had taken estrogen-only
HRT.
During the study, the women were given continuous combined
HRT. The researchers took biopsy samples from the women before they
started the combined HRT, at 9 months, between 24 and 36 months,
and then again at the end of the five-year study.
The biopsy results showed that 21 of the women had abnormal
endometrium before the start of the study. When associated with
other cellular changes, that can be an early sign of cancer. But
after nine months of the combined HRT, the endometrium in all 21
women had reverted to normal. None of the 534 women developed endometrial
cancer during this study.
The authors say the study indicates that women who take daily
combined HRT may be better protected against endometrial cancer
than women who don't take any kind of HRT.
HRT has been the subject of several recent studies, with controversial
results. A national U.S. clinical trial was recently halted after
a little more than five years when the health risks were found to
outweigh the benefits. The Journal of the American Medical Association
( news
- web
sites) reported last month that women in the trial who were
taking the combination of estrogen and progestin experienced a 29
percent increased rate of coronary heart disease problems, compared
to women taking a placebo.
More information
The National
Cancer Institute has some more facts about the use of hormones
after menopause.
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Nurses
Provide Top Care for Chronic Lung Disease
Reuters Health
Thursday, August
1, 2002
LONDON (Reuters Health) - Specially trained nurses can be as
effective as doctors for managing routine outpatient care of patients
with stable chronic lung disease, British researchers report.
According to Dr. Andrew Exley and colleagues from the Medical
Research Council, finding alternative ways to address the ongoing
needs of patients with chronic diseases is becoming urgent as the
number of hours junior doctors are allowed to work is reduced under
European rules.
Routine monitoring and minor changes to treatment could be
managed by trained nurse practitioners, but little research has
looked at their possible role in the UK setting, the researchers
report in the August issue of Thorax.
The team randomly assigned 80 patients with a chronic lung
disease called bronchiectasis to 1 year attending outpatient clinics
run by a nurse practitioner and 1 year going to clinics run by a
doctor.
Bronchiectasis is a progressive disease that causes increasing
difficulty breathing. The disease accounts for about 1 in 200 admissions
to hospital in England and Wales.
The researchers monitored the lung function and general health
of the patients, as well as the use of healthcare resources. There
was little or no difference in lung function, ability to complete
a 12-minute walking test or other measures of health-related quality
of life, they report.
"I think this study shows nicely how valuable a nurse
practitioner can be as part of a combined specialist team,"
Exley said. He added that there was "high patient satisfaction
with this approach."
Nursing care did cost on average 1,497 pounds more per patient,
largely because there were more hospital admissions under nurse-led
care, but the paper showed that the difference in costs between
physician-led and nurse-led models dropped significantly in the
second year of the study.
"There's a lot of sense suggesting that if you're doing
something slightly different that there are going to be some additional
costs up-front in order to enable one to achieve this sort of model,"
Exley explained. "The mean difference in resources came down
dramatically in the second year and I would expect it to drop further."
The researchers conclude that in this setting, nurse practitioner
care is safe and as effective as doctor-led care. How far the results
can be extended to other diseases needs discussion, they note.
Source: Thorax
2002;57:661-666.
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Chronic
Lung Obstruction Now a Woman's Disease
By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Thursday, August
1, 2002
THURSDAY, Aug. 1 (HealthScoutNews) -- The death rate from chronic
lung obstruction has tripled among American women in the last two
decades, according to a new government report that also shows the
disease in general is vastly under-diagnosed.
As many as 24 million Americans suffer symptoms of chronic
obstructive pulmonary disease (COPD), mostly due to smoking, the
report says. But 14 million of them aren't properly diagnosed with
these health problems, which include chronic bronchitis and emphysema,
it adds.
Not only is the prevalence of COPD about 2.4 times higher than
physicians formally determine, but women are now more likely than
men to die from the disorder, according to the new figures.
"COPD is now a woman's disease," says Dr. David Mannino,
a lung expert at the U.S. Centers for Disease Control and Prevention
( news
- web
sites) and lead author of the surveillance report. Mannino blames
the "alarming" increase on the rise in smoking among women
after World War II.
In the year 2000 alone, COPD caused 8 million doctor and outpatient
visits, 1.5 million trips to the emergency room and 726,000 hospitalizations
in this country, on its way to killing almost 120,000 people, the
CDC says. It is the nation's fourth leading cause of death, generally
afflicting the elderly.
The rate of death from the disease among women tripled between
1980 and 2000, from 20 per 100,000 to 57 per 100,000. It rose much
more modestly among men, from 73 to 82 per 100,000, during that
period.
But in the year 2000, government officials say, there were
59,936 female deaths from COPD in 2000 vs. 59,118 male deaths.
Smoking is believed to account for 80 to 85 percent of COPD
cases in the United States, with the rest attributed to various
other causes such as pollution and on-the-job dust, Mannino says.
In developing countries, the disease's origins are somewhat broader,
and include coal burned during cooking and heating.
COPD is irreversible, and the treatments that exist can only
soothe symptoms. However, quitting smoking can slow the progression
of the disease, says Dr. Gail Weinmann, of the National Heart, Lung,
and Blood Institute. "It's never too late to stop smoking and
it's always too early to start," Weinmann says.
Some research has suggested that women may be more vulnerable
than men to lung damage from tobacco, Weinmann says. But it's hard
for scientists to separate this effect from that of gender differences
in lung and airway size.
The good news in the report, officials say, is that the share
of Americans under age 55 with mild or moderate COPD dropped between
1971 and 1994, implying that it will become less common as the population
ages. Fewer people between the ages 25 and 54 are smoking, Mannino
says, likely explaining the decline in prevalence.
Still, experts call for building awareness of the disease among
patients and doctors. In 1993, it led to an estimated $23.9 billion
in direct and indirect costs.
"We're very pleased with the report because it will give
some data to the magnitude of the problem," says Suzanne Hurd,
coordinator of the US COPD Coalition.
Hurd's group wants doctors to take a more active role in screening
their patients, particularly smokers, for evidence of lung impairment.
That includes using a device called a spriometer that measures airway
function, and not simply relying on self-reported complaints.
Indeed, one reason the CDC report revealed such a dramatic
undercount in the prevalence of COPD was that it relied on spirometer
evidence, in addition to patient surveys and medical records. Mannino
says 13.5 percent of American adults show signs of mild-to-moderate
lung impairment when tested with the device, but only 30 percent
of those are diagnosed with the disease.
As a result, some experts recommend that every current or former
smoker age 45 and up have an occasional lung function test. The
same applies for those with breathing trouble or a history of asthma.
What To Do
The USCOPD Coalition wants to make November National COPD Awareness
Month, and Nov. 20 World COPD Day. For more information, check the
group's
web site. The American
Lung Association also has more on the disease.
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Brain
defect may play role in stuttering
From the Science & Technology
Desk
United Press International
Thursday, August 1, 2002
HAMBURG,
Germany, Aug. 1 (UPI) -- Stuttering could be caused by a structural
defect in the left hemisphere of the brain that triggers nerve disconnection
in the regions controlling speech, a new study released Thursday
suggests.
Researchers
from the Universities of Hamburg and Göttingen report chronic stuttering
seems to be the result of a lapse in the brain's cortex in the left
hemisphere, the area responsible for speech. To demonstrate this,
the researchers compared 15 individuals with persistent stutters
to 15 people with normal speech.
Using
magnetic resonance imaging or MRI, they reviewed the brain tissue
structure in each participant. They found the tissue structure of
a region in the left hemisphere of the brain was significantly different
among stuttering patients compared to the normal group. Fiber tracts
in this region act as links for brain structures involved in the
articulation and planning of speech. The defect could explain how
disrupted signal transmissions between brain structures in this
area prevent an individual from speaking fluidly.
"Stutterers
have none or a less developed pathway connecting language areas
with the mouth motor output areas," in the brain, Cornelius
Weiller, director of the University of Hamburg's neurology institute,
told United Press International.
"We
know now where to look for treatment," Weiller said. "So
far, some believed an overactive right hemisphere would be the problem,
which would have resulted in a suppression of right hemisphere activity.
Our results suggest a left hemisphere problem."
It is
possible this structural change occurs during childhood when early
language and speech-acquisition skills are being developed, Weiller
said. However, it is unclear why some children who stutter go on
to become fluent speakers and others must endure persistent stuttering
through adulthood.
Dr. Anne
Foundas, a neurology professor at Tulane University in New Orleans,
has studied stuttering and also found structural differences.
"We
found that there were differences in the anatomy of some of these
gray matter regions in (the brains of) adults with persistent developmental
stuttering," Foundas said. "We did not study the white
matter connections."
This
German study, she added, "did not study gray matter anatomy,
so it may be that both are affected in people who stutter. A lot
more research needs to be done to learn more about the neural mechanisms
that induce stuttering."
Martin
McKeown, a neurologist at Duke University Medical Center in Durham,
N.C., agreed the mystery behind stuttering has not been completely
solved, though these findings provide important clues.
"Because
speech is a really complicated sequence of motor movements that
requires coordination between different brain areas," McKeown
told UPI, "it is therefore reasonable that abnormalities of
the connections between these areas of the brain may play role in
this disorder."
The findings
appear in the August 3 issue of The Lancet.
(Reported
by Katrina Woznicki, UPI Science News, in Washington)
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Ultrasound
Detects Silent Clots in Brain
By Merritt McKinney
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - In an advance that may reduce the
side effects of coronary artery bypass surgery, researchers in Norway
report that an ultrasound device is highly effective at detecting
tiny blood clots that can enter blood vessels in the brain.
In testing in the lab and in patients with mechanical heart
valves or blocked neck arteries, the technique, known as multi-frequency
transcranial Doppler ultrasound (MTCD), correctly distinguished
between blood clots and other substances in the blood, such as tiny
gas bubbles, nearly all of the time. In the human tests, MTCD correctly
identified almost 99% of clots, according to a report in the August
issue of Stroke: Journal of the American Heart Association ( news
- web
sites).
"We can now precisely detect very small blood clots when
they enter the patient's brain," said Dr. David Russell, a
professor of neurology at The National Hospital in Oslo.
These small clots are thought to contribute to the memory and
concentration problems experienced by many bypass patients after
surgery, but distinguishing the clots from harmless gas bubbles
has been difficult.
Russell explained that the clots are so small that they do
not cause immediate symptoms, so they would otherwise go undetected.
Though each clot is tiny, if enough of them enter the brain they
can affect memory and concentration, Russell noted.
The build-up of small clots in the brain may also be a warning
sign that blood clots are forming in other parts of the body, such
as the heart or a major artery in the neck, according to Russell.
If this is the case, the next clot that travels to the brain may
be big enough to block a major artery and cause a stroke, Russell
explained.
According to Russell, the new clot-detection technique may
help minimize the side effects of bypass surgery. During bypass
surgery, blood vessels are taken from other parts of the body and
grafted onto the heart to bypass a blocked vessel. Though the surgery
can reduce the risk of heart attack and other cardiovascular complications,
up to 50% of people who have bypass surgery experience some mental
decline, such as impaired memory or a reduced ability to pay attention,
afterwards.
These side effects are due "at least in part" to
small blood clots entering the brain during surgery, according to
Russell.
"This new device can warn the surgical team when small
blood clots begin to enter the brain," he said. Surgeons may
then make changes to their technique to reduce the risk that larger
clots will enter the brain, he said. Another future possibility,
according to Russell, would be to give patients medications to reduce
the harmful effects of these tiny clots.
"We hope therefore that this method in the future will
help to reduce the number of patients with memory and concentration
problems following surgery and make this operation safer for the
patient," Russell said.
The Norwegian researcher added that the technique may have
other benefits as well. Detecting small blood clots may identify
patients with mechanical heart valves who are at high risk of stroke,
he said. Currently, these patients have a 1% to 5% risk of stroke
per year. Similarly, the technique may also be useful in evaluating
patients who have a narrowed carotid artery in the neck, he said.
Russell noted that the screening technique has only recently
become available in Europe and is currently being evaluated by the
US Food and Drug Administration ( news
- web
sites).
Source: Stroke 2002;33.
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Millions
May Suffer from Long Disease
From the Science & Technology
Desk
United Press International
Thursday, August 1, 2002
ATLANTA, Aug. 1 (UPI) -- About 14 million Americans
may have chronic obstructive pulmonary disease -- a lung condition
primarily due to smoking and the fourth leading cause of death in
the United States -- and not even know it, the Centers for Disease
Control and Prevention announced Thursday.
Ten million
adults were listed as diagnosed with chronic obstructive pulmonary
disease or COPD in 2000, the CDC said. Of those, about 1.5 million
adults visited emergency rooms due to COPD-related conditions, 726,000
were hospitalized and 119,000 died.
In addition,
data from a large government study -- the National Health and Nutrition
Examination Survey III -- estimates 14 million adults suffer from
the condition without diagnosis, bring the total for COPD to 24
million Americans.
The CDC
is encouraging physicians to test lung function in current and former
smokers and anybody with respiratory problems, the agency's David
Mannino said at a news briefing. Mannino also urged people with
a history of smoking or respiratory problems to discuss the condition
with their doctors.
COPD
actually is a group of diseases -- including emphysema and chronic
bronchitis -- that obstruct airflow in the lungs. Its symptoms include
shortness of breath, chronic cough and phlegm production. The condition
can be so debilitating that it limits people's ability to work or
carry out daily activities.
Barry
Make, director of the emphysema program at the National Jewish Medical
and Research Center in Denver, told UPI one reason people do not
realize they have COPD is it is "a silent disease. People are
often in the early stages of disease and do not have symptoms, so
it's hard to know to get tested." Or, they might ignore some
of their symptoms and avoid seeing a doctor.
In addition,
Make said, although COPD is a leading killer of adults, it is associated
with smoking so it has not received as much attention as heart disease
and cancer. He recommended all smokers or former smokers over the
age of 40 have their lung function tested, especially if they exhibit
"smoker's cough," a sign of bronchitis. People with shortness
of breath should also get tested, he said.
CDC also
found in 2000, women for the first time surpassed men in number
of deaths from COPD. About 800 more women than men and their rate
of death from the disease has tripled over the last 20 years. This
reflects an increase in the number of women who smoke, a trend that
first began in the 1940s. The disease can take decades to show up,
Mannino said. Typically, lung function decline begins in smokers
in their forties and death occurs when they reach their sixties
or seventies.
Overall,
the number of COPD cases has decreased over the last 25 years among
adults younger than 55, Mannino said. This is due largely to an
overall decrease in smoking since the 1960s and suggests the disease
may continue to decline.
However,
Make said he believes the "incidence of COPD is rising and
will continue to rise." He predicted in the next 10 years it
will probably move up from fourth to become the third leading cause
of death. He also noted COPD is "an issue worldwide, too"
and is among the top 10 leading causes of death around the globe.
The most
effective treatment for COPD is to stop smoking, Make advised. However,
there are some effective medications, such as bupropion and nicotine
patches, now available to aid people with the condition.
Medications
also are available that may prevent symptoms of COPD from worsening,
and medications are in development that appear to decrease the shortness
of breath. Other options are also available such as pulmonary rehabilitation
and oxygen, which can be life saving, Make said.
(Reported
by Steve Mitchell, UPI Medical Correspondent, in Washington)
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Excess
Weight in Teens Linked to Ovarian Cancer
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - Women who are overweight as young
adults may be more likely than slender women to develop premenopausal
ovarian cancer later in life, new study findings suggest.
While several studies have examined a possible link between
body weight and ovarian cancer, the findings have been mixed.
In the current study, Dr. Kathleen M. Fairfield of Harvard
Medical School ( news
- web
sites) in Boston, Massachusetts, and colleagues assessed current
weight, weight at age 18 and adult weight change, in relation to
ovarian cancer risk. The findings are published in the August issue
of the journal Obstetrics and Gynecology.
In all, 109,445 adult female nurses participated in the investigation
with 402 cases of ovarian cancer being reported among the group.
While current weight and weight gain over time were not associated
with ovarian cancer, women who reported that they were overweight
or obese when they were 18 years old were roughly twice as likely
to develop premenopausal ovarian cancer, Fairfield and colleagues
report.
Specifically, women who had a body mass index (BMI) of 25 or
greater had a greater risk of premenopausal ovarian cancer compared
with women who had a BMI of less than 20.
BMI is a measurement that takes into account a person's height
and weight; values of 25 to 29 are an indication of being overweight,
and 30 or higher signifies that a person is obese. For example,
an individual who is 5'6" tall would have a BMI of 20 if they
weighed 125 pounds, a BMI of 25 if they weighed 155 pounds and a
BMI of 30 if they weighed 185 pounds.
"Women who were heaviest at age 18 were at increased risk
of ovarian cancer in the premenopausal period," the authors
write.
"This is particularly concerning, given the current epidemic
of obesity among adolescents and young adults. If confirmed, these
findings suggest an additional reason for avoiding adolescent obesity,"
Fairfield and colleagues conclude.
There was no link between weight at age 18 and risk of developing
ovarian cancer after menopause. In the study, 91 cases of cancer
were diagnosed before menopause and 222 were diagnosed after menopause,
while in the other cases, menopause status was unknown.
Most cases of ovarian cancer occur after menopause, according
to the American Cancer Society ( news
- web
sites).
Source: Obstetrics and Gynecology 2002;100:288-295
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Cutting
cargs risks health problems
From the Science & Technology
Desk
United Press International
Thursday, August 1, 2002
DALLAS, Aug. 1 (UPI) -- The popular high-protein,
low-carbohydrate diet many overweight people are using to shed pounds
quickly also can increase the risk of kidney stones and bone loss,
a new study revealed Thursday.
Researchers
at the University of Texas Southwestern Medical Center said they
have reached that conclusion after studying 10 healthy individuals
who followed this diet.
"It's
already been known a high-protein diet will produce high acid loads,"
researcher Dr. Chia-Ying Wang, a professor of internal medicine,
told United Press International. The high-protein diet is widely
used in this country, Wang said, and scientists wanted to confirm
the dangers of this diet. Dieters will lose weight from the high-protein
approach, but it is not a healthy way to shed those pounds, she
said.
All 10
subjects began by eating a regular diet for two weeks. Then they
were placed on a highly restrictive diet that allowed for some vegetables
but no fruits and less than 20 grams of carbohydrates. Protein consumption
was unrestricted. The subjects followed this diet for two weeks
before starting a less-restrictive diet for the final four weeks.
Everyone took daily multivitamin supplements to reduce the risk
of vitamin deficiency. During the last five days of each stage of
the study, participants underwent various tests to see how the various
diets were affecting their bodies.
Test
results showed acid load in the blood rose as much as 90 percent
while subjects were on the high-protein diet -- a state called ketoacidosis,
which also is associated with diabetes. Levels of urinary citrate,
which inhibits kidney stones, dropped by almost 25 percent. Urinary
citrate readings improved slightly when subjects went on to the
more moderate diet.
Researchers
also reported acid excretions rose from baseline levels of 61 milli-equivalents
per day to 116 during the restricted diet. These levels dropped
slightly to 112 when the group resumed eating moderate levels of
carbohydrates. The chronic acid excretion involved in ketosis suppresses
the function of osteoblasts, cells that help form bone, increasing
the risk of bone loss. The high acidic content of meat and the lack
of alkaline foods such as carbohydrates in the diet increased the
risk for kidney stones and bone loss, researchers reported.
Wang
said, on average, people should consume half their daily calories
from carbohydrates. The high-protein diet permits only 15 percent
of daily calories to come from carbohydrates. Limiting carbohydrates
forces the body to search for other sources of energy, one of which
is fat, Wang said. Ketone bodies, which cause ketoacidosis, are
formed when the body is forced to burn fat for energy.
"This
type of study is unique because they put healthy people on the diet,"
and they still went on to develop abnormal urinary citrate levels,
Liz Applegate, a professor of nutrition at the University of California
at Davis, told UPI. "There's a chunk of the population that
could be susceptible to kidney stones and if they're trying out
this diet, it's dangerous."
Although
excessive animal protein levels are linked to calcium loss, Applegate
said people rarely stay on the low-carbohydrate, high-protein diet
long enough to develop any potential for bone problems because too
often people start to miss the foods they've been asked to cut out.
"Anybody
can lose weight," Applegate added. "I can stick you on
a butter diet and you'll lose weight." The key is keeping those
pounds off, she said.
The U.S.
Surgeon General's office in Washington and the Centers for Disease
Control and Prevention in Atlanta report 61 percent -- nearly two-thirds
-- of all Americans are either overweight or clinically obese.
The research
is reported in the August issue of The American Journal of Kidney
Diseases.
(Reported
by Katrina Woznicki, UPI Science News, in Washington)
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UK
Viagra Patients Report Days-Long Nosebleeds
By Richard Woodman
Reuters
Thursday, August
1, 2002
LONDON (Reuters) - A man who took Viagra to boost his sexual
performance ended up in hospital for almost a week with an unstoppable
nosebleed, British surgeons reported Thursday.
Lucy Hicklin and colleagues at St. George's Hospital in London
said the man was admitted to the accident and emergency department
after a six-hour nosebleed.
Even there, several attempts to stop the bleeding failed and
doctors kept him in hospital for six days.
The man, who was in his late 50s, told them he had engaged
in energetic sexual activity in the hours before his first nosebleed.
To enhance his performance, he had taken a 50 mg dose of Viagra.
The doctors said they had also seen another Viagra patient
who suffered the same fate though his nosebleed was stopped after
only two days.
Both men had high blood pressure, a recognized risk factor
for heavy nosebleeds, but neither had needed to go to hospital before.
Writing in the Journal of the Royal Society of Medicine, they
said Viagra may act on the nose as well as the penis.
They said that cases of "honeymoon rhinitis," where
men and women experience nasal stuffiness during sex, are well documented,
and it is listed as a potential side-effect of Viagra.
They suggested the drug could have engorged the veins in the
nose and made heavy bleeding more likely to happen, but stressed
this was still only a theory.
A Pfizer spokesman said the drugmaker did not believe there
was any connection between Viagra and nosebleeds, adding that not
a single nosebleed had been reported during a four-year follow up
study of 1,000 men taking the drug.
Reports of any kind of bleeding in Viagra patients were also
extremely rare and there was no evidence of a causal link.
Although this side effect did not seem to have been reported
before, the doctors said this might be because patients are too
embarrassed to discuss sexual matters, especially sexual dysfunction.
Viagra has been a huge commercial success for Pfizer Inc, with
more than $1.5 billion in worldwide sales last year.
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Swedish
Study Shows Mammography Saves Lives
By Linda Carroll
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - A new analysis of breast cancer
( news
- web
sites) data from Sweden shows that mammography may reduce deaths
from breast cancer by as much as 45%, a finding that may help settle
the ongoing debate over the cancer screening test, experts said.
An international group of researchers who compared breast cancer
death rates before and since the establishment of county screening
programs found that mammography consistently saved lives, according
to the report published in the August 1st issue of the journal Cancer.
"The take-home message is that women who get regular mammography
can reduce their risk of dying by 40% to 45%--maybe even more in
this country," study co-author Dr. Robert A. Smith, director
of cancer screening at the American Cancer Society ( news
- web
sites) in Atlanta, Georgia, said in an interview with Reuters
Health.
The new study goes a long way to settling the mammogram debate,
Dr. Stephen A. Feig, a professor of radiology and director of breast
imaging at the Mount Sinai Hospital in New York City, said in an
interview with Reuters Health.
"There has been a controversy in the past 2 years,"
added Feig, who wrote an editorial accompanying the article. "Some
researchers had said that the randomized trials that had shown benefit
were flawed. This study proves that screening does have a benefit.
I think this will be the final word on it."
For the new study, researchers looked at data from seven counties
that include more than 30% of Swedish women. Because of the completeness
of Swedish medical records, the researchers were able to examine
the number of women invited to be screened and to identify who did
and who did not get mammograms.
They were also able to figure out whether women who died had
been diagnosed with breast cancer before or after mammograms were
offered. This allowed the researchers to leave out deaths from women
who were diagnosed with cancer before the county screening program
was instituted, but who died during the period when mammograms were
available.
Ultimately, there were 5,728 breast cancers diagnosed in the
years preceding the establishment of county screening programs,
which led to 1,169 deaths. During the years in which mammography
was offered, there were 8,364 cancers found, but only 875 deaths.
In counties that had had screening programs for 10 or more
years, the risk of death from breast cancer dropped 45%. The policy
of offering mammograms--whether or not women actually had them--appeared
to reduce the mortality by 30%. About 8% to 30% of women offered
a mammogram declined to have the test.
The Swedish system offered scientists a rare chance to evaluate
the performance of screening programs outside a research setting,
Smith said.
"We had the opportunity in Sweden to see how well it's
performing in the community setting," he explained.
The new study actually shows better results than previous clinical
trials. Smith attributes this to the Swedish system.
"First, the radiologists in these counties were very well
trained and read lots of mammograms," Smith said. "The
women had high rates of participation. And in many settings, diagnosis,
follow-up and treatment were all managed by a small group of doctors
working together."
There is evidence in the US that mammograms have been saving
lives, Feig said. Over the past two decades the number of women
diagnosed with breast cancer has gone up, he explained. "And
yet, the death rates have been coming down," Feig added. "The
reason is screening, coupled with better treatments (and) heightened
public awareness about breast cancer."
Feig offers this advice to women who are aged 40 or older:
"Get a mammogram every year. And go to the best place you can
find."
How do you know which is the best place? "It's hard to
know," Feig admits. "But places that do more mammograms
may be doing a better job. And places where the radiologist does
nothing but read mammograms."
Source: Cancer 2002;95:458-469.
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Early
Morning Swim May Up Risk of Colds
By Alison McCook
Reuters Health
Thursday, August 1, 2002
NEW YORK (Reuters Health) - Swimmers who train in the morning
may have a slightly higher risk of developing infections in their
mouths or noses than those who train later in the day, according
to UK researchers.
Dr. Lygeri Dimitriou of Brunel University in Middlesex, UK
and colleagues discovered that when competitive swimmers swam in
the morning, they had higher levels of a stress hormone that suppresses
the activity of the immune system than when they swam in the evening.
The investigators also found that swimmers secreted less IgA--a
substance that helps defend the body against upper respiratory infections--during
the morning hours.
In an interview with Reuters Health, Dimitriou said that the
current findings do not mean that people who tend to get their exercise
during the early morning hours should stop exercising. These results
do not necessarily apply to sports other than swimming, the researcher
explained, and some exercise--at any time of the day--is better
than nothing.
"No exercise at all is worse than exercising in moderation
in the morning. So, for the general public, don't stop exercising
merely because your exercise session has to be in the morning,"
Dimitriou said.
However, the researcher added that these findings suggest that
competitive swimmers at increased risk of infections--after an injury
or illness, for example--may wish to schedule training during other
times besides first thing in the morning, if possible.
Dimitriou bases this recommendation on analyzes of 14 male
competitive swimmers, who were an average of 18 years old. During
the study, the participants swam 400 meters five times in a row,
with a 1-minute rest between each 400 meters. The athletes completed
each round of exercise at 6 AM and 6 PM on two different days.
All study participants said they regularly trained for up to
2 hours during both morning and evening hours, according to the
report in a recent issue of the British Journal of Sports Medicine.
The investigators found that swimmers had higher levels of
the stress hormone cortisol in their saliva during the morning hours
before exercise than before evening exercise. Dimitriou and colleagues
also discovered that swimmers secreted IgA more slowly in their
saliva before morning exercise than before the evening training
period.
Based on these findings, the authors recommend that competitive
swimmers with weakened immune systems avoid training during the
early morning hours.
However, Dimitriou emphasized that other athletes, who have
no increased infection risk, should continue training as usual.
"The study provides no evidence that in normal circumstances,
athletes who train more than once a day should discontinue with
their early morning training," Dimitriou said.
Source: British Journal of Sports Medicine 2002;36:260-264.
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Nun
Study: Childbirth May Not Cause Incontinence
By Alison McCook
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - Women who have never experienced
childbirth are just as likely as those who have given birth to develop
urinary incontinence, a finding that casts doubts on the theory
that vaginal deliveries increase the risk of incontinence, US researchers
report.
In a survey of nuns who had never given birth, half said they
had urinary incontinence, according to Dr. Gunhilde M. Buchsbaum
and her colleagues at the University of Rochester in New York. This
is a rate roughly equivalent to that seen in women who have experienced
vaginal birth.
These findings fly in the face of the theory that women who
give birth vaginally undergo anatomical stress during delivery that
places them at risk of urinary incontinence. Indeed, Buchsbaum told
Reuters Health that some mothers have since requested to receive
a cesarean section during childbirth, in order to reduce their risk
of developing incontinence.
"What we found was pretty much against common belief,"
Buchsbaum said.
The authors base their findings on surveys of 149 nuns, who
were an average of 68 years old. The nuns provided information about
whether they had experienced incontinence, and the impact the condition
had on their lives.
Buchsbaum's team found that 30% of the nuns experienced stress
incontinence, a condition in which urine leaks when coughing, sneezing,
or exercising due to weakness in the muscles that hold back urine.
Twenty-four percent of the nuns had symptoms of urge incontinence,
in which they lose control of their urine due to an overactive bladder.
Some of the nuns also had incontinence that appeared related to
both stress and urgency, while others had incontinence that was
not related to either type.
Nuns who were depressed, had a history of urinary tract infections
(UTI), and a relatively high body mass index (a measure of obesity
that factors people's height into their weights) were more likely
than others to also be incontinent, according to the report in the
August issue of Obstetrics & Gynecology.
In an interview with Reuters Health, Buchsbaum speculated that
the theory that vaginal birth increased the risk of incontinence
stems from the fact that so many women have given birth. Consequently,
more incontinent women have given birth than haven't, which may
have led researchers to suspect that childbirth played a role in
the condition.
As to why urinary incontinence was linked to depression, multiple
UTIs and weight, that remains unclear, the researcher said, although
these findings are in sync with what has been previously reported.
Many of the nuns in this study experienced a profound effect
of their incontinence on their lives, Buchsbaum added, and about
half of those who reported incontinence used sanitary pads to protect
themselves from urine leaks. In addition, some reported being unable
to sleep through the night, or go on long trips. The researcher
noted that some nuns said their incontinence even prevented them
from going to church. "And that's a big deal for a nun,"
she noted.
This study does not totally discredit the theory that vaginal
childbirth plays a role in incontinence, Buchsbaum noted. As such,
she and her colleagues are continuing to investigate the roots of
incontinence in another study, which compares women who have never
given birth to their sisters who have delivered at least one baby
vaginally, to see if there are any genetic predisposition to becoming
incontinent.
Regardless, these findings "seriously put into question
that childbirth is the major factor for the development of urinary
incontinence," Buchsbaum noted.
Source: Obstetrics & Gynecology 2002;100:226-229.
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US
State Health Insurance Program for Kids Turns 5
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - The US program created to expand
health insurance to children who do not qualify for Medicaid, called
the State Children's Health Insurance Program (SCHIP), turns 5 years
old this month.
And while there is cause to celebrate the program's achievements,
many hurdles have yet to be overcome, including enrolling many more
still uninsured children who qualify for the program, according
to the American Academy of Pediatrics (AAP).
Consequently, the AAP marked SCHIP's birthday by issuing a
set of recommendations to improve the program, such as making it
easier for children to enroll and stay enrolled, and encouraging
physicians to accept this form of insurance.
The US Congress created SCHIP in 1997 to expand health insurance
coverage for low-income, uninsured children, whose household incomes
are too high to qualify for Medicaid but not high enough to pay
for private health insurance. As part of the program, states were
provided with funds to expand Medicaid or to create a separate health
insurance plan for children.
"Because of SCHIP, close to 4 million children and teenagers
have health insurance today," AAP president Dr. Louis Z. Cooper
said in a statement. "That's a major accomplishment, and I
am proud of the role pediatricians have played in their communities
to make this program a reality."
However, Cooper added, much work still needs to be done to
improve SCHIP. The AAP recommends that SCHIP should alter the application
process to make it easier for eligible children to enroll and to
re-enroll each year, provide children with coverage before approval
of their families' applications, and improve payment rates to encourage
more physicians to participate.
In addition, the AAP notes, SCHIP is not the ultimate solution
to the problem of uninsured children: even if all the eligible children
in the US enrolled in SCHIP, millions more would still be left uninsured,
because they don't qualify for any health insurance program.
"It's certainly appropriate to celebrate the healthcare
so many children are receiving through SCHIP," Cooper said.
"But we also have to acknowledge we have more work ahead of
us to insure each and every child in this country."
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Study
Zeroes in on Causes of Huntington's Disease
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - A possible mechanism for the degeneration
of brain cells in people with Huntington's disease has been identified
by a group of researchers.
Huntington's disease is a fatal hereditary disease that causes
certain cells in the brain to become dysfunctional and eventually
die. Symptoms gradually develop between the ages of 30 and 50 and
include memory lapses, depression, irritability and movement problems.
Researchers have identified the cause of the disease as a mutated
gene that produces an abnormal protein called huntingtin. But how
this defect leads to the degenerative effects of the disease has
been a mystery.
Now, a team led by Dr. J. Timothy Greenamyre from Emory University
in Atlanta, Georgia, reports that the mutant huntingtin protein
seems to throw a wrench in the cellular machinery that processes
calcium, which results in abnormally high levels of calcium. Too
much calcium can damage brain cells. A report on the findings appears
in the advance online edition of the journal Nature Neuroscience.
The researchers took blood samples from patients with Huntington's
and healthy individuals and examined structures called mitochondria,
which provide the energy needed by cells to function. Compared to
the samples taken from healthy individuals, those from Huntington's
patients showed signs of abnormalities in mitochondria.
When the researchers studied mice that had been genetically
engineered to have the mutant huntingtin gene, they detected similar
mitochondrial abnormalities involved in calcium processing. The
abnormalities appeared when the mice were around 3 to 4 months old,
several months before symptoms typically appear in mice. This suggests
that the problems with the mitochondria may cause, at least in part,
the symptoms of Huntington's disease, according to the report.
The defect in calcium processing "may play a pivotal role"
in the development of Huntington's disease, the authors conclude.
However, they point out that it remains uncertain how the defect
causes the specific symptoms of the disease.
"Elucidation of the responsible mechanisms and the consequences
of this defect should provide new targets for neuroprotective therapeutic
intervention," Greenamyre and colleagues report.
Source: Nature Neuroscience 2002;10.1038/nn884.
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Artists,
Show Biz Workers at Higher Asthma Risk
By Charnicia E.
Huggins
Reuters Health
Thursday, August
1, 2002
NEW YORK (Reuters Health) - Artists, designers, photographers
and other entertainment industry workers are five times more likely
to have work-related asthma than workers in other fields, new study
findings show.
"This study confirmed associations between certain industries
and asthma, which can assist health agencies on where to target
their interventions," lead study author Dr. Ahmed A. Arif,
now of Texas Tech University Health Sciences Center in Lubbock,
told Reuters Health.
Arif and his colleagues investigated the prevalence of work-related
asthma and wheezing among US workers by analyzing 1988-1994 data
from the third national health and nutrition examination survey
(NHANES III).
Nearly 4% of the more than 6,800 study participants reported
work-related asthma and close to 11.5% said they experienced work-related
wheezing, the investigators report in the August issue of the journal
Occupational and Environmental Medicine.
Furthermore, certain industries may account for 27% to 37%
of work-related asthma and wheezing, the authors note.
For example, workers in the entertainment industry had a fivefold
increased risk of work-related asthma, and workers in the lodging
industry had a fourfold increased risk of work-related wheezing,
most likely from exposure to chemicals in cleaning products, the
report states.
The increased risk of asthma among entertainment industry workers
may potentially be caused by their exposure "to chemicals used
in art media, stage set production, theatrical make-up and photographic
chemicals," the researchers speculate.
Laborers in some other industries also had a higher risk of
both work-related asthma and work-related wheezing, according to
Arif's team.
Workers in the agricultural, forestry and fishing industries,
for example, were twice as likely to experience both work-related
asthma and wheezing compared to workers in other industries, the
report indicates. Electrical machinery, equipment and supply workers
were also twice as likely to experience work-related asthma and
wheezing.
The reasons for the increased prevalence of work-related asthma
and wheezing among these workers are unknown. Farmers and poultry
workers, however, may be at greater risk because of their potential
exposure to organic dust, insecticides, fertilizers and other respiratory
irritants and asthma triggers, the author suggest.
Also at increased risk of developing work-related wheezing
or asthma were construction workers, textile industry workers, repair
industrial workers (such as vehicle mechanics and welders), and
teachers and other educational service workers, the study found.
"As national and international health agencies continue
to target asthma as a disease of public health importance, a better
understanding of environmental causes and triggers of asthma, including
those found in certain workplaces, can play an important role in
controlling this chronic inflammatory disease," Arif said.
However, workers in at-risk fields should also do their part
by properly using personal protective equipment in the workplace,
according to Arif. And, he advised, "Contact your doctor immediately
if you notice any symptoms of asthma, like wheezing, shortness of
breath, chest tightness, or cough while at work or when you return
to work after a weekend."
Source: Occupational and Environmental Medicine
2002;59:505-511.
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UK:
Alcohol-Liver Deaths Tied to 1970s IV Drug Use
By Richard Woodman
Reuters Health
Thursday, August 1, 2002
LONDON (Reuters Health) - Hepatitis C spread by an "epidemic"
of heroin use in Britain during the 1970s and 1980s appears to be
resulting in a huge increase in the number of men dying from alcoholic
liver disease, researchers said on Thursday.
Researchers at Imperial College and St. Mary's Hospital, London,
said deaths from liver damage where the cause was unspecified shot
up 259% in middle-aged men in England between 1993 and 1999.
They said such a huge rise could not be explained by increased
alcohol consumption alone and suggested that exposure to the liver-damaging
virus hepatitis C, as a result of drug users sharing infected needles,
was also to blame. The increase has not been seen in women, or in
younger men.
"Hepatitis C normally takes 20 or 30 years to lead to
liver damage and so does alcohol, but if you are hepatitis C-positive
and you also drink alcohol it races away," said Professor John
Henry, of the academic department of accident and emergency medicine
at St. Mary's.
"That is what we think is happening. It is a sort of reaping
effect," he told Reuters Health.
Writing in the Journal of Clinical Pathology, the team said
anyone infected with hepatitis C who also drank alcohol was 31 times
more likely to suffer from liver cirrhosis.
They said that a generation of men, now aged 40 to 59 years
old, was involved in an "epidemic of illicit drug use which
took hold in the 1970s and 1980s."
They point out, "Significantly, this was before the introduction
of needle exchange and other interventions to reduce the risk of
HIV ( news
- web
sites) transmission in drug users."
The report said hepatitis C infection--which had not even been
recognized at the time--was now a worldwide health issue. In Britain
alone, an estimated 300,000 people were infected though fewer than
5% had been diagnosed.
The pathology of alcoholic liver disease and chronic hepatitis
C were very similar. Clinicians and pathologists could fail to recognize
hepatitis C infection as a cause of rapid progression of alcoholic
liver disease unless they specifically tested for the virus.
The scientists recommended more hepatitis C testing so that
those found to be infected could be advised to cut down on their
drinking and increase their chances of successful treatment and
longer survival.
Source: Journal
of Clinical Pathology 2002;55(9).
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WEDNESDAY,
JULY 31, 2002
VA
Hospitals Face Budget Crunch
By Melissa B. Robinson
Associated Press
Writer
The Associated Press
Wednesday, July 31, 2002
WASHINGTON (AP) - Veterans hospitals and clinics have been
ordered to halt efforts aimed at recruiting new veterans into the
health care system because of a budget crunch, a move that drew
some sharp criticism. "I am directing each network director
to ensure that no marketing activities to enroll new veterans occur
within your networks," Laura Miller, a Department of Veterans
Affairs ( news
- web
sites) undersecretary, wrote in a July 18 memo to the VA's 23
health network directors.
Word of the directive prompted Sen. John Kerry, a Vietnam veteran,
to call for Miller's removal. In a letter Wednesday, he also asked
President Bush ( news
- web
sites) to direct the VA to overturn the anti-outreach policy.
"Veterans need advocates in the VA, not bureaucrats willing
to deny them needed health care," Kerry, D-Mass., said in the
letter.
Citing a tight budget and overwhelming demand, Miller said
in her memo that marketing health care services with activities
such as health fairs, open houses or enrollment displays at veterans
service organization meetings was "inappropriate."
Other prohibited activities include "generalized mailings
to veterans, local newspaper or newsletter articles encouraging
veterans to enroll, or similar public service announcements,"
Miller said.
Even if some local facilities were able to absorb new patients,
she said, "as a national system, all facilities are expected
to abide by this policy."
VA spokesman Phil Budahn said veterans seeking emergency medical
care would not be turned away.
But in many parts of the country, veterans have to wait months
for an appointment for a routine checkup, or to begin the process
of receiving care for a chronic condition.
Because of that, "We just decided it was unfair to aggressively
try and recruit people just to have them come wait in a line for
months," Budahn said.
The crunch stems in part from a law passed by Congress in 1996
that opened VA medical facilities to nearly all veterans — not just
the very poor and those with service-related disabilities. Since
then, the number of veterans enrolled in VA health care has doubled,
to 6 million.
Bill Bradshaw, director of national veterans services for the
Veterans of Foreign Wars, the nation's oldest veterans group with
1.7 million members, said over 300,000 veterans — both new and established
VA patients — are on waiting lists for clinic appointments.
"We understand that's a problem for them, but it's a financial
problem," said Bradshaw, adding that the new policy means the
VA will no longer be offering health screenings at local VFW posts
or at the group's convention next month in Nashville, Tenn. "I'm
not sure you can just say, `We're not going to advertise.'"
Congress last week approved an additional $417 million for
VA health care in the current budget year, which ends Sept. 30.
President Bush wants $1.5 billion more for the VA in 2003,
which would be a record increase for the agency.
To ease budgetary pressures, VA Secretary Anthony Principi
had proposed charging veterans with higher incomes copayments totaling
up to $1,500 for services, but Congress balked at the idea.
On the Net:
Veterans Affairs: http://www.va.gov
Veterans of Foreign Wars: http://www.vfw.org/
Sen.
John Kerry: http://kerry.senate.gov/
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Sperm
Test Offers Clues to Male Infertility
By Serena Gordon
HealthScoutNews Reporter
HealthScoutNews
Wednesday, July
31, 2002
WEDNESDAY, July 31 (HealthScoutNews) -- Researchers from the
University of Missouri-Columbia may soon be able to offer hope to
couples struggling to conceive a child.
That hope comes in the form of a new test that can identify
sperm with high levels of a protein believed to be found in defective
sperm, the researchers report in the current issue of Human Reproduction.
"This study provides evidence that increased levels of
this protein are linked to infertility," says the study's lead
author, Peter Sutovsky, an assistant professor of animal sciences
and clinical obstetrics and gynecology at the University of Missouri-Columbia.
Sutovsky says as many as 15 percent of all couples trying to
have a baby in the United States are infertile. Male infertility
is responsible for about half the cases, he adds.
But in 20 percent of all infertility cases, the cause is never
discovered, according to Sutovsky.
Those are the cases where he thinks this new test will be most
useful.
In the current study, the researchers tested sperm samples
from 13 men. Eight were fertile men and five were infertile due
to a disorder known as stump tail syndrome. Tails are the "motors
that drive the sperm," says Sutovsky. So, when sperm tails
are abnormally short -- as they are in stump tail syndrome -- the
sperm have no motility, and therefore are unable to fertilize an
egg.
Sutovsky and his colleagues found that sperm from the infertile
men had much higher levels of a protein called ubiquitin than did
the sperm of the fertile men.
The researchers hope that by testing for ubiquitin, they will
be able to detect abnormal sperm that have no obvious defects. Sutovsky
says the test could be particularly useful for couples undergoing
in vitro fertilization or intracytoplasmic sperm injection -- the
procedure in which a single sperm is injected into an egg.
Testing for ubiquitin could help improve the success rates
of those procedures because only healthy sperm would be selected.
Sutovsky says the cost of the test won't be that high. But
it will be six months or more before it might become available.
Michael Stahler, director of the In Vitro Fertilization Lab
at William Beaumont Hospital in Royal Oak, Mich., feels that while
the test may prove useful in the future, much more research remains
to be done.
"This study is an interesting beginning, but there were
not a lot of patients involved," he says. "It may eventually
prove to be a marker that explains some unexplained infertility."
What To Do
For more information on male infertility, visit the Yale
Center for Reproductive Medicine and Infertility, or The
Endocrine Society.
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Straighten
Up
HealthScoutNews
Wednesday, July 31, 2002
(HealthScoutNews) --
Back pain is so common you might think it's inevitable. But the
Mayo Clinic offers some simple steps to avoid the problem.
Chief among them is to follow your mother's old advice: sit
up straight. The clinic says poor posture is often a cause of back
ache. And even if you've spent years slouching, you can start practicing
good posture now.
Other
Mayo Clinic advice includes: stand as straight as possible; use
straight-back chairs or chairs that have lumbar support; and avoid
high heels, which put stress on your back.
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Battling
that Bulge
HealthScoutNews
Wednesday, July 31, 2002
WEDNESDAY, July 31 (HealthScoutNews) -- Even though you're
not overweight, is your stomach more fat than flat?
It may be that you're genetically inclined to accumulate fat
in that area. Also, as you age and lose height, your bulges can
become more prominent.
Here's the skinny on some tummy tips from the August issue
of the Mayo Clinic Women's HealthSource:
