The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
August 6, 2002

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of July 27 - August 2

FRIDAY, AUGUST 2, 2002

  1. THURSDAY AUGUST 1, 2002

  2. Fewer Calories May Lengthen Lives
  3. Calling Your Doctor

    TUESDAY, JULY 30, 2002


  4. Dirty Air Pollutes the Heart, Too

    MONDAY, JULY 29, 2002


  5. Vegetarian group calls Atkins diet unsafe
  6. Boiling Best Bet to Avoid Harmful Food By-Product
  7. Some Student Vaccine Rules Relaxed
  8. Older Husbands Relied on by Wives Outlive Peers
  9. West Nile Spreads Quickly in U.S.
  10. Man Contracts Hepatitis A Despite Vaccination
  11. Child Added to Nev. Cancer Cluster
  12. Soil Bacteria Compound Potential Transplant Drug
  13. Teenagers' Anxiety Tracked in Real Time
  14. Fast Food Chains Display Fat Content
  15. Kneedy Tests
  16. Illness Prompts FDA Warning About Lettuce
  17. Come in from the Cold
  18. Panel: Soften Rules to Increase Heart Donors
  19. Alcohol, Mental Problems Rife in U.S. Workforce
  20. Senators Plan Bill to Combat Child Obesity
  21. A Sunny Outlook on Aging Lengthens Life
  22. Football Deaths May Be Linked to Supplements
  23. Study: Retiring drivers lack alternatives
  24. Drug suggests promise for heart failure
  25. Med Students May Be Tested for Bedside Manner
  26. Whole Grains Can Help Cut Insulin, Cholesterol
  27. Infected Moms May Transmit H. Pylori to Children
  28. Enzyme Works as 'Tool Kit' to Repair Gene Damage: Study

    SUNDAY JULY 28, 2002


  29. Growing Your Own Cartilage
  30. Virtual Doctor Visits Are a Virtual Reality

    SATURDAY, JULY 27, 2002

  31. First W. Nile Case Found in S.D.
  32. Wine, Cheese and a Bit of Botox
  33. Lactose Lore
  34. Nuts Over Pecans
  35. Study Links Autism With Smoking in Early Pregnancy
  36. Meat Recall Delay Jeopardized Public, Lawmakers Charge 

 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.

BACK TO TOP

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:

  • Get regular, general exercise. The secret to reducing your overall body fat is burning calories. Doing endless sit-up sessions won't do anything to banish that stomach bulge.
  • Do exercises that target the lower and deeper abdominal muscles. The pelvic tilt is a good one. Lie on your back on the floor with your knees bent. Flatten your back against the floor by tightening your abdomen and bending your pelvis up. Hold it for 5-10 seconds. Work your way up to be able to do 10-20 repetitions.
  • Stand straight and tall. When you slouch, it makes your stomach more prominent.
  • Bloating caused by certain foods such as beans, cabbage and bran can accentuate a stomach bulge.

More information

It never hurts to keep yourself in healthy shape. The American Heart Association ( news - web sites) has this primer on exercise.

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Rise in Body Weight Linked Directly to Heart Risk

By Alison McCook

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - The risk of developing heart failure increases with a person's weight: rising slightly in those who are only slightly overweight, and eventually doubling in those who are obese, US researchers report.

Based on these findings, Dr. Ramachandran S. Vasan of the National Institutes of Health ( news - web sites) and his colleagues propose that body weight itself can influence the risk of developing heart failure, independent of other obesity-related factors that affect heart health.

"There seems to be an independent effect of obesity on heart failure," Vasan told Reuters Health.

Almost 60% of Americans are either overweight or obese, and these results suggest that strategies that target the nation's bulging waistlines could reduce the incidence of heart failure, Vasan added.

"There is a huge list of conditions associated with being obese. And heart failure is now added to that list," he said.

Vasan and his colleagues base their findings on surveys of nearly 5,900 adults. The researchers followed the study participants for an average of 14 years and noted their weights and whether they developed heart failure.

The investigators measured body weight according to a person's body mass index (BMI), which is a measurement that factors in both height and weight. People classified as obese have BMIs of at least 30, while those with BMIs of 25 to 29.9 are considered to be overweight.

During the study period, 496 participants developed heart failure. Using statistics to eliminate the influence of other risk factors for the condition, the researchers found that the risk of heart failure rose by 5% for every increase of 1 point in BMI for men. Each time women increased their BMIs by 1 point, their heart failure risk jumped by 7%. Both men and women who were obese had twice the risk of heart failure compared with people with healthy BMIs.

Based on the study findings, obesity itself likely accounts for 11% of the cases of heart failure in men and 14% of those in women, Vasan's team reports in the August 1st issue of The New England Journal of Medicine ( news - web sites).

In an interview with Reuters Health, Vasan said that researchers previously suspected that morbid obesity (BMI of 40 or more) could directly cause heart failure, while lower BMIs likely contributed to the risk by simply increasing other factors related to heart health, such as diabetes and high blood pressure.

However, the fact that even slight increases in BMI over normal values can increase heart failure risk indicates that excess body weight--even small amounts--can independently and adversely affect health, Vasan noted.

In an accompanying editorial, Dr. Barry M. Massie of the Veterans Affairs Medical Center in San Francisco, California, notes that these findings should throw a log on the fire of determination in those motivated to reduce obesity in this country.

"An increased risk of heart failure is yet another reason to encourage lifestyle modification for the prevention or treatment of obesity," Massie writes.

"Recognition of the excessive risk of heart failure and other vascular events associated with overweight and obesity should lead to more frequent inclusion of overweight and obese patients in clinical trials, which would, in turn, help to identify additional therapies that may be particularly effective in preventing adverse cardiovascular outcomes in this population," he adds.

Source: The New England Journal of Medicine 2002;347:305-313, 358-359.


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Making Pre-Cooked Foods Safter

HealthScoutNews
Wednesday, July 31, 2002

WEDNESDAY, July 31 (HealthScoutNews) -- University of Arkansas food scientists have created an edible film that can prevent the growth of Listeria bacteria on ready-to-eat chicken and other pre-cooked foods.

The film consists of two proteins called zein and nisin. While the combination is harmless to humans, it kills Listeria bacteria that can contaminate chicken and other foods such as deli meats and hot dogs between the cooking and packaging stages.

Listeria bacteria, which can survive refrigeration, can cause serious illness and poses a special risk to children and the elderly and causes miscarriage in pregnant women.

To test their protective film, the researchers bought chicken breast tenders, froze them and irradiated them to eliminate bacteria. They then cooked and cooled them and immersed them in Listeria cultures.

The researchers then dipped the chicken pieces in two solutions, one containing a combination of zein and nisin and one containing zein alone. The combination of the two proteins was the most effective in lowering bacterial counts.

The findings will be published in an upcoming issue of the Journal of Food Science.

More Information

The Centers for Disease Control and Prevention has all the facts about listeria and other foodborne diseases.

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Deaths Prompt Deer Disease Probe

By Robert Imrie

Associated Press Writer

The Associated Press

Wednesday, July 31, 2002

WAUSAU, Wis. (AP) - The deaths of three outdoorsmen from brain-destroying illnesses are under investigation by medical experts who want to know whether chronic wasting disease has crossed from animals into humans, just as mad cow disease did in Europe.

The men knew one another and ate elk and deer meat at wild game feasts hosted by one of them in Wisconsin during the 1980s and '90s. All three died in the 1990s.

Investigators want to know whether the deaths were just a coincidence or whether the men contracted their diseases from the meat of infected game.

There has never been a documented case of a person contracting a brain-destroying illness from eating wild animals with chronic wasting disease.

"We are not saying it absolutely can't happen. We know that it's a mistake to say that," said Dr. Larry Schonberger, a specialist at the Centers for Disease Control and Prevention ( news - web sites) in Atlanta. "It gets a lot of people scared and it has economic consequences and everything, so we need to check it out."

In February, chronic wasting disease — an incurable, brain-destroying illness that causes deer, elk, moose and caribou to grow thin and die — was found in Wisconsin deer, marking the first time it was discovered east of the Mississippi River. It was identified in Colorado elk more than three decades ago and is now known to exist in deer or elk in eight states and Canada; thousands of animals are now being slaughtered to contain it.

Chronic wasting disease is related to mad cow disease in cattle and Creutzfeldt-Jakob disease ( news - web sites) in humans. All three diseases are caused by mutant proteins called prions that make spongelike holes in the brain.

During the 1990s, scientists confirmed that people in Europe developed Creutzfeldt-Jakob from eating beef from cattle infected with mad cow disease. The finding devastated Europe's beef industry.

If elk and deer meat prove to be a similar threat, the effects would not be nearly as disastrous, in part because beef eating is far more widespread. But such a finding could raise fears of the disease spreading from wild animals to livestock and endangering the food supply.

Also, hunting where the disease is known to exist would drop off dramatically, said Steve Torbit, a National Wildlife Federation biologist.

"It may be possible hunting persists as a way to collect hides or heads and antlers," he said. "It is a rocky ride we are in for."

The Wisconsin Division of Health and the CDC are looking at autopsy results and other records regarding James Botts, Wayne Waterhouse and Roger Marten. Waterhouse, of Chetek, Wis., and Marten, of Mondovi, Wis., both 66, died in 1993. Botts, 55, of Blaine, Minn., died in 1999. Waterhouse and Marten were avid hunters; Botts fished.

Waterhouse and Botts died of what was diagnosed as Creutzfeldt-Jakob, their families said. Creutzfeldt-Jakob is always fatal and occurs in just one in a million people. Marten died of Pick's disease, a more common brain-destroying disorder, said his son, Randy.

Jeff Davis, the state epidemiologist, said four or five cases of Creutzfeldt-Jakob are diagnosed in Wisconsin each year. What makes the deaths of Waterhouse, Botts and Marten worth investigating is that the men knew one another and attended game feasts that Waterhouse held at his cabin near Superior, Davis said.

Botts' widow, Judy, believes her husband's illness came from the meat he ate at the feasts. She said the gatherings were the only thing the three occasional friends had in common, other than their love of hunting or fishing.

In 1999, a World Health Organization ( news - web sites) panel concluded there was no scientific evidence that chronic wasting disease can infect humans. But it also said no part of a deer or elk believed to be infected should be eaten.

After years of suspicions, it was not until 1994 that there was enough evidence for scientists to conclude that humans could get a form of mad cow disease from beef.

Dr. G. Richard Olds, chairman of medicine at the Medical College of Wisconsin in Milwaukee, said it is possible scientists could come to same conclusion about chronic wasting disease, though it could take as long as 15 years.

"I am not trying to scare people inappropriately," he said. "But we need to be honest about this situation."

On the Net:

National Prion Disease Pathology Surveillance Center: http://www.cjdsurveillance.com

CDC: http://www.cdc.gov

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Moms Who Breast-Feed Reduce Infants' Asthma Risk

Reuters Health
Wednesday, July 31, 2002

NEW YORK (Reuters Health) - Mothers who breast-feed infants for 4 months or longer may help protect their children from developing asthma, according to a new study conducted in Australia.

In general, breast-feeding is the best nutrition for infants. It is full of beneficial hormones, enzymes and growth factors, and reduces infections, respiratory illness and diarrhea in babies.

However, previous studies of the effects of breast-feeding on infants of asthmatic mothers have been mixed, with some showing decreases in asthma while another reported the opposite.

To investigate, Dr. Wendy H. Oddy, of the Telethon Institute for Child Health Research in Perth, and colleagues evaluated asthma outcomes of more than 2,600 infants that they followed from preterm to age 6 years. Mothers answered questions about their own asthma status and how long they breast-fed, if at all.

The risk of childhood asthma increased by 28% if exclusive breast-feeding was stopped and other milk was introduced before the infant was 4 months old, the authors report in the July issue of the Journal of Allergy and Clinical Immunology. This was true regardless of whether the mother had asthma.

"Among many other health benefits, breast-feeding provides protection against infection through defense agents in the milk," Oddy and colleagues write.

"Given our findings, we continue to recommend that infants with or without a maternal history of asthma be exclusively breast-fed for 4 months and beyond," the authors conclude.

Asthma remains an incurable chronic illness, and death from the disease is highest among children aged 1 to 4 years--an age group accounting for about half of all asthma-related emergency department visits.

Source: Journal of Allergy and Clinical Immunology 2002;110:65-67.


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Making Pre-Cooked Foods Safer

HealthScoutNews
Wednesday, July 31, 2002

WEDNESDAY, July 31 (HealthScoutNews) -- University of Arkansas food scientists have created an edible film that can prevent the growth of Listeria bacteria on ready-to-eat chicken and other pre-cooked foods.

The film consists of two proteins called zein and nisin. While the combination is harmless to humans, it kills Listeria bacteria that can contaminate chicken and other foods such as deli meats and hot dogs between the cooking and packaging stages.

Listeria bacteria, which can survive refrigeration, can cause serious illness and poses a special risk to children and the elderly and causes miscarriage in pregnant women.

To test their protective film, the researchers bought chicken breast tenders, froze them and irradiated them to eliminate bacteria. They then cooked and cooled them and immersed them in Listeria cultures.

The researchers then dipped the chicken pieces in two solutions, one containing a combination of zein and nisin and one containing zein alone. The combination of the two proteins was the most effective in lowering bacterial counts.

The findings will be published in an upcoming issue of the Journal of Food Science.

More Information

The Centers for Disease Control and Prevention has all the facts about listeria and other foodborne diseases.

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Seniors Report Fewer Psych Problems Than Young

By Charnicia E. Huggins

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - Senior citizens may have more chronic medical problems than their younger counterparts, but they may be less likely to be depressed or have other psychological disorders, new study findings suggest.

"Thus, the assumption that aging is associated with increased psychological distress may not fit in older primary care patients," lead study author Dr. Joshua Klapow, of the University of Alabama at Birmingham, told Reuters Health.

"However, the findings in no way should be interpreted as evidence for discounting the possibility of psychological disorders in older primary care patients," he added. "Rather, they highlight the importance of understanding how age may influence physical and psychological symptoms."

To investigate, Klapow and his colleagues studied 3,000 patients, including 534 individuals aged 65 years and older. The patients completed mental health questionnaires and assessments of their general health-related quality of life.

Five percent of the seniors reported having a psychological disorder, such as depression or anxiety, in comparison to 17% of the younger patients, the investigators report in the July/August issue of Psychosomatic Medicine. Furthermore, younger patients reported experiencing more severe psychological symptoms and stressors, including worries about their health, weight or finances.

Overall, younger patients experienced more frequent and more severe psychological symptoms than did older patients. This finding remained true even after the study participants' gender, race, education, and number of physical conditions was taken into consideration, the researchers note.

Younger patients also reported visiting the doctor more often and taking more days off for disability than did the seniors, even though the seniors had two to three times more chronic medical conditions, the report indicates.

It is not known why psychological disorders were more common among the younger patients than among the seniors, Klapow said. He speculates that "older patients may develop coping strategies that enable them to manage multiple medical conditions and stressful life events more adaptively than younger patients."

In light of the findings, Klapow advises that both older and younger patients be screened for "distress-related symptoms" and that doctors "recognize that age alone is not necessarily associated with greater psychological distress."

Source: Psychosomatic Medicine 2002;64:635-643.


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Study: Birth Control Pill Does Not Make Teens Fat

By Charnicia E. Huggins

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - The idea that taking birth control pills leads to weight gain appears to be a myth, new study findings show.

"Perceived weight gain is the number-one reason for adult women discontinuing use of oral contraceptives," Dr. Tom Lloyd, director of the Pennsylvania State Young Women's Health Study at Pennsylvania State College of Medicine, told Reuters Health. "Our study demonstrated that oral contraceptive use by teen women does not affect body weight or body composition."

To investigate, Lloyd, a professor in health evaluation sciences, and his colleagues conducted a 9-year study of 66 white girls who were age 12 at the start of the study. Thirty-nine of the girls were taking oral contraceptives at age 21.

The birth control users reported being on the Pill for an average 28 months, yet their increases in weight, body mass index (a measurement of weight in relation to height) and percent body fat was similar to that of their peers, the investigators report in the August issue of Obstetrics and Gynecology.

The two groups also had similar increases in height and decreases in percent lean body mass, the report indicates.

On the other hand, the birth control users exhibited much greater increases in their levels of total cholesterol, LDL (the "bad" cholesterol), and triglycerides than did their peers who did not use oral contraceptives--a finding opposite to what has been observed among adult women, the researchers note.

Still, the girls' total cholesterol, LDL cholesterol and trigylceride levels were all within the normal range, Lloyd said.

"The present study provides evidence that oral contraceptive use by teenage girls...does not affect body composition, and we suggest that potential users be counseled accordingly," Lloyd's team concludes.

Because the study was conducted among healthy white females, however, "the results might differ (among other individuals) according to ethnicity, obesity, and exercise patterns," Lloyd added.

Source:  Obstetrics and Gynecology 2002;100:235-239.


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Humming a Few Bars May Bar Sinusitis 

By Amanda Gardner
HealthScoutNews Reporter

HealthScoutNews

Wednesday, July 31, 2002

 WEDNESDAY, July 31 (HealthScoutNews) -- Could it be possible to hum your way to better health?

Swedish scientists have found that humming increases ventilation in the sinuses, raising the prospect that daily "tune-ing" might reduce the risk of sinusitis in patients who are susceptible to upper respiratory infections.

"Since humming increases sinus ventilation dramatically, we speculate that daily periods of humming could be helpful to prevent sinusitis in certain patients where bad ventilation is a part of the disease process," says Dr. Jon Lundberg, one of the study authors and an associate professor of physiology and pharmacology at the Karolinska Institute in Stockholm. "This is, of course, speculative and must be tested in controlled studies."

The findings, which appear in the July issue of the American Journal of Respiratory and Critical Care Medicine, may also lead to a more accurate way to diagnose sinusitis.

Some 14 percent of the U.S. population suffers from this condition, which involves inflammation of one of the sinus cavities -- usually from upper respiratory infections. The illness has so far defied effective diagnosis and treatment.

The sinuses are cavities within the facial bone that lie next to the nasal cavity. The two chambers communicate with each other through openings called ostia. Previous researchers have pointed out that blocked or partly blocked ostia lead to reduced exchange of air between the two areas, which in turn helps foster the growth of bacteria, Lundberg says. This is a perfect setting for sinusitis.

Dr. Eddie Weitzberg, lead author of the study and an associate professor in the department of anesthesiology and intensive care at Karolinska Hospital, likens the sinuses to a bad basement that constantly needs to be ventilated.

One measure of how well the sinuses are ventilated is the amount of nitric oxide being expelled. When the sinuses are working properly, exhaled air contains a high concentration of nitric oxide. Less nitric oxide can indicate the presence of a problem, including asthma.

In this study, the researchers tested 10 healthy adult males with no history of allergy or airway disease and found that humming increased the nitric oxide rate 15-fold, compared with "quiet exhalation." In a mechanical model of the nose and sinus, humming also caused a dramatic rise in gas exchange between the two cavities -- almost the entire volume (96 percent) of the sinus was turned over in one exhalation, vs. only 4 percent during a regular exhalation.

Humming might end up as one of the easiest diagnostic tools available.

"Measuring nitric oxide during humming could be a measurement of the size of the holes from the sinus to the nose [ostia], and that could be of great interest to ear-nose-throat doctors, because one of the main promoters of sinusitis is narrow ostia," Weitzberg says.

"The idea is that if the passage between the sinus cavity and the nose is reduced, the humming-induced increase in nasal nitric oxide would be reduced," Lundberg adds.

What To Do

The theories aren't proven yet but, since humming appears to pose few health risks, why not try humming your sinus troubles away?

For more information on sinusitis, check out the National Institute of Allergy and Infectious Diseases or the American Academy of Allergy, Asthma and Immunology.

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Fish Oils Soften Arteries, May Fight Heart Attack

By Melissa Schorr

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - Eating fatty acids found in fish oils may help reduce the risk of a heart attack by keeping arteries flexible, Australian researchers report.

"This is good evidence that eating fatty fish improves the health of the large arteries," lead author Dr. Paul Nestel, head of cardiovascular nutrition at the Baker Medical Research Institute in Melbourne, Australia, told Reuters Health.

It has been found that fish--especially fatty fish such as tuna, salmon and sardines--contain omega-3 fatty acids, which have protective effects on the cardiovascular system. However, the mechanism for this is still being explored.

The researchers investigated whether omega-3 fatty acids can help prevent hardening of the arteries, which constricts blood flow from the heart and can lead to high blood pressure and heart attacks.

In the study, which included 38 men and women with high cholesterol, patients received either a capsule containing one of two forms of purified omega-3 fatty acids--eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA)--or a dummy placebo pill for 7 weeks. The researchers then measured the elasticity of the participants' arteries by ultrasound.

According to the findings, published in the American Journal of Clinical Nutrition ( news - web sites), those who received the omega-3 fatty acids had a significant reduction in arterial hardness, while those taking the placebo pill had no change. Those taking EPA had a 36% increase in systemic arterial compliance, a measure of the large artery's elasticity, while those who took DHA had a 27% increase.

"We found a significant improvement in arterial elasticity after 7 weeks on either EPA or DHA," Nestel said. "Eating fish is possibly the best nutritional advice to reduce risk of fatal heart attacks."

The study was partially funded by the drug company F Hoffmann-La Roche.

Source: American Journal of Clinical Nutrition 2002;76:326-330.

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For Women, Weight Control is Mind Control

By Kathleen Doheny
HealthScoutNews Reporter

HealthScoutNews

Wednesday, July 31, 2002

WEDNESDAY, July 31 (HealthScoutNews) -- Attitude is everything, and that's especially true if you're a woman trying to maintain your weight.

Women who believe that weight maintenance is under their control rather than entirely predetermined by genetics are thinner, a new study has found.

Fred Kuchler and Biing-Hwan Lin, both researchers with the U.S. Department of Agriculture ( news - web sites)'s Economic Research Service, used data from two government surveys that polled 5,274 men and women. (One was the Continuing Survey of Food Intake by Individuals; the other, the Diet and Health Knowledge Survey.)

The aim was to find which diet and lifestyle choices mattered for weight control and whether the choices varied by gender. The analysis was meant to help those who design weight maintenance programs.

As expected, the studies linked several habits to effective weight control, including getting regular exercise and eating breakfast regularly. "A lot of what we found confirms [findings] from other studies," says Kuchler, whose report appears in the current issue of the International Journal of Obesity.

Then they asked both men and women to tell whether they agreed or disagreed with this statement: "Some people are born to be fat, others thin; there is nothing I can do." They called it the "gene theory."

"About the same proportion of men to women agreed with the statement," Kuchler says.

But when they correlated the response to the statement with the person's body mass index (BMI), a measure of height to weight to assess optimal weight, they found that women (but not men) who disagreed that there was nothing that could be done tended to have lower BMI's.

"What's important is that women who disagreed with the statement had lower BMIs than those who agreed with it," Kuchler says. The difference was a shade under a point.

Lowering the BMI by a point could mean the difference between optimal weight or overweight. A five-foot, four-inch tall woman who weighs 145 pounds, for instance, has a BMI of 25, which is considered overweight. A woman of the same height who weighs 140 pounds has a BMI of 24, considered an appropriate weight.

"Women who disagreed [with the gene theory] were thinner," Kuchler says.

Why did attitude about weight not seem to matter for men?

"I can't really say why," Kuchler says. His goal, he says, was to look at the variables that seem to matter for weight control to advise those who design weight loss programs what to include.

A weight loss expert who has studied the causes of overeating says the finding about attitude is interesting and bears out his experience with persons trying to lose weight.

"I think that attitude is very important," says Edward Abramson, professor of psychology at California State University, Chico, and author of several weight control books. "The notion of efficacy -- that you have some control -- is critical in any weight loss program. To maintain the motivation, to persist [in losing weight and keeping it off], you need the sense of being able to have an impact based on your behavior."

The take-home point, at least for women, is that genetics plays a role but doesn't write the entire script.

"While it is true there are some women who will never be petite, they can be more healthy and feel better about their bodies if they take control of their weight," Abramson says.

What To Do

For information on people who have lost weight and kept it off, see the National Weight Control Registry. Calculate your body mass index at the National Heart, Lung, and Blood Institute.

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Drug May Help Quiet Behavior Problems in Autism

By Linda Carroll

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - A medication commonly used to treat schizophrenia may help quiet tantrums and other serious behavioral problems in certain autistic children, researchers suggest.

More than two thirds of the autistic children treated with the antipsychotic drug risperidone showed significant improvements in behavior, according to the report published in the August 1st issue of The New England Journal of Medicine ( news - web sites).

Risperidone is one of a newer class of antipsychotic medications. The drug was appealing as a possible treatment for autistic children because it produces fewer side effects than some other antipsychotic medications, study co-author Dr. Lawrence Scahill, an associate professor of child psychiatry and nursing at Yale University in New Haven, Connecticut, said in an interview with Reuters Health.

Approximately 1 in 500 children are diagnosed with autism, a developmental disorder that generally becomes apparent in the first couple of years of life. The condition is typified by social isolation, disinterest in having reciprocal relationships with others, delayed and unusual speech and repetitive behaviors, Scahill explained.

The study was a multi-site clinical trial that followed 101 children, aged 5 to 17, for 8 weeks. At the outset, the children were rated as to how irritable they were.

Children included in the study had serious behavioral problems on a daily basis. The behavior problems are not rooted in maliciousness, Scahill pointed out. "Children with autism want things to be the same," he noted. "They like routine. If the routine is changed their reactions can be rather extreme."

These reactions can include hitting or biting themselves, throwing things, knocking things over, screaming and yelling for extended periods of time, Scahill said. He estimates that such serious behavior problems occur with regularity in about one third of autistic children.

Scahill and his colleagues found that risperidone produced significant improvements in 69% of the children. After 8 weeks of treatment, children treated with risperidone had a decrease in irritability scores of almost 57%, compared with 14% in the group given an inactive placebo.

What this means, Scahill said, is that "children weren't yelling or screaming when things didn't go exactly the way they thought they should go."

Tantrums and incidents of biting and scratching others dropped from a couple of times a day to a couple of times a week. Such improvement was a relief to parents, Scahill added.

The researchers suspect that by quieting the bad behaviors, the drug will allow the children to benefit more from other kinds of therapy.

"We assumed if this medication worked, that it would make a child more amenable to educational and rehabilitation interventions," Scahill said.

The study was funded by the National Institute of Mental Health.

Source: The New England Journal of Medicine 2002;347:314-321.

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Flavoring Ups Lung Disease Risk in Popcorn Factory 

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - Some workers who mix and package flavored microwave-popcorn or are involved in other flavoring manufacturing may have up to 11 times the expected risk for a serious lung obstruction disorder, the results of a new study suggest.

The report is a follow-up to last year's widely published news of severe lung illnesses in eight people who all worked in a small Missouri microwave-popcorn factory. Initially, health officials did not associate their illnesses with their jobs. After the eight cases accumulated and came to the attention of a lawyer, an eagle-eyed physician brought it to the attention of the state.

Missouri brought the CDC's National Institute of Occupational Safety and Health (NIOSH) in to investigate and their new report on the matter is published in the August 1st issue of The New England Journal of Medicine ( news - web sites).

The eight workers had no other risk factors for lung disease, but became severely ill with a respiratory illness called bronchiolitis obliterans--a severe, obstructive lung disease that has normally been seen in people exposed to a toxic irritant in a big spill. In these workers, it appears they became ill from long-term exposure to a chemical used in making artificial butter flavoring.

After studying conditions at the plant, investigators concluded that workers were likely getting sick from exposure to chemicals being given off by flavor additives being mixed into the popcorn.

Soybean oil, salt and flavorings are mixed in a large, heated vat. The heat produces visible dust, aerosols and vapors with a strong buttery odor.

The vapors were found in greatest concentration around the mixers, and in lesser amounts near the packaging operation. Not surprisingly, mixers were at higher risk of developing illness than packagers.

In their investigation, which was conducted in November 2000, lead investigator Dr. Kathleen Kreiss of NIOSH in Morgantown, West Virginia and colleagues conducted medical exams and environmental surveys of 117 workers in the plant.

All of these workers were 2.6 times more likely than those in the general population to experience chronic cough and shortness of breath, and twice as likely to have these symptoms compared to people diagnosed with asthma and chronic bronchitis, the study indicates.

"Overall, the workers had 3.3 times the expected rate of airway obstruction (and) those who had never smoked had 10.8 times the expected rate," the authors write.

In other findings, chemical analysis of the air in the mixing room revealed high levels of the artificial butter-flavoring ingredient diacetyl (2,3-butanedione).

According to Kreiss and colleagues, studies of the effects of butter-flavoring vapors with diacetyl levels at 352 parts per million "damaged" cells lining the respiratory tract of rats. Mixers at the microwave-popcorn plant in question may have been exposed to levels between 3 and 4 times that amount, they note.

"Our findings of excess rates of lung disease and associations between indexes of exposure to volatile organic chemicals and obstructive lung disease support the conclusion that an agent in butter flavoring caused occupational bronchiolitis obliterans in exposed workers at this popcorn plant," Kreiss and colleagues conclude.

"Clearly, work in the mixing room of this microwave popcorn plant conferred a high risk of this rare, severe lung disease," writes Dr. E. Neil Schachter of Mount Sinai School of Medicine in New York City in an accompanying editorial.

"As for the health effect of microwave-popcorn products in the general population, there are no findings to date to suggest that consumers are at any risk," Schachter concludes.

Source: The New England Journal of Medicine 2002;347:330-338, 360-361.

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Natural Proteins in Brain Wipe 'Fear' Slate Clean

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - The brain contains naturally-occurring substances that can wipe away fearful memories and with time may help soften the jolt of fear that can become associated with innocuous triggers, according to a new study in mice.

The compounds are known as cannabinoids, and they share some similarities with the active ingredient in marijuana, THC. Mice that lacked a particular cannabinoid receptor in the brain stayed forever fearful of a certain sound that once was accompanied by an electric shock.

In contrast, normal mice quickly lost their fear of the sound if it was no longer heard in tandem with the painful jolt, according to a report in the August 1st issue of the journal Nature.

The discovery may lead to a better understanding, and perhaps treatment, for people who experience post-traumatic stress disorder (PTSD)--a condition that can affect survivors of natural disasters, violent crimes and serious accidents. Symptoms of PTSD include flashbacks to the trauma, nightmares and emotional withdrawal.

In the study, Dr. Beat Lutz of the Max Planck Institute of Psychiatry in Munich, Germany and colleagues looked at mice genetically engineered to lack a particular cannabinoid receptor known as CB1.

The researchers conditioned the mice to associate a sound with an electric shock. The mice were repeatedly exposed to the sound and the shock for several days. All of the mice that lacked CB1, as well as normal mice, developed a fear response to the sound.

The mice were later exposed to the sound without the shock and the researchers noted a different response in those lacking CB1.

The normal mice "quickly recovered from (their) fear reaction," Lutz explained. In contrast the CB1-deficient mice, showed little reduction in fear and seemed unable to forget their past experience.

"Until now, the function of the endogenous cannabinoid system in memory processing has not been clear," Lutz said. "Our work could assign, for the first time, a specific function of memory processing to the endogenous cannabinoid system--extinction of aversive memories."

With regard to people, the authors note that ordinarily healthy people are equipped with "balanced" emotional responses to potentially dangerous situations. For example, if a person sees a poisonous snake, they relax relatively quickly once the imminent threat of being bitten has passed. An individual who has a phobia, on the other hand, can not adapt to such situations and may develop an uncontrollable over-reaction, which could lead to an anxiety or panic attack.

Similarly, individuals with PTSD may have uncontrollable emotional reactions to triggers that others might find innocuous.

"We think that our work could stimulate novel therapeutic approaches for the treatment of phobias or post-traumatic stress disorder," Lutz added.

However, Lutz stressed, "we do not recommend to smoke marijuana to get rid of bad memories or to treat PTSD or phobics."

The compounds found in marijuana are unlikely to have the same effect because they are not specific enough for these receptors, according to Lutz.

The active ingredient in marijuana, THC, "binds to all cannabinoid receptors in the body, irrespective of whether or not (they are) involved in extinction in aversive memories," he said.

"However, it might be possible that the combined action of psychiatrist or trained psychologists together with pharmacological interventions targeting the endogenous cannabinoid system may lead to novel therapeutic concepts to treat above mentioned conditions," he said.

Source: Nature 2002;418:530-533.

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Study Looks at Breast Cancer in Young Black Women

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - Young African-American women who develop breast cancer ( news - web sites) appear to be more likely to die from the disease than their white counterparts, according to the results of a new study.

But the investigators also found a bit of good news--the percentage of African-American women who have their breast cancer detected while it is still in an early stage, and therefore more treatable, has nearly doubled during the 1990s. This finding suggests that education campaigns targeting African-American women may be working. However, detection rates in blacks still lag behind detection rates in whites, the researchers point out.

In their investigation, Dr. Lisa A. Newman of Wayne State University in Detroit, Michigan and colleagues evaluated the outcomes of 507 African-American and 1,378 white women diagnosed with breast cancer before age 40. All of the women lived in Detroit.

Although most study patients with localized breast cancer survived, Newman's team found that black women were nearly twice as likely to die as white women.

"Young African-American women are clearly facing increased risks for breast cancer mortality, and this public health issue warrants further investigation and research," Newman and colleagues write.

With regard to detection of breast cancer among women with disease that has yet to spread, African-American women jumped up from a rate of 6.4% in the early 1990s to 11.3% in the later part of that decade. White woman actually saw a slight decrease in their rates of early detection--from 16.4% to 15.7%.

The study authors are calling for more education campaigns to be targeted at African-American women, and that this group be included in more clinical research.

"These are not new findings," said Dr. Vilma Cokkinides, a spokesperson for the American Cancer Society ( news - web sites). "Racial disparities for young women with breast cancer have been reported over and over."

With regard to the current study, Cokkinides notes that socioeconomic factors including level of education and access to healthcare "have not been properly accounted for," and if they were, the death rate differences may be "somewhat reduced."

Regardless, what remains controversial is the cause for the differences in cancer rates and death rates attributed to the disease, according to Cokkinides.

There is currently a "big debate" as to whether the differences are related to socioeconomic factors or cancer tumor biology, Cokkinides noted. In other words, experts are not sure if African-American women are more likely to develop more aggressive forms of breast cancer or if other, society-related factors play a role. Researchers continue to investigate the issue, Cokkinides said.

Source: Cancer 2002;95:21-27.

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Many Asthmatics Skip Anti-Inflammatroy Meds: Survey

Reuters Health

Wednesday, July 31, 2002

NEW YORK (Reuters Health) - The results of a new US survey suggest that up to 75% of asthmatic patients may not be taking anti-inflammatory medications, which are an important part of asthma treatment.

"The results from this representative national population study present a bleak picture of the status of asthma treatment in the United States," according to Dr. Anne L. Fuhlbrigge of Brigham and Woman's Hospital in Boston, Massachusetts, and colleagues.

Asthma is marked by inflammation in the airways, which leads to wheezing, breathlessness and coughing that can range from mild to severe. Asthma attacks are often triggered by an allergic response to an environmental irritant such as tobacco smoke, mold, pollen or other allergic triggers. The disease is becoming more common worldwide, particularly among US children living in urban areas.

One primary treatment for asthma involves the use of anti-inflammatory medications, which help combat the underlying inflammation that can contribute to asthma. Other types of medication include beta-agonists, which work to open constricted airways.

To assess the rate of asthma medication use, the researchers conducted a telephone interview with 2,509 adults; 721 were the primary guardian of a child with asthma and the remaining 1,788 had asthma themselves. The findings are published in the July issue of the Journal of Allergy and Clinical Immunology.

Roughly 90% of those surveyed reported that they experienced limitations in their lives due to asthma. For people in this group, only 21% who described some limitations from asthma reported current use of anti-inflammatory medication, and only 26% with severe limitations reported such current use, the authors report.

In other findings, significantly fewer poor, uninsured, unemployed, less educated and nonwhite persons with asthma reported anti-inflammatory medication use.

About 80% of those with persistent asthma and 43% of those with mild intermittent asthma used "reliever medication," drugs designed to relieve symptoms but not combat inflammation.

"The starkness of our findings on the disparities of medication (use) by socioeconomic status, and in particular by race-ethnicity, emphasize that the current systems used for asthma management are failing to provide adequate care for a large proportion of the population," Fuhlbrigge and colleagues write.

"Attainment of optimal asthma care remains elusive," they conclude.

The study was funded by the drug company GlaxoSmithKline.

Source: Journal of Allergy and Clinical Immunology 2002;110:58-64.

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US Experts Target Elderly, Adolescent Immunizations

By Todd Zwillich
Reuters Health

Wednesday, July 31, 2002

WASHINGTON (Reuters Health) - Government health officials announced a new round of projects Wednesday aimed at narrowing the gap in immunization rates between elderly white and minority Americans.

The US Department of Health and Human Services ( news - web sites) (HHS) unveiled a 2-year plan to organize doctors, insurers and community groups in five locations to boost the number of elderly minorities receiving annual influenza and pneumococcal shots.

Influenza and pneumococcal illnesses including pneumonia together kill 24,000 to 30,000 seniors each year, and experts have long sought ways to expand yearly vaccination against the diseases. Sixty-seven percent of white seniors but only 56% of Hispanics and 48% of blacks were vaccinated against influenza in 2000, according to HHS. Fifty-seven percent of whites and 30% of blacks and Hispanics were immunized for pneumococcal diseases.

Claude Allen, the 2nd-ranking official at HHS, called the figures "unacceptable."

"In the areas of adult immunization, we are not doing as well as we should be doing," he said.

Officials said they would spend $250,000 to $400,000 in each of five minority communities looking for ways to help doctors and community groups bring in more elderly persons for vaccinations.

Planners intend to send out money starting in September for year-long implementation programs and then follow them with a year of evaluation. Funds will be sent to Rochester, New York; Chicago, Illinois; Milwaukee, Wisconsin; San Antonio, Texas; and Mississippi.

Experts also warned that few adolescents are receiving the full recommended course of vaccinations, leaving many of them vulnerable to infectious diseases.

Just 44% of adolescents in one 2000 survey had received the full series of shots against hepatitis B, a serious liver disease that is transmitted through sexual contact or contact with tainted blood.

Adolescents usually go to the doctor only when sick, and few doctors check up on immunizations when they do see adolescent patients, said Dr. Bonnie Word, a pediatrician who serves on CDC's Advisory Committee for Immunization Practice.

"The adolescent has not fared as well" as younger children, she said. Many laws requiring vaccinations for all elementary and middle school children are not properly enforced, and many low-income parents remain unaware that federal programs pay for all childhood and adolescent vaccines, according to Word.

Officials reported that overall childhood immunization rates held steady in 2001, despite shortages of several key vaccines. National vaccination rates ticked up slightly from 76% of children in 2000 to 77% in 2001, though regional disparities remain, said Dr. Walter Orenstein, director of the National Immunization Program at the Centers for Disease Control and Prevention ( news - web sites).

Most states in the Northeast and Southeast sustain child vaccination rates between 80% and 90%, while most Midwestern and Western states lag in the 70% to 79% range.

Experts faced widespread concern earlier this year that shortages in five vaccines covering 11 childhood infectious diseases could damage immunization rates. Only one vaccine, the pneumococcal conjugate vaccine known as PCV7, remains in short supply.

Officials will not know until next year if vaccine production shortfalls affected child vaccination rates in 2002.

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FDA Pressed for Action on Ephedra 

By Randolph E. Schmid

Associated Press Writer

The Associated Press

Wednesday, July 31, 2002

WASHINGTON (AP) - A leading senator took the Bush Administration to task Wednesday for its failure to act on the potentially dangerous food supplement ephedra. "Today I am asking the Secretary of Health and Human Services ( news - web sites) to determine whether the dietary supplement ephedra poses an 'imminent hazard' to the public's health, and if so, use his authority to suspend sales of the product in the U.S. until we can ensure that it is safe," said Sen. Richard J. Durbin, chairman of the Senate Governmental Affairs Committee ( news - web sites)'s oversight panel.

"This is a strong step, but one that must be taken if we are serious about protecting the health and well-being of our citizens," the Illinois Democrat said.

His comments came just over a month after the administration outraged doctors by delaying action on ephedra, instead launching a new safety review of the herbal stimulant.

Durbin spoke at the end of a Senate hearing called to examine the validity of claims made for weight-loss supplements and the government's system of oversight for the supplements.

The food supplement industry has grown explosively in recent years and is on track to reach $19 billion in sales this year, Durbin said.

Joseph A. Levitt, director of the FDA ( news - web sites)'s Center for Food Safety and Applied Nutrition, said the agency does have a plan to deal with ephedra but lacks enough data, which is currently being collected.

The use of food supplements is growing rapidly and represents a "significant challenge" for the agency, Levitt said.

Durbin retorted: "Evidence keeps piling on about the danger of this product. Proposed rules are fine, but nothing has been done."

Canada a year ago warned consumers not to use ephedra and it has been banned by the International Olympic Committee ( news - web sites), National Football League and National Collegiate Athletic Association.

Because ephedra, made from herbs, is sold as a food supplement, U.S. law does not require its manufacturers to prove safety, meet standard drug manufacturing rules or provide any specific warning labels.

To remove a supplement from the market, the FDA has to prove it is dangerous. It has blocked sales of synthetic ephedra.

Three years ago, citing death reports, the agency attempted to bar certain high doses of ephedra. Industry protests killed the move, and a General Accounting Office ( news - web sites) report said that while ephedra clearly was risky to some people, the FDA's statistics were sloppy.

So FDA officials reanalyzed and began working toward warning labels. The consumer group Public Citizen petitioned for a ban.

But instead of deciding on either option, the Department of Health and Human Services ( news - web sites) in June surprised the medical community and hired Rand Corp. to review all scientific reports on ephedra's safety. Results are due this fall, when the National Institutes of Health ( news - web sites) will determine what additional research is needed.

Michael F. Mangano, principal deputy inspector general of the department, noted that the FDA's system for supplement makers to report customers who suffer bad reactions to their products is voluntary.

"For the year 1999, we found that FDA received 460 reports compared to 13,000 reports that poison control centers reported receiving nationwide related to dietary supplements," Mangano said.

In written testimony submitted to the subcommittee, the Council for Responsible Nutrition, a trade association of the dietary supplement industry, contended that it had commissioned a study that showed ephedra is safe under the recommended uses with a daily dose of 90 milligrams.

Durbin noted that at least one product on sale in the United States is a pill containing 325 milligrams of ephedra.

Michael McGuffin, president of the American Herbal Products Association, said in testimony that members of his group engage in self-regulation, recommending business and safety practices.

The Consumer Healthcare Products Association issued a statement urging improvements in the FDA's system for learning of bad reactions to products and calling on the agency to establish standards for good manufacturing practices.

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When to Stop Driving

HealthScoutNews
Wednesday, July 31, 2002

 (HealthScoutNews) -- To many people, the ability to jump in the car and go where and when they want translates to independence. And that freedom can be hard to give up.

But the American Academy of Family Physicians ( news - web sites) warns that as all of us age, it can eventually impair our ability to safely handle a car.

Reasons to consider an end to your driving career include conditions such as arthritis, poor eyesight, and memory loss. The academy says it's important to follow your doctor's advice to keep yourself and others safe.

TUESDAY, JULY 30, 2002 

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Calling Your Doctor

HealthScoutNews

Tuesday, July 30, 2002

(HealthScoutNews) -- Trying to get your doctor on the phone when you or a loved one is sick can be frustrating. And when she finally comes to the phone, she always seems to be in a hurry.

The University of Michigan's M-Care says it's important to get right to the point when calling your doctor. Before dialing, write down the questions and symptoms you have, including whether you have a fever or diarrhea.

Be ready to write down any instructions the doctor gives you and have your pharmacist's phone number handy, in case your doctor prescribes medication. Be sure to ask if you need to come to the office and whether your condition could worsen enough to merit a visit to the emergency room.

And, M-Care says, manners count. Say thank you when you're finished.

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Program Gets Kids Moving, Eating Better

By Merritt McKinney

Reuters Health

Tuesday, July 30, 2002

NEW YORK (Reuters Health) - The encouraging results of a health initiative in the border city of El Paso, Texas, suggest that school-based health programs can succeed in encouraging children to exercise more and eat a healthier diet.

In most of the schools involved in the program, the time children spent in moderate to vigorous physical activity increased and the fat in school meals and sodium in school breakfasts decreased, according to a report in the August issue of the journal Health Education and Behavior.

There is still room for improvement, since not all of the schools met or maintained the healthy goals, but the results show that a program can improve children's health, according to one of the study's authors, Dr. Karen J. Coleman of the University of Texas at El Paso.

"You need faith, tenacity, community money and mouths, and good, clear data, and you can change the health of your community," Coleman told Reuters Health.

It is no secret that eating a healthy diet and exercising regularly can go a long way toward preventing heart disease, diabetes and other diseases, but most Americans are still missing the boat when it comes to personal fitness. Though Americans of all backgrounds have expanding waistlines, physical inactivity and obesity are "especially prevalent" among Hispanics, according to Coleman and her co-author, Dr. Edward M. Heath, of Utah State University in Logan.

With the aim of preventing later health problems by promoting exercise and a healthy diet among schoolchildren, the non-profit Paso del Norte Health Foundation funded the implementation of a health program called Coordinated Approach to Child Health (CATCH) in elementary schools in the El Paso area. In national studies, children participating in CATCH programs became more physically active and ate healthier diets.

The CATCH program has several components, but the El Paso program focused on physical education classes and school meals. The program started in the El Paso region in 1997 and included 83 area schools during the 2000-2001 school year.

To evaluate the impact of CATCH in El Paso, Coleman and Heath compared 20 elementary schools in the program with 4 schools that did not participate in the program. The study findings suggest that CATCH has encouraged healthier lifestyles in children in the El Paso area, although the results were somewhat inconsistent.

In most of the schools in the CATCH program, children's levels of physical activity increased during the first year of the program. However, in many of the schools, levels of physical activity dropped somewhat after the first year of the program.

Results of the drive to make school meals healthier were somewhat mixed, the report indicates. All schools seemed to meet the goal for breakfast--less than 30% of calories from fat and sodium below 1,000 milligrams. Schools had a harder time reaching the nutritional goals for lunch, however.

Though the study identified several improvements, Coleman and Heath caution that due to a lack of baseline information from some of the schools, they cannot prove that the CATCH program was responsible for the improvements. They note, however, that in schools not enrolled in the program, physical activity did not increase and the percentage of fat in school lunches did.

According to Coleman, taking a "cookie-cutter" approach to improving the health of schoolchildren is a "recipe for failure."

"School-wide interventions must be built from the ground up," Coleman said, "with special considerations for the culture of the school, not just the community in which the schools are located."

Coleman said that the success so far in the El Paso program is due to a combination of "sheer determination," private funding and "a few dedicated, overworked souls."

Besides the CATCH program, Coleman said that the El Paso community has taken other steps to improve the health of its schoolchildren. For example, she said that the city's largest school district turned down a $20 million contract that would have granted a soft drink company exclusive rights to supply the school system for 10 years. Instead, the school district and the beverage company agreed on a 2-year contract to provide water, 100% fruit juice and nonfat milk in all elementary andmiddle schools, according to Coleman.

Source: Health Education and Behavior 2002;29:444-460.

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Senators Introduce Obesity Bill

The Associated Press

Tuesday, July 30, 2002

WASHINGTON (AP) - Like a trio of relentless aerobics instructors, three senators want Americans to start feeling the burn.

The senators — Bill Frist, Jeff Bingaman and Christopher Dodd — introduced legislation Tuesday aiming at reducing obesity, especially among children.

"Obesity is, for the most part, preventable," said Frist, R-Tenn. "There is no single solution, but better information, improved nutrition and greater opportunities for physical activity will guarantee progress."

To provide those resources, the three senators are proposing spending as much as $217 million next year and additional money in future years on a variety of programs to encourage better nutrition and more physical activity.

The money would go to the Institutes of Medicine, the Centers for Disease Control and Prevention ( news - web sites) and the Department of Health and Human Services ( news - web sites) to identify risk factors, analyze government food assistance programs and work with state governments on nutrition and exercise programs.

Obesity is a factor in heart disease, diabetes and cancer. According to statistics cited by the senators, an estimated 61 percent of U.S. adults and 13 percent of children are overweight. An estimated 300,000 deaths per year are associated with obesity. There are twice as many overweight children and three times as many overweight adolescents as there were 30 years ago.

"Obesity is our nation's fastest rising public health problem," said Bingaman, D-N.M. "As a nation, we can no longer afford to ignore the escalating costs associated with obesity and unhealthy lifestyles, such as physical inactivity and poor dietary habits."

Dodd, D-Conn., said a failure to address the problem of obesity would endanger more and more children.

On the Net:

Sen. Bill Frist ( news, bio, voting record): http://frist.senate.gov

Sen. Jeff Bingaman ( news, bio, voting record): http://bingaman.senate.gov

Sen. Christopher Dodd ( news, bio, voting record): http://dodd.senate.gov

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Talking Women Through Exam Spurs Repeat Mammograms

By Merritt McKinney
Reuters Health

Tuesday, July 30, 2002

NEW YORK (Reuters Health) - Having an unpleasant experience during a mammogram screening, particularly a negative interaction with the technologist performing the screen, may discourage women from having another mammogram, researchers report. The problem may be more common in heavier women, the findings suggest.

"Further research should focus on how best to coach women through the mammographic experience," Dr. Patricia A. Carney, of Dartmouth Medical School in Lebanon, New Hampshire, and colleagues state in the July 15th issue of the journal Cancer.

The study included 625 New Hampshire women aged 50 years and older who had a mammogram. The researchers had the women complete a questionnaire to see if they could identify any differences between women who did and did not return for another mammogram within the next 2 years.

To the surprise of the researchers, the women were similar in many respects. There were no differences between the groups in the number of relatives who had been diagnosed with breast cancer ( news - web sites), in women's age at their first menstrual period or first childbirth, or in the number of previous breast biopsies.

The women were not identical, though. Women who returned for another mammogram were more likely to be taking hormone replacement therapy, suggesting that they may have been more likely to have a regular source of healthcare. And women who did not have another mammogram were less likely to have health insurance, although the difference was so small that the researchers question whether it had a significant effect on women's likelihood of getting another mammogram.

In what the investigators call a key finding, the study indicated that women who returned for another mammogram and those who did not had significantly different experiences with previous mammograms.

Surprisingly, 66% of women who did not return for another screen said their mammogram experience was positive, compared with 50% of women who had another screen. And just 9% of women who did not have another screen said their last mammogram was a negative experience compared with 29% of women who came back for another screen.

Among women who had a negative experience, though, the reasons for the unpleasant screen varied between the two groups. For women who continued having mammograms, the number-one complaint was trouble getting an appointment, but the most frequent complaint for women who did not have another mammogram was pain.

To have a positive mammogram experience, both groups of women placed high importance on the technologist who performed the screen, including the technologists' skill in talking women through the procedure. The study "may lay the groundwork for future intervention research to enhance technologists approaches to patients," according to the report.

Carney's team found that women with a higher body mass index (BMI)--a measure of obesity that takes into account weight and height--were less likely to have a repeat mammogram.

Heavier women may be more likely to have a negative experience with a mammogram, "perhaps due to embarrassment or greater sensitivity among heavier women about how they are coached or how their bodies are handled during this very personal procedure," Carney and colleagues conclude.

The American Cancer Society ( news - web sites) advises women to have an annual mammogram beginning at age 40. Some experts, however, believe that most women can wait until age 50 to begin annual mammograms. In 1997, a consensus panel convened by the National Institutes of Health ( news - web sites) determined that there was not enough evidence to advise all women in their 40s to have mammograms.

Source: Cancer 2002;95:219-227.

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When You Can't Fall Asleep 

HealthScoutNews

Tuesday, July 30, 2002

(HealthScoutNews) -- More than 100 million Americans often have trouble getting a good night's sleep, according to the St. Francis Hospitals and Medical Centers of Indiana.

So, what can be done? St. Francis says most sleep problems can be remedied with lifestyle changes. If you have insomnia, the hospital advises:

  • Avoid caffeine or tobacco six hours before bedtime;
  • don't nap;
  • don't use your bedroom as an office or to watch TV;
  • and set aside time earlier in the day to worry about things that are bothering you, so you don't lie awake thinking about them.

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Some Kids' Modeling Clays May Post Health Risk: Group

By Melissa Schorr
Reuters Health
Tuesday, July 30, 2002

NEW YORK (Reuters Health) - Certain polymer modeling clays may pose a health risk for children and should be removed from the market for further safety testing, according to a report issued Tuesday by the Vermont Public Interest Research Group (VPIRG), a consumer watchdog organization.

The products are a form of modeling clay that are soft at room temperature but can be molded into an item, which then hardens when baked at a low temperature in a conventional oven.

"These products contain chemicals that have potential to damage the health of our children, and possibly their fertility," Jeremiah Baumann, environmental health advocate for the US Public Interest Research Group in Washington DC, a consortium for the state-run advocacy groups, told Reuters Health. "There's no excuse for a regulatory system that allows these products to go onto store shelves and be marketed to children."

The group investigated the safety of plastic-based modeling clays that contain phthalate plasticizers, chemical compounds that keep clay soft and pliable. Some human and animal studies have suggested that phthalates may be linked to liver damage and infertility. In addition, when overheated or accidentally burned, polyvinyl chloride (PVC) in the clay may also release toxic hydrochloric acid gas, the report asserted.

Previous concerns about the presence of phthalates in toys intended for children's mouths led the European Union ( news - web sites) to ban such products from containing more than 0.1% of phthalates two years ago. The US government asked manufacturers to voluntarily discontinue their use, Baumann said.

VPIRG conducted laboratory testing on two popular polymer clay products, Sculpey and Fimo, and found that Fimo clay contained from 11% to 14% phthalates while Sculpey contained from 3% to 4% phthalates. The group reported that exposure to phthalates approached or exceeded various state drinking water standards and federal guidelines for air transmission.

The researchers measured the amount of phthalates remaining on workers' hands after they used the clay and washed it off. They then extrapolated that a higher than recommended dose of the chemical might be ingested if children worked with the clay and then placed their hands in their mouths.

The group is calling for the US Consumer Product Safety Commission ( news - web sites) (CPSC) to recall or suspend the sale of such clays until further safety testing can be conducted.

"Our recommendation would be that CPSC should issue a moratorium unless and until studies show there's no health risk," Baumann said.

The group also advocates that a warning label be placed on the product advising children and pregnant women to avoid handling the clay. Adults who still want to use the clays should use gloves and avoid inhaling fumes when baking the product, he advised.

"I would recommend not using them," Baumann said. "When there's evidence of a hazardous chemical, we should not be exposing ourselves to it if we don't need to. There are safer alternatives out there--nothing about this product justifies the risk."

Polyform Products Co., the makers of Sculpey, referred all comments to the Arts and Creative Materials Institute, a trade group for arts and crafts manufacturers based in Hanson, Massachusetts.

Executive Vice President Deborah Fanning said the group's toxicologist, Dr. Woodhall Stopford of Duke University, disputed the report's findings on the exposure levels to phthalates, as well as the risk assessment of the potential health hazard.

"We think this report is inaccurate, overkill and sensational," she told Reuters Health. "We'd rather see research not blown out of proportion; some of the information may be totally incorrect and have everybody worrying."

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Support Groups May Boost Busy Mom's Exercise Level

Reuters Health

Tuesday, July 30, 2002

NEW YORK (Reuters Health) - Moms with young children who join forces in an effort to get more exercise may gain some benefits, at least in the short run, new study findings from Australia suggest.

Young women between the ages of 18 and 22 with children are particularly unlikely to be adequately physically active, according to lead investigator Dr. Wendy J. Brown of the University of Queensland and colleagues.

"Less than half (46%) of this group of women engaged in adequate physical activity compared with 56% of women without children," the authors report in the August issue of the American Journal of Preventive Medicine.

In their report, Brown's team wondered what effect, if any, organized group discussions to motivate women to get more exercise would have on otherwise busy moms.

A total of 554 women were enrolled into one of three groups. One group of women received an informative booklet that outlined ways to "overcome physical activity barriers." Another group got the same booklet and also met once a week in a support group that focused on how mothers with young children could boost their physical exercise habits. A third group, which acted as the "control" group, received nothing.

After 8 weeks, 60% of women who participated in the group motivational sessions reported getting an amount of exercise considered to be adequate for a health benefit, compared with only 50% of the women who only received the booklet, and 46% of the control group.

However, after 5 months, the women were back to physical activity levels seen before the study started, Brown and colleagues found.

Nevertheless, the researchers note that community support groups "are promising strategies" for increasing physical activity among women with young children.

Source: American Journal of Preventive Medicine 2002;23.

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Gingko Biloba Will Be Tested on Leg Artery Disease

HealthScoutNews

Tuesday, July 30, 2002

TUESDAY, July 30 (HealthScoutNews) -- Stanford University researchers want to see whether the popular herbal extract ginkgo biloba can actually walk the walk when it comes to treating peripheral artery disease -- narrowing of the arteries caused by a buildup of cholesterol.

They're looking for volunteers who suffer from leg discomfort caused by peripheral artery disease to take part in a study of ginkgo biloba.

"Many with peripheral artery disease are surprisingly unaware of the impairment of their arteries. Only about one-quarter have clear-cut pain when walking," says Christopher Gardner, an assistant research professor of medicine at Stanford University Medical Center.

"The main goal of this study is to find out if people who take gingko biloba will be able to increase the distance they are able to walk free of pain or discomfort," Gardner says.

The 72 study volunteers will be randomly given ginkgo biloba or placebos. Over the course of the 48-week trial, they'll have to report four times to walk on a treadmill and give blood samples.

Gingko biloba is commonly prescribed by doctors in Europe for patients with peripheral artery disease. But whether it's actually effective is open to debate. Gingko biloba is one of the most popular herbal products in the United States.

Peripheral artery disease affects about 14 percent of Americans over age 50. It's most common in people who have diabetes, high blood pressure, and heart disease and in those who smoke.

Walking is considered one of the best self-help treatments for peripheral artery disease. But people with advanced artery narrowing may suffer extreme pain after walking for just short periods.

More information

If you're interested in participating in the study, call coordinator Joel Nicholus at 650-723-7022. For a fuller explanation of peripheral artery disease, you can read this American Heart Association primer.

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Caffeine Boosts Stress Level All Day Long: Study

By Alison McCook

Reuters Health

Tuesday, July 30, 2002

NEW YORK (Reuters Health) - People who consume caffeine may experience an increase in blood pressure, feel more stressed and produce more stress hormones than on days when they opt for decaf, US researchers report.

Furthermore, Dr. James D. Lane and his colleagues at Duke University in Durham, North Carolina found that the effects of caffeine appear to persist until people go to bed, even if they don't consume any caffeine after 1 p.m.

Given the long-lasting effects of caffeine, the authors suggest that regular consumption of the substance could contribute to the risk of developing heart disease. Furthermore, Lane told Reuters Health that any condition influenced by stress could also be aggravated by caffeine.

For example, in people with the type 2 form of diabetes--often associated with obesity--stress can worsen the condition by influencing how well the body regulates blood sugar, Lane said. He added that people with stress-related disorders, such as post-traumatic stress disorder or social anxiety, could also experience adverse effects from caffeine consumption.

"Any stress-related disease could be aggravated by caffeine," Lane said.

In the US, approximately 85% of adults drink caffeine every day, in the form of coffee, soft drinks, or tea.

In the current study, the participants--47 regular coffee drinkers--consumed 500 milligrams of caffeine, in the form of two pills. This quantity of caffeine is roughly equivalent to that contained in 4 small (8 ounce) cups of coffee. The second pill was taken no later than 1 pm. Each participant took caffeine pills during one workday, and inactive pills during another workday, and frequently recorded how stressed they felt. The participants never knew whether the pills contained caffeine ora placebo.

The researchers monitored the participants' blood pressure, heart rate, and the quantity of certain substances they excreted in their urine.

Reporting in the July/August issue of Psychosomatic Medicine, Lane and his colleagues found that people had slightly higher blood pressure levels, produced 32% more of the stress hormone epinephrine, and felt more stressed on days when they took a caffeine-containing pill compared to the days they took the placebo.

In an interview with Reuters Health, Lane said that the effects of caffeine likely persist in the body because the substance takes a long time to deteriorate. More specifically, caffeine has a "half-life" of an average of 4 hours, meaning that however much caffeine you consume, it will take your body 4 hours to rid itself of half that amount. And 4 hours later, your body will contain only one-quarter of the original amount. Consequently, 12 hours after consuming caffeine, Lane explained, your body still contains one-eighth of what you first drank.

Lane added that he hesitates to tell people exactly how much caffeine they should consume each day. However, for those with conditions that are aggravated by stress, or have high blood pressure, "one simple thing they can try is to cut back on caffeine," he said, and see if that helps alleviate their symptoms.

Cutting out caffeine "doesn't cost a thing, and it may make you feel better. So it's worth a try," Lane advised.

Source: Psychosomatic Medicine 2002;64:593-603.

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Doctors No Better Than Patients at Sun Protection

By Alison McCook

Reuters Health

Tuesday, July 30, 2002

NEW YORK (Reuters Health) - Doctors are no more likely than patients to protect themselves from the sun, despite the fact that they are familiar with the medical risks associated with exposure to the sun's harmful rays, a new study shows.

There are many possible reasons doctors don't protect themselves from the sun any more than others, lead author Dr. Christopher N. Sciamanna of Brown University in Providence, Rhode Island told Reuters Health.

Doctors may spend less time in the sun than their patients, he suggested, or may not believe that sun exposure poses any real danger to them.

Furthermore, the skin cancers linked to adult sun exposure are less deadly than those associated with exposure to sun as a child, Sciamanna said. Consequently, doctors often learn in medical school that adults should protect themselves from the sun for mainly cosmetic reasons.

"There are benefits and costs to every health behavior," Sciamanna said. "It's probable that the benefits of protecting yourself from the sun, at least for physicians, doesn't outweigh the costs they perceive--such as inconvenience or mess."

However, previous research has demonstrated the costs of spending time in the sun. In 2000, over one million people developed one of two largely curable forms of skin cancer, basal or squamous cell carcinoma. In addition, the American Cancer Society ( news - web sites) estimates that 53,600 people will be diagnosed with melanoma--the deadliest form of skin cancer--in the United States in 2002.

To help people protect themselves from the sun's harmful rays, a number of organizations recommend that people adopt protective behaviors, such as using sunscreen, wearing protective clothing, and avoiding the sun during the midday hours when exposure is at its peak.

In order to assess how often doctors and patients followed those recommendations, Sciamanna and his colleagues conducted surveys of 100 patients and 84 doctors about their behaviors when outside for more than 1 hour on a sunny summer day. Doctors consisted of a sample of primary care physicians and specialists. The authors report their findings in the July/August issue of American Journal of Health Promotion.

Sciamanna and his team found that about 46% of all respondents said they used some form of sun protection, including sunscreen, choosing shade, and wearing a hat or long-sleeved shirt. Overall, doctors were no more likely to use sun protection than patients, although the choice of sun-protection strategies differed between the two groups of people.

More than 42% of doctors said that they would use sunscreen, a behavior adopted by only 28% of patients. However, patients were almost twice as likely as doctors to stay in the shade during sunny summer weather, and were also more likely to wear a wide-brimmed hat or long-sleeved shirt.

In an interview with Reuters Health, Sciamanna said that it was unclear why doctors opted for sunscreen over other protection strategies. However, the doctors in this sample were, overall, younger than patients, and younger respondents tended to be less likely to wear a shirt or stay in the shade.

Numerous studies have demonstrated that doctors advise their patients to adopt the same healthy behaviors the doctors themselves employ, and Sciamanna and his team found that doctors who reported fewer sun protection strategies were less likely to tell their patients to protect themselves from the sun.

"Docs preach what they practice," Sciamanna said. Consequently, one possible way to improve physicians' behavior--and in turn, the advice they give to their patients--might be to include programs in medical school that encourage students to practice healthy lifestyles, including protecting themselves from the sun.

"If we want doctors to spread the word, we've got to intervene on them," Sciamanna said.

Source: American Journal of Health Promotion 2002;16:319-322.

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Cervical Plugs Give Fetus Protection from Bacteria

Reuters Health
Tuesday, July 30, 2002

NEW YORK (Reuters Health) - In pregnant women, the mucus plug in the cervix (located between the vagina and the uterus) serves as a physical barrier between a developing fetus and germs that can lead to pre-term labor and other complications.

Now, researchers report that it also has anti-microbial properties that kill bacteria, such as group B Streptococcus and E. coli.

In fact, anti-microbial proteins in cervical mucus plugs were found to be similar to those in nasal fluid. Both mucus plugs and nasal fluid, the researchers point out, provide barriers for sterile environments, such as the lungs and the uterine cavity, and the germ-rich outside world.

The findings suggest that women who are predisposed to infections in their uterus and other complications may have deficiencies in the composition of their mucus plugs, conclude researchers in the July issue of the American Journal of Obstetrics and Gynecology ( news - web sites).

"The cervical mucus plug is not only a physical barrier to microbial entry into the uterine cavity, but it also contains diffusible substances that exhibit antibacterial activity," Dr. Tomas Ganz from the University of California, Los Angeles, and colleagues, write.

At conception, mucus that is normally present in the cervical canal thickens to form a plug between the uterus and the vagina. The plug remains intact during pregnancy to keep out bacteria, which can cause intrauterine infection and increase the risk of pre-term labor and neurologic and developmental delays among the fetus.

To determine whether the plug's powers of protection are more than just as a physical barrier, the researchers analyzed 60 cervical mucus plugs from healthy women, aged 28 to 33.5 years, at full-term delivery, as well as cervical mucus from women who were not pregnant.

Cervical plugs and mucus both contained immune system proteins that fight infection, the study found.

Source: American Journal of Obstetrics and Gynecology 2002;187:137-144.

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Living Liver Donors Recuperate Well, No Regrets

By Alison McCook

Reuters Health
Tuesday, July 30, 2002

NEW YORK (Reuters Health) - A sample of adults who donated a portion of their livers to a child who needed a liver transplant---in most cases, their own child-- said they eventually recuperated well from the procedure, US researchers report.

Furthermore, the majority of donors said they endorsed so-called "living donation," regardless of how well the receiving child fared after the procedure.

"Even when you look at adults whose babies did not do well, they still don't regret it," study author Dr. John F. Renz of the University of California, Los Angeles told Reuters Health.

When an adult donates a portion of his or her liver to a child, doctors extract up to one-quarter of the adult's liver and transplant it into a child. The procedure differs markedly from living donations from one adult to another, which require that the donor offer up to 65% of their own livers. The donor and recipient need not be genetic matches, but both must share a blood type.

Incredibly, adult donors typically recover up to 95% of their original liver volume within 7 days, on account of the organ's powerful ability to regenerate itself. Consequently, most of the recuperation period stems from elements of the operation itself, such as the size of the incision and the need to divide abdominal muscles to reach the liver.

Children need new livers for a variety of reasons, such as end-stage liver disease as a result of chronic illness, or sudden liver failure, which can develop within a matter of days.

While living-donor liver transplants have cut children's waiting time for organs and reduced their risk of death while waiting, 10% to 15% of donors experience complications from the procedure, ranging from bleeding, developing a potentially fatal blood clot in the lungs, hernia, or bowel obstruction after the procedure.

To determine how adult donors felt after portioning off some of their liver to a child, Renz and his team conducted surveys of 41 adults who had donated a portion of their livers to a child between 1992 and 1999. Donors completed the survey after an average of more than 1 year following the procedure.

The authors found that most donors (74%) said they believed they completely recuperated from the procedure in less than 3 months, while 16% said they thought their recuperation took between 3 and 6 months. Only 10% of donors said they needed more than 6 months to recover from the transplant operation, the authors write in the July issue of the Annals of Surgery.

Furthermore, Renz and his team report that 89% of donors said living-donor liver transplantation should be used in more than just "emergency" situations, when the child needs a liver immediately.

In an interview with Reuters Health, Renz said he suspected these results applied strictly to adults who donate livers to children. Transplanting from one adult to another is a more extensive procedure, and as such, the recovery period can take longer. In some cases, liver donors have died after the operation.

Furthermore, when an adult donates a portion of his or her liver to another adult, the relationship between the two is likely different than when a parent donates to a child, Renz said.

Based on studies of living-donor kidney transplantation, donors can feel differently about the procedure depending on their relationship with the recipient, the researcher added. "There's always, always higher donor satisfaction among first degree relatives than among any other group," Renz said.

Source:  Annals of Surgery 2002;236:120-126.

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Belgium to Ban Fluoride Tablets, Chewing Gum

Reuters
Tuesday, July 30, 2002

BRUSSELS (Reuters) - Belgium plans to ban the sale of tablets and chewing gum that have fluoride in them because of the risk that they may cause fluoride poisoning if overused, a health ministry spokesman said on Tuesday.

But it will stop short of banning toothpaste with fluoride, which protects teeth from decay, he said.

The move is believed to be the first such ban in the European Union ( news - web sites), officials said, and may spark renewed debate about the safety of fluoride, which some countries add to public drinking water supplies as a means of improving dental health.

It will probably come into force by late August, said Belgian health ministry spokesman Tom Ruts.

"Those products are used excessively and often abused," he told Reuters, confirming comments made by Health Minister Magda Aelvoet in the latest issue of the weekly magazine, Humo.

Aelvoet told the magazine she hoped her European Union partners would follow her example.

"In these cases, a harmonization within the European Union is of course desirable but I can't always wait until the European Union is ready," she was quoted as saying.

"We will however communicate our official decision to the other European member states in the hope that they will follow us swiftly."

Fluoride supplements--such as fluoride tablets or fluoride chewing gum--are promoted by dentists to fight dental caries.

They have been sold in Belgium without a prescription.

The ministry made its decision after the results of a study commissioned by an advisory board to the ministry, the spokesman said. It found that excessive use of fluoride products could cause fluoride poisoning, damage the nervous system and foster osteoporosis.

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Germany Spending More, Not Less, on Medication

By Ned Stafford

Reuters Health
Tuesday, July 30, 2002

FRANKFURT (Reuters Health) - Drug spending in the German public health insurance system rose in the first half of this year leaving little hope the government will achieve its ambitious goal of cutting drug costs by 5% this year, a leading pharmacist said on Tuesday.

The Federal Union of German Associations of Pharmacists (ABDA) reported that first-half 2002 drug spending by the public system reached 10.77 billion euros, up 450 million euros, or 4.4%, from the first 6 months of 2001.

Frank Diener, head of the ABDA's department of economics and social affairs, told Reuters Health that the system will almost certainly spend more on drugs this year than last year, when spending totaled around 21 billion euros, up 11.2% from 2000.

"I do not see a realistic chance that there can be an effective decrease in drug spending this year," he said.

"With so many innovative drugs in the pipeline, none of the industrialized countries will be able to cut drug spending. It is not possible."

The ABDA noted that drug makers had made a one-time payment of 200 million euros earlier this year in an agreement with the health ministry to avoid a 4% price-cut of on-patent drugs. If that payment is taken into account, actual spending in the first half of 2002 would be 10.57 billion euros, up 2.4% from a year ago.

Diener's assessment backs statements made a couple of weeks ago by Dr. Leonhard Hansen, chairmen of the National Association of Statutory Health Insurance Physicians (KBV). Hansen said it would not be possible for doctors to fulfill a pledge made in January to cut public health insurance funded prescriptions in 2002 by nearly 5% from 2001 levels.

His confession was greeted the next day by stern criticism from German Health Minister Ulla Schmidt, who reminded the KBV of their January pledge and said she "expected doctors to do their part in the urgently required task of cost-cutting in the medicine sector."

Rising healthcare costs--with politicians pointing fingers at the rise in drug prices as a major culprit--have become a major campaign issue in national elections scheduled for Sept. 22. Schmidt's fellow SPD party member Chancellor Gerhard Schroeder is battling to be re-elected.

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Campaign Urges Diabetics to Prevent Heart Disease

Reuters Health
Tuesday, July 30, 2002

NEW YORK (Reuters Health) - A new campaign urges Hispanics and Latino Americans with diabetes to reduce their risk of heart disease by controlling their blood sugar, blood pressure and cholesterol.

The campaign, "Si Tiene Diabetes, Cuide Su Corazón" (If You Have Diabetes, Take Care of Your Heart), was unveiled last week by the National Diabetes Education Program (NDEP) during the National Council of La Raza's annual conference in Miami, Florida.

"This important new national campaign will do exactly what its name implies--help people all over the country with diabetes take better care of their hearts," US Health and Human Services ( news - web sites) Secretary Tommy G. Thompson said in a statement.

Diabetes currently affects more than 2 million Hispanic and Latino Americans, the NDEP estimates. And recent study findings have shown that these individuals are more likely to die from heart disease than their non-diabetic peers.

"At least 65% of people with diabetes die from heart disease or stroke, and yet only one in four Hispanic and Latino Americans with diabetes know they are at risk for heart disease," Yanira Cruz Gonzalez, chair of the NDEP's Hispanic/Latino work group said in a statement.

To minimize their risk of heart disease, diabetics ( news - web sites) should have their blood glucose levels checked at least twice annually, their cholesterol levels checked annually and their blood pressure checked during every visit to the doctor, the NDEP advises. Levels of LDL ("bad") cholesterol should be below 100 milligrams per deciliter (mg/dL) of blood and blood pressure readings should be lower than 130 mm Hg systolic (the first number in a blood pressure reading) and 80 mm Hg diastolic (the second number).

People with diabetes should also maintain a healthy lifestyle by engaging in physical activity for at least 30 minutes each day, taking their prescribed medications and staying on a healthy diet in order to control their blood sugar, blood pressure and cholesterol.

To that end, the NDEP is offering a free recipe booklet featuring flavorful Hispanic and Latino recipes that are low in fat and salt, and additional bilingual Spanish and English diabetes education information. Both can be obtained from the National Diabetes Information Clearinghouse via their toll-free number--1-800-438-5383.

"It's more than just food--it's life," Gonzalez said. "If people know what to do, and they take care of their hearts, they can remain the heart of their families for a long time."

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Motorcycle Deaths Drop After Helmet Law Reinstated

By Charnicia E. Huggins

Reuters Health
Tuesday, July 30, 2002

NEW YORK (Reuters Health) - A controversial motorcycle helmet law that was reinstated in Maryland in 1992 appears to have led to a more than one-third decrease in the number of motorcycle deaths, new study findings show.

"Maryland's controversial motorcycle helmet law appears to be an effective public health policy and may be responsible for saving many lives," according to lead study author Kimberly M. Auman, of the University of Maryland in Baltimore, and her colleagues.

Yet, "it's the helmet, not the law that protects against brain injury," Auman told Reuters Health.

The law, which requires both motorcycle drivers and motorcycle riders to wear helmets approved by the state department of motor vehicles, was first instituted in 1967. In 1979, however, the law was modified so that only minors were required to wear state-approved helmets. Fourteen years later, in 1992, the original law was reinstated.

To investigate the law's effectiveness, the researchers compared the number of motorcycle fatalities that occurred before the law was enacted--from January 1, 1990 to September 30, 1992--with the number of fatalities that occurred from January 1, 1993 to September 30, 1995.

Of the 212 overall deaths, 61% occurred in the pre-law period and nearly 40% occurred afterwards, representing a roughly 37% drop in motorcycle fatalities, the investigators report in the August issue of the American Journal of Public Health, journal of the American Public Health Association ( news - web sites).

What's more, the death rate among motorcyclists decreased by 56% over the 5-year period after the law was enacted, from a high of 10.3 deaths per 10,000 registered motorcycles in 1992 to 4.5 deaths per 10,000 vehicles in 1996, the report indicates. The number of registered vehicles essentially remained the same during that period.

In contrast, the percentage of motorcyclists wearing helmets at the time of a fatal crash jumped from roughly 25% in the pre-law period to 80.5% in the post-law period, the investigators found.

During both the pre-law and the post-law periods, however, motorcyclists who wore helmets were 70% less likely to suffer a traumatic brain injury than were their peers who did not use helmets, study findings indicate.

"Helmets protect against brain injury," Auman said.

The Maryland Department of Transportation funded the study.

Source: American Journal of Public Health 2002;92:1352-1355.

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Red Wine May Cut Heart Disease Risk in Obese: Study

Reuters Health

Tuesday, July 30, 2002

NEW YORK (Reuters Health) - While it is well established that obese people have a greater risk of developing heart disease, a new report suggests that this risk may be offset, at least in part, by consuming moderate amounts of red wine.

In their study, Dr. J. B. Dixon and colleagues of Alfred Hospital in Melbourne, Australia, found that obese people who consumed moderate amounts of red wine had lower levels of a blood protein called homocysteine.

High levels of homocysteine have been linked to an increase in cardiovascular disease risk, so keeping homocysteine levels under control may cut heart disease risk, the report indicates.

In the study, Dixon's team measured blood levels of homocysteine in 350 obese men and women, and interviewed them about their alcohol consumption habits. The findings are published in the July issue of the European Journal of Clinical Nutrition.

According to the investigators, red wine consumers had blood homocysteine concentrations that were 17% lower than those consuming no alcohol and 13% lower than individuals who reported primarily drinking beer or spirits.

The slightly lower homocysteine levels were seen in people consuming less than 100 grams of wine per week, which is roughly equivalent to six to eight 5-ounce glasses of wine.

Mild to moderate red wine consumption in obese individuals is associated with lower homocysteine concentrations, the authors conclude, and this may reduce their cardiovascular risk.

Source: European Journal of Clinical Nutrition 2002;56:608-614.

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New Research ID's Eating Disorder Risk Factors 

HealthScoutNews

Tuesday, July 30, 2002

TUESDAY, July 30 (HealthScoutNews) -- Girls who do gymnastics, ballet, and other sports that emphasize low weight are 50 percent more likely than other girls to have eating disorders, new research suggests.

A study in the July/August issue of the American Journal of Health Promotion also says certain other risk factors -- depression, history of sexual abuse, or abuse of cigarettes, alcohol, or tobacco -- can be used to identify girls in these sports who are particularly vulnerable to eating disorders.

"Although weight-related sports involvement has been associated [in previous studies] with elevated risk for eating disorders, not all youth involved in [these sports] display symptoms," says lead author Nancy E. Sherwood, University of Minnesota, Twin Cities.

She and her colleagues analyzed data from 5,174 female public school students in grades 7,9, and 11, collected in a 1995-1996 Connecticut adolescent health survey. They found that girls involved in weight-related sports were 1.5 times more likely to have an eating disorder.

When they identified other risk factors for these girls, they found that being underweight wasn't a reliable indicator of an eating disorder.

The authors say coaches, school officials, and doctors should monitor girls in weight-related sports who have the additional risk factors for eating disorders.

The authors suggest coaches be careful about the messages they give these girls about weight related issues. Coaches should emphasize healthy approaches to exercise and eating.

More information

The Food and Drug Administration ( news - web sites) offers this fact sheet on teens and eating disorders.

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US School Lunches Cause Many Illnesses: Report

Reuters Health
Tuesday, July 30, 2002

NEW YORK (Reuters Health) - Over the last 25 years, outbreaks of food-borne illness linked to subsidized school lunches sickened tens of thousands of students and school staff, sent hundreds to the hospital and caused one death, according to a new report.

Currently, the US Department of Agriculture (USDA) spends about $7 billion annually to provide food or funding for more than 33 million lunches and breakfasts served daily to American schoolchildren.

"However, USDA directly provides only a small percentage of food served in schools," according to lead author Dr. Nicholas A. Daniels of the University of California, San Francisco, and colleagues.

Roughly 83% of food served in the federal program is purchased by local schools with USDA funding, the report indicates, with the remainder donated directly to schools by the USDA in the form of beef, poultry, fruits, vegetables, grain and milk.

In the current report, Daniels and colleagues evaluated information collected by the Centers for Disease Control and Prevention ( news - web sites)'s Foodborne Outbreak Surveillance System between 1973 and 1997. Their findings are published in the July issue of the Pediatric Infectious Diseases Journal.

Outbreaks of foodborne illness linked to subsidized school lunches sickened an estimated 49,963 children and teachers, sent slightly more than 1,500 individuals to the hospital and caused one death, the researchers report.

During that time, a total of 604 outbreaks of foodborne disease were reported, with the number of annual outbreaks ranging from 9 to 44. Salmonella was the most commonly identified illness-causing bug, accounting for 36% of outbreaks, the findings indicate.

Salmonella can cause vomiting, diarrhea and fever in healthy adults, and can be deadly for the elderly or people with weak immune systems.

Foods containing poultry (18.6%), salads (6%), Mexican-style food (6%), beef (5.7%) and dairy products excluding ice cream (5%) were most commonly identified as being contaminated. Improper food storage and holding temperatures, and food contaminated by a food handler were the most commonly reported food handling practices associated with outbreaks, according to the report.

"Strengthening food safety measures in schools would better protect students and school staff from outbreaks of foodborne illness," the authors write.

"Infection control policies, such as training and certification of food handlers in the proper storage and cooking of foods, meticulous hand washing and paid sick leave for food handlers with (gastrointestinal illness) could make meals safer for American students," Daniels and colleagues conclude.

Source: Pediatric Infectious Diseases Journal 2002;21:623-628.

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Take Warnings About Sleep Apnea to Heart

By Serena Gordon
HealthScoutNews Reporter

HealthScoutNews

Tuesday, July 30, 2002

TUESDAY, July 30 (HealthScoutNews) -- The snoring caused by sleep apnea isn't just a nuisance -- it can increase your chances of developing cardiovascular disease.

In a new study published in the American Journal of Respiratory and Critical Care Medicine, researchers found that people with obstructive sleep apnea had a dramatically higher risk of developing cardiovascular disease than people without the condition.

But the good news is that with treatment, the risk drops.

"Obstructive sleep apnea was associated with an almost five-fold increase in risk for development of cardiovascular disease independent of age, body mass index, blood pressure and smoking," says study author Dr. Yuksel Peker, a pulmonologist at Sahlgrenska University Hospital in Gothenburg, Sweden.

Adds Dr. David Rapoport, medical director of the Sleep Disorders Clinic at New York University School of Medicine, "This is one more piece of evidence that even if you control for other known risk factors, there is a higher risk of cardiovascular disease in people with obstructive sleep apnea."

Almost one-in-four middle-aged American men and 9 percent of women have sleep apnea, the study says. People with sleep apnea stop breathing frequently while they sleep. Because their sleep is interrupted many times, they're often excessively sleepy during the day. Some of the risk factors for sleep apnea are being overweight, male and over 40, according to the American Sleep Apnea Association.

For this study, the researchers recruited 182 middle-aged men to observe them over a seven-year period. Sixty of the men were diagnosed with obstructive sleep apnea. None had any other known health problems when the study began.

After seven years, 22 of the 60 men with sleep apnea had developed some form of cardiovascular disease, which includes high blood pressure, heart disease and stroke. By contrast, only eight of the 122 who didn't have sleep apnea had developed cardiovascular disease by the end of the study.

Peker says he suspects the increased risk comes from the intermittent periods of low oxygen supply, which stresses the body.

The researchers also found that treatment for sleep apnea was an effective way to reduce cardiovascular risk. Fifteen of the study participants with sleep apnea were considered "effectively" treated. Only one man in that group developed cardiovascular disease. But, 21 men out of the 37 who were "incompletely" treated -- for example, they may not have followed the therapy described by the doctors -- developed some form of cardiovascular disease, the study reports.

Treatment for sleep apnea can include surgery, oral devices that keep the airway open or a machine that patients wear during sleep that supplies continuous "positive airway pressure," or forcing air into the lungs.

"There was a very big difference between the treated and the untreated groups," says Dr. Glenn Gomes, medical director of the sleep lab at the Ochsner Foundation Clinic in New Orleans, who says this study further illustrates the need for people who suspect they have sleep apnea to get properly diagnosed and then seek treatment.

What To Do

To learn more about sleep apnea, visit the American Sleep Apnea Association, or Stanford University.

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Brain Receptor May Be Key to Non-Addictive Morphine

Reuters Health
Tuesday, July 30, 2002

NEW YORK (Reuters Health) - Blocking a particular brain receptor may minimize the addictive nature of morphine without diminishing the drug's pain-killing effects, new research suggests.

Morphine is widely used to treat severe pain, but one of its drawbacks is that patients can become addicted to the drug. A structure in the brain called the M5 muscarinic acetylcholine receptor is a component of the brain system involved in the pleasurable effects of morphine. Researchers set out to see whether blocking the receptor would minimize the risk of morphine addiction.

The investigators first genetically engineered mice to deactivate the gene for the M5 receptor. Switching off the M5 receptor substantially reduced the desire for morphine in these mice.

When normal mice were given morphine, the animals, presumably in search of another fix, spent extra time hanging around the part of the cage where they had received the drug. In contrast, mice that had the receptor turned off did not linger in this part of the cage unless they were given a very high dose of the drug.

Dr. Anthony S. Basile, formerly of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, is the lead author of a report on the findings published in the Early Edition of the Proceedings of the National Academy of Sciences ( news - web sites). Basile is now at Alkermes, Inc. in Cambridge, Massachusetts.

The researchers wanted to make sure that blocking the receptor did not affect the pain-killing powers of morphine. Even though switching off the receptor seemed to make morphine less addictive, the engineered mice experienced the same level of pain relief as normal mice, the report indicates. And the investigators also found that the genetically engineered mice experienced fewer withdrawal symptoms after being taken off morphine.

The findings suggest that a drug that blocks the M5 receptor may be an effective way to reduce the risk of addiction to morphine without sacrificing pain relief, according to Basile and his colleagues. They note that the receptor is present mainly in the brain, so a drug that blocks the receptor is unlikely to cause serious side effects.

Because nicotine, alcohol, cocaine and other drugs all affect similar brain circuitry as morphine, the M5 receptor may also be involved in other types of addiction, the researchers report.

Eli Lilly Research Laboratories provided some of the funding for the research.

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.162371899.

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Meningitis Cases Tied to Cochlear Implants

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Tuesday, July 30, 2002

TUESDAY, July 30 (HealthScoutNews) -- A Texas ear surgeon who has implanted hundreds of hearing devices like those recently linked to fatal cases of meningitis said it would be "foolish" to undergo the procedure without getting vaccinated against two forms of bacteria known to cause brain inflammation.

The Food and Drug Administration ( news - web sites) announced last week that more than two dozen cases of meningitis, leading to nine deaths, have been detected in people who have received cochlear implants in the United States and abroad.

Dr. Peter Roland, a specialist at the University of Texas Southwestern Medical Center in Dallas, said people shouldn't forgo the high-tech hearing aids ( news - web sites) because of the potential risk. But Roland said anyone who receives them should be immunized against Streptococcus pneumoniae (also called pneumococcus) and Haemophilus influenzae, both of which can cause meningitis, an infection of the brain lining.

FDA officials said 13 cases of meningitis associated with the implants have been confirmed in this country, and seven more are unconfirmed. Two of these involved deaths of children, ages 2 and 3, with the most recent fatality occurring in June.

Officials said germ typing from 11 patients revealed seven confirmed cases of pneumococcus and four likely cases of the bug. As a result, the agency is recommending that people considering implants or who've already received them also consider getting vaccinated against meningitis-causing bacteria. None of the five patients for whom vaccination histories were available had been immunized against pneumococcus, the FDA said.

The infections occurred in the very young as well as the elderly, with ages ranging from 21 months to 63 years, officials said. Symptoms of meningitis sometimes appeared within hours after the procedure, or as long as more than five years later.

Cochlear implants are electronic devices embedded deep in the ear that shuttle sound impulses directly into the auditory nerve. The agency said two of the three American makers of the implants have reported cases of meningitis in patients who received their products, and that preliminary surveys indicate that the problem is larger than reported cases alone would indicate.

Although officials haven't identified the source of the infections -- or even if there truly is an increased risk of meningitis from the devices -- one company, Advanced Bionics Corp., has stopped selling its version of the product. Investigators are focusing on a positioning wedge deployed with that device, called the Clarion, that sits in the inner ear and may be a harbor for bacteria.

Douglas Lynch, a spokesman for Advanced Bionics, said there's "no direct evidence" connecting the wedge and meningitis. However, Lynch said, the majority of cases involving the Clarion occurred in patients who'd received the positioner, which is sometimes not used in Europe.

Lynch said Advanced Bionics first noticed a potential problem earlier this year, and that it seemed centered largely in two areas of Europe. The company reported the infections to the FDA about two months ago, he said.

Ironically, bacterial meningitis is a leading cause of deafness in children -- and thus a principal reason they receive the hearing implants. Children with abnormal earway architecture are at increased risk of the disease.

In addition, children who receive the devices are often in day-care settings, like speech therapy classes, where they're exposed to meningitis-causing germs, Lynch said. For these reasons, experts said, it's hard to determine if the devices are to blame for the meningitis or whether the illnesses aren't simply reflecting a high-odds group.

Roland said officials may ultimately find that the meningitis scare proves unfounded, or that only the positioning component of the Clarion device increases the risk of the disease. "I think it's probably a mixed bag," he said.

Peg Williams, executive director of the Cochlear Implant Association in Washington, D.C., said people considering implants or who already have them should be aware that the surgery, like all operations, carries an infection risk. Still, she said, that shouldn't deter them from seeking the aids.

"It's not an issue I think should create panic or great concern, and I do not think it's enough of an issue that it would create enough of a problem for a person to consider not having an implant," Williams said.

Since the late 1970s, roughly 60,000 children and adults worldwide have undergone the operation, which can restore hearing even to the profoundly deaf. The success of the devices has sparked an emotional debate within some families, as deaf parents worry that if their children receive them, they will become estranged from their children. That tension is easing "considerably," Williams said, as parents discover that the devices don't intrude on their ability to communicate with their children.

What To Do

For more on the investigation, visit the Food and Drug Administration. To find out more about cochlear implants, try the Cochlear Implant Association or Cochlear Implant Central.

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Study Looks at Dual-Action Heart Failure Drug

By Linda Carroll

Reuters Health

Tuesday, July 30, 2002

NEW YORK (Reuters Health) - A drug called omapatrilat that blocks two enzymes is at least as good and may be slightly better for certain heart failure patients than standard therapy that blocks just one, new study findings show.

Death or hospitalization among patients with both heart failure and high blood pressure was less likely in those treated with omapatrilat compared with those treated with ACE-inhibitors, researchers report in the July 30 rapid track release of Circulation: Journal of the American Heart Association ( news - web sites).

For patients with heart failure alone, the two drugs were essentially the same, according to the report.

There still needs to be more research done to confirm the results of the new study, said study co-author Dr. Milton Packer, a professor of medicine at Columbia University's College of Physicians and Surgeons in New York.

"But the take-home message is that there may be a special role for this drug in the treatment of patients with high blood pressure and heart failure combined," he said.

Standard ACE-inhibitors help keep blood vessels from narrowing by blocking angiotensin-converting enzyme (ACE), a substance that encourages blood vessel constriction. Omapatrilat not only blocks ACE, but also blocks a neighboring enzyme called neutral endopeptidase (NEP).

When NEP is blocked, there is an increase in the levels of substances that widen arteries, Packer said. "So if you inhibit both of them, you get a better effect," he added.

The new study reported the results of a multi-center trial that included 5,770 heart failure patients who were randomly assigned to receive either omapatrilat or the ACE-inhibitor, enalapril.

The patients were followed for an average of 14.5 months. In the group treated with omapatrilat, there were 914 deaths, compared with 973 in the enalapril-treated group. And when the researchers compared the two groups, they found that those treated with omapatrilat were about as likely to die or end up in the hospital because of heart problems as those treated with enalapril.

When the investigators re-examined their data and only looked at patients with heart failure and high blood pressure, omapatrilat appeared to have an effect. Among these patients, those who received omapatrilat were less likely to die or end up in the hospital because of heart problems.

"This was very interesting to us, because high blood pressure and heart failure co-exist in many people," Packer said. "And high blood pressure is hard to control in people with heart failure."

That's because some of the drugs commonly prescribed for high blood pressure can't be taken by patients with heart failure, Packer said.

"So we tend to run out of options," he added. "What's nice about omapatrilat in patients with high blood pressure and heart failure, is that we were not only able to lower blood pressure, but it seems as if lowering blood pressure translated into an advantage in terms of lowering the risk of death or hospitalization."

Three of the study's authors, including Packer, serve as consultants for Bristol-Myers Squibb, which funded the research.

Source: Circulation 2002;10.1161/01.CIR.0000029801.86489.50.

MONDAY, JULY 29, 2002 

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Dirty Air Pollutes the Heart, Too

By Ed Edelson
HealthScoutNews Reporter

HealthScoutNews

Monday, July 29, 2002

MONDAY, July 29 (HealthScoutNews) -- Pollution isn't just hard on the lungs -- it's bad for the heart, too.

A new study that confirms what many would deem to be common sense says that fine pollution particles squeeze off the oxygen supply to heart patients when they exercise.

"It's really been the last couple of years that data have accumulated showing a relationship between air pollution and heart disease -- increased incidence of heart attacks and admissions to hospitals during periods of high air pollution," says Dr. Murray A. Mittleman. "But we don't understand the mechanisms by which this happens. This study addresses that issue."

Finnish researchers put 45 patients with heart disease on exercise bicycles and had them pedal for six minutes, sometimes when the outdoor air was clear, sometimes when it was polluted, as the researchers recorded their electrocardiograms and looked for effects on the heart and blood supply.

What they found, says a paper in tomorrow's issue of Circulation: Journal of the American Heart Association ( news - web sites), was that many of the volunteers were much more likely to experience ischemia, a reduced supply of oxygen to the heart muscle, after exposure to polluted air. They also were more likely to have an abnormal ECG pattern called an ST segment depression, which is linked to ischemia.

And the research indicates that these cardiac problems are related to specific air pollutants -- the fine particles that come primarily from factory smokestacks and the ultra-fine particles that come from diesel exhausts, among other sources.

The Finnish study thus "highlights myocardial ischemia as a significant potential mechanism responsible for adverse cardiac outcomes associated with poor air quality," says an editorial accompanying the Finnish report co-authored by Mittleman, who is director of cardiovascular epidemiology at Beth Israel Deaconess Medical Center in Boston.

The study won't change the advice he gives to patients, Mittleman says. "I've been telling my patients who are at high risk to avoid excessive exposure to outdoor air on days of high pollution, to try to avoid exercise and to spend more time in an air-conditioned environment," he says.

But the finding could have implications about measures to reduce the health problems associated with air pollution, "because the sources of the fine and ultra-fine particles are different from those of larger particles," Mittleman says.

And it does indicate locations that people with heart trouble should avoid, he adds. Fine and ultra-fine particles do not have a long life in the atmosphere; they tend to clump together to form larger particles. So it is wise to avoid the emission sources of those small particles, such as bus depots, he says.

Dr. Len Horovitz, a pulmonary physician at Lenox Hill Hospital in New York City, says the Finnish study, done at the Unit Environmental Epidemiology of that country's National Public Health Institute, produced a logical result.

"It is the reduction of the oxygen level in the air that is causing ischemia," he says. "Evidently, an area that is polluted has the same kind of reduced oxygen level as seen in high-altitude areas."

Horovitz says the results are important for people with lung disorders as well as those with heart disease.

"We all need a certain level of oxygen" he says. "People who need more oxygen are at risk when air pollution is high."

Running the air conditioner is one way to remove particulate pollutants from a room, Horovitz says. He also recommends use of portable air filter units, which do the same removal job without cooling the air.

Research to determine what different kinds and levels of air pollution cause health problems is going on at the Environmental Protection Agency ( news - web sites) and other centers, Horovitz says. The results of those studies will have "broad implications for the kind of legislation that is passed," he adds.

Meanwhile, Mittleman says, people who don't have heart or lung problems "can do the common-sense thing. If they have the choice to avoid excessive exposure on very polluted days, they should do so."

What To Do

You can learn about air pollution and the heart from the American Heart Association or the Environmental Protection Agency.

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Tick Disease Poses Threat to Blood Supply

By Steve Mitchell
UPI Medical Correspondent
From the Science & Technology Desk
United Press International

Monday, July 29, 2002

A potentially fatal disease spread by ticks may be on the increase and government and public health officials are concerned it could be infiltrating the blood supply.

Babesiosis, a mild malaria-like illness, is transmitted by Ixodes scapularis, the black-legged tick, the same creature that carries Lyme disease. So far, babesiosis largely has been confined to Nantucket and Martha's Vineyard, Mass., and parts of Long Island, N.Y.

In recent years, however, the tiny black-legged ticks -- also called deer ticks -- that carry the disease appear to be expanding their range, Sam Telford, a researcher at Harvard University, in Cambridge, Mass., who focuses on tickborne diseases, told United Press International.

"We do believe it's probably spreading," Peter Krause of the Connecticut Children's Medical Center in Hartford and the University of Connecticut School of Medicine in Farmington, told UPI. Krause noted people have become infected with the disease in New Jersey and farther inland in Connecticut, indicating it is spreading westward in that state.

This raises concern on two levels. People who pick up the disease from a tick are at risk of death because the disease can be fatal in 5 percent of cases and there is a risk they could transmit the protozoan that causes the disease to others if they donate blood, Krause said.

More than 30 cases of people contracting the disease through blood transfusions have been documented but the total number of cases is likely much higher because the disease often goes unrecognized and unreported, he said. In most people, the disease causes fever and aches for about a week, but it can have severe consequences and some people may have to be placed on life support.

"This disease is definitely underestimated," Krause said. "There are more cases than we realize and it's increasing." He added many physicians are becoming more aware of the disease and more labs are starting to test for it, "so we're going to be seeing more cases just because of increased recognition. Scientists know the risk of transmitting babesiosis via blood transfusions is a problem ... and they are looking for ways to decrease the possibility of this."

Krause noted both the American Red Cross and the Centers for Disease Control and Prevention in Atlanta are involved in a study to determine the prevalence of the disease and the risk posed to the blood supply.

Barbara Herwaldt, a medical epidemiologist with the CDC, told UPI the threat of babesiosis getting into the blood supply is "of concern," but she declined to elaborate further on the study or how much of a risk contaminated blood poses to the general population.

The Red Cross did not respond to phone calls from UPI seeking comment. Other blood bank organizations also are worried about the threat of babesiosis.

"It is relatively high on our priority list for transfusion infections," said Louis Katz, vice president of medical affairs at the Mississippi Valley Regional Blood Center in Davenport, Iowa, and chair of the American Association of Blood Banks transfusion/transmitted diseases committee.

"The reason it is an issue in blood banking now is due to environmental and demographic changes over the past years and people are now living where ticks are," Katz said. This means babesiosis infections are increasing so it is more likely infected people will donate blood, he said.

Although there is no test for screening blood for babesiosis, the Food and Drug Administration does require blood centers to ask about the disease and bar people from donating if they report ever having the disease, an FDA spokesman told UPI. However, this may not catch everyone infected with the disease because often people will catch it but the symptoms are so minor they do not realize they are infected, Krause said.

The FDA spokesman stressed, "The benefit of receiving a blood transfusion far outweighs any theoretical risk associated with receiving that transfusion." But he said, "The FDA would be very interested in a blood screening test (for babesiosis) being brought forward for evaluation," adding the agency is attempting to develop such a test.

People at greatest risk of contracting babesiosis via blood transfusions are the elderly, patients whose spleens have been removed and those with weakened immune systems due to surgery, cancer or HIV/AIDS, Krause said. In these patients, babesiosis is more likely to cause serious health problems or death. The disease also could interfere with recovery from surgery.

Krause said children also are at risk of contracting the disease but they seem to be protected from the serious complications.

Scientists likely will continue to focus on babesiosis in the near future. Telford said "the disease will get a lot of interest" next month at an international conference on Lyme and other tickborne diseases in New York City. He also predicted it will continue to spread and become more of an issue with the public at large.

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Antiobiotics May Be Useful Against 'Mad Cow' Disease

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters Health) - A common antibiotic may be a useful weapon against the abnormal proteins that cause "mad cow" and other brain-wasting diseases, researchers in Italy report.

Mad cow disease, or bovine spongiform encephalopathy ( news - web sites) (BSE ( news - web sites)) as it is officially called, is an incurable brain-wasting disease in cows. More than 100 people in Europe, almost all of them in Britain, have developed a similar ailment, new variant Creutzfeldt-Jakob disease ( news - web sites) (vCJD), from eating BSE-infected meat.

BSE, vCJD and other related illnesses, such as the animal disease scrapie, are marked by the build-up in the brain of abnormal versions of proteins called prions. The abnormal prions are resistant to enzymes that would otherwise remove them, which leads to degeneration of brain cells.

There is no treatment for vCJD and other prion diseases, although several compounds do interfere with prion formation. Unfortunately, these compounds either cannot travel from the blood into the brain, cause severe side effects, or both.

But a report in the online Proceedings of the National Academy of Sciences ( news - web sites) Early Edition suggests that tetracyclines, a class of commonly used antibiotics, may affect the ability of prions to cause disease.

Dr. Fabrizio Tagliavini of the Istituto Nazionale Neurologico Carlo Besta in Milan, Italy and colleagues treated tissue samples taken from patients with vCJD and cows with BSE with the drug tetracycline. When the prions were exposed to the antibiotic, they became less resistant to digestion by enzymes. The greater the dose, the less resistant the prions became to enzymatic digestion and, therefore, removal.

After these promising results, the researchers tested tetracycline in hamsters with scrapie. When the prions were exposed to tetracycline before injection, the hamsters did not become sick until significantly later and lived longer. And this delay was accompanied by a lag in brain abnormalities that normally develop in brain-wasting diseases.

The findings suggest that tetracyclines, which are already approved for human use, could be helpful for people with brain-wasting diseases, the report notes. "Tetracyclines should be reconsidered for pharmacological effects independently from the antibiotic activity," the authors state.

Antibiotics could also have a role in preventing infections, the investigators suggest. When Tagliavini's team mixed tetracycline into a highly diluted solution containing scrapie, one third of the hamsters exposed to the solution did not develop the disease.

The results suggest that it may be possible to use antibiotics to inactivate prions in potentially contaminated products, the authors conclude.

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.162195499.

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Morning Exercise Could Increase Infection Risk

HealthScoutNews

Monday, July 29, 2002

MONDAY, July 29 (HealthScoutNews) -- Do you like to start your day with an invigorating run or swim? If so, you may be more likely to get tripped up or torpedoed by an infection.

New research from Britain now says early morning exercise may increase a person's susceptibility to infection.

The researchers studied 14 competitive male swimmers, average age 18. The swimmers swam the 400-meter crawl five times, with a minute rest between each swim. They did this on two days at 6 a.m. and 6 p.m. each day.

Samples of spit were taken from the swimmers before and after each swim in order to measure their saliva production. The saliva was measured for levels of cortisol, a stress hormone that suppresses the immune system.

The researchers also checked the swimmers' saliva for IgA secretory rate. IgA helps defend the body from infections in the nose and mouth.

The study found the swimmers' cortisol levels were higher in the morning than in the evening before exercise. The levels were significantly higher after the swimming sessions. IgA secretory rates were much lower in the morning than in the evening, but only slightly affected by the swimming.

Salivary flow rate was significantly reduced by both the morning and evening swims. The salivary flow rate was lower before the morning swims.

The authors say their findings indicate that a person's body clock has a considerable impact on the immune system. They suggest it's best to do your exercise or training in the evening when you have lower levels of cortisol and a higher rate of saliva flow, which also helps protect against infections.

People returning to exercise and training after an illness or injury should avoid early morning workouts, the authors advise. The same is true for athletes who have increased stress levels because of an upcoming competition and those training at high altitudes. Both of those can depress the immune system.

The findings are reported in the latest issue of the British Journal of Sports Medicine.

More information

The American Council on Exercise has more insight into exercise and the immune system.

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Huntington's Study Looks Promising

By Paul Recer

AP Science Writer

The Associated Press

Monday, July 29, 2002

WASHINGTON (AP) - A bile acid the body produces in small amounts is able in laboratory studies to slow the progress of Huntington's disease, a fatal, inherited brain disorder that destroys the mind and has affected about 30,000 Americans.

"We found in mouse studies that this compound protects the animals' neurons (brain cells) from the effects of the Huntington's disease gene," said C. Dirk Keene, first author of a study appearing this week in the Proceedings of the National Academy of Sciences ( news - web sites).

Keene, a researcher at the University of Minnesota, said many more laboratory studies are needed before the drug could be considered for testing in humans, but he said the research is important because it offers the hint of a future treatment for a lethal disorder that now has no treatment.

"We hope it will be as effective in humans as it seems to be in rodents," Keene said.

"It is an interesting finding that needs to be followed up," said Dr. James F. Gusella, a Huntington's disease researcher at Massachusetts General Hospital and the Harvard Medical School ( news - web sites). But he cautioned that although animal research provides clues about Huntington's, "They are still quite distant from being able to treat human patients."

Huntington's disease, or HD, is caused by a single defective gene that is inherited. About one in every 10,000 babies worldwide is born with the gene mutation and about 30,000 Americans have been diagnosed with HD.

The disease causes a progressive loss of neurons in the brain, leading to changes in personality, mood and judgment. As the disease progresses, patients develop slurred speech, an unsteady walk and difficulty in swallowing. Symptoms can appear as early as age 2 or as late as age 70 and will lead to death in 10 to 25 years.

Researchers discovered the gene that causes Huntington's in 1993, but there are still no approved drugs or treatments to slow its progression.

In the study, Keene and his co-authors used a type of mouse, called R6/2, that was developed to have a part of the flawed HD gene and to develop symptoms of the disorder.

For comparison, the researchers also tested a group of mice with normal genes.

Starting at about six weeks of age, half of the R6/2 mice were injected with a compound called tauroursodeoxycholic acid, or TUDCA. Earlier studies had shown that TUDCA, a type of bile acid, tended to block cell death. The new study was designed to see if it would prevent the HD-caused death of brain cells.

At 10 weeks, the two groups of R6/2 mice and the normal mice were tested in a maze and on a treadmill. Keene said TUDCA-treated mice could perform up to 50 percent better on the tests than the R6/2 mice not given TUDCA.

"The treated animals were no different than the ... non-Huntington's disease animals," said Keene.

An examination of the animals' brains after 13 weeks showed that TUDCA-treated mice had significantly fewer dead neurons than the R6/2 mice not given TUDCA.

Keene said researchers now want to start the TUDCA treatments on R6/2 mice at an earlier age to see if it can extend their life. The mice usually die of HD symptoms at about 14 weeks. He said it is believed that HD starts killing brain cells long before symptoms of the disorder appear.

The flawed gene that marks HD can now be detected before birth. If a drug can be found that prevents the death of brain cells starting at an early age, it may be possible to control the disorder throughout life, said Keene.

On the Net:

Proceedings of the National Academy of Sciences: http://www.pnas.org/

Huntington's Disease Society of America: http://www.hdsa.org/

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Clot-Busting Protein May Lead to Clogged Arteries

By Linda Carroll

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters Health) - A protein that is commonly used as a clot-busting drug may worsen atherosclerosis if it is supplied in large quantities through gene therapy, the results of a new study suggest.

Urokinase-type plasminogen activator is a naturally-occurring protein that is used as a drug to dissolve dangerous blood clots in patients with atherosclerosis (hardening of the arteries). Because it works by thinning blood, a potential side effect is excessive bleeding in other areas of the body.

Researchers have previously discovered that they could use gene therapy to induce the body to produce excess amounts of the protein only at the location of the thickened arteries. This targets the blood-thinning effects without the risk of bleeding elsewhere.

In the current study, published online in the Proceedings of the National Academy of Sciences ( news - web sites) Early Edition, researchers sought to discover if there were any adverse effects of this gene therapy approach.

Using rabbits as subjects, the investigators found that high levels of urokinase can actually lead to thickened blood vessels, according to study co-author Dr. David Dichek, a professor of medicine and associate director for research in the division of cardiology at the University of Washington School of Medicine in Seattle.

"We were interested in engineering blood vessels so they wouldn't form blood clots inside them," Dichek said. "Our approach was to get the blood vessels to express larger quantities of a molecule that would prevent or dissolve blood clots."

Dichek and his colleagues started by cloning the gene for urokinase in rabbits and then used a virus to carry the gene into rabbit arteries. The rabbits were fed a special high-cholesterol diet, which presumably would make them more likely to develop clogged arteries. A second group of rabbits received an inactive placebo injection and were also fed an artery-clogging diet.

The researchers then checked the rabbits' arteries every week for 4 weeks after the gene was injected.

Even after one week the results were surprising, Dichek said, noting that rabbits in the genetically-engineered group had narrowed arteries. Scientists have noticed that arteries tend to narrow in the early stages of atherosclerosis, Dichek said.

During the second week of the study, there were no major differences between the normal rabbits and those with higher levels of urokinase. But between the third and fourth weeks, the researchers noticed that inner linings of the arteries of the genetically-engineered rabbits were starting to thicken.

Ultimately, the study showed that gene therapy with urokinase would be a poor choice for patients with clogged arteries, Dichek said. Still, the results may help researchers better understand the processes that lead to atherosclerosis, he added.

Other studies have shown that patients with clogged arteries have higher levels of urokinase in their blood vessels, Dichek said. This study shows that the protein may be part of the cause of atherosclerosis rather than the result of the disease.

"I think gene therapy has gotten a bit of bad press," Dichek said. "This is an example of where, if you proceed slowly and carefully, you can gain useful information even if the results are negative. They may help you understand the disease you're treating better."

Source: Proceedings of the National Academy of Sciences Early Edition 2002;10.1073/pnas.162236599.

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Vegetarian group calls Atkins diet unsafe

By Steve Mitchell
UPI Medical Correspondent
From the Science & Technology Desk
United Press International

Monday, July 29, 2002

 

WASHINGTON, July 29 (UPI) -- A vegetarian advocacy group says high-fat/low-carbohydrate diets -- such as the Atkins diet -- are dangerous and will launch an ad campaign later this week targeted at physicians and consumers.

The Physicians Committee for Responsible Medicine "is particularly concerned about the health effects of these high-fat diets" because "more people are going on them," spokeswoman Simon Chaitowitz told United Press International.

The goal of the ad campaign, which will appear on the Internet on Yahoo.com and in a medical journal, is to "alert both consumers and physicians to the dangers of high-protein diets," Chaitowitz said.

PCRM also will launch a Web site -- scheduled to premiere on Thursday -- for consumers who have had problems with high-fat/low-carb diets to register their experiences. PCRM will compile this information to help evaluate these types of diets. The group's main objections to the high-fat diets is they are composed of foods -- particularly animal products -- that may increase the risk of colorectal cancer, osteoporosis, heart disease, kidney problems and diabetes complications.

"Even if the diets induce weight loss ... people need to focus beyond weight loss and focus on overall health," Brie Turner-McGrievy, a clinical research coordinator and registered dietician with the physicians committee, told UPI. She noted little research has been done on these diets so the long-term effects are unknown, adding there are concerns diets high in protein can lead to kidney problems and diets rich in saturated fats found in meat and dairy products can lead to clogged arteries and cancer.

Katherine Tallmedge, a registered dietician and spokeswoman for the American Dietetic Association, said, "Diets high in fruits and vegetables produce a lower risk of cancers and without them you have a higher risk." Fruits and vegetables "have also been shown to lower blood pressure and the risk of stroke and heart disease."

"Diets high in saturated fat raises LDL ("bad" cholesterol) in most people," which increases the risk of heart disease and heart attacks, Tallmedge said, noting that Atkins himself recently developed heart problems.

Low-carbohydrate diets often are touted for their ability to reduce LDL and triglycerides, but this effect is caused by the initial weight loss, Tallmedge said. "Once the weight loss has stopped, they often go higher than ever before," she said.

Another dangerous facet of the high-fat diets is ketosis -- state the body goes into when it is deprived of carbohydrates. In ketosis, the body mainly relies on fat and protein for energy, but it can lead to a variety of physical problems, including calcium loss from the bones and kidney stones. "Ketosis is not a state you want to be in," Turner-McGrievy said.

There are other health consequences of these diets. Tallmedge said an unpublished, six-month study funded by Atkins found 68 percent of the people in the study who were on his diet experienced constipation, 63 percent had bad breath, 51 percent had headaches and some also experienced hair loss.

Some people swear by the high-fat diets and insist nothing else has worked for them, but two studies found people on these diets only lost about an average of 20 pounds in six months. That is similar to the type of weight loss that could be achieved by any kind of diet you would put people on, Turner-McGrievy said.

She said a study conducted by the U.S. Department of Agriculture found vegetarians had lower body mass indexes and were slimmer overall than people on high-fat diets. Turner-McGrievy conceded people may lose weight on the Atkins or similar diets, but said, "A lot of things help people lose weight. Smoking can help you lose weight ... but it's about overall health. There are definitely a lot better weight loss diets out there for people to try."

Tallmedge agreed. "You don't have to go through a depressing angst-ridden diet to keep the weight off," she said. Long-term studies have shown most people who successfully lose weight and keep it off did so with a low-fat diet consisting of fruits, vegetables, lean meats and whole-grain foods, she said.

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Boiling Best Bet to Avoid Harmful Food By-Product

By Adam Marcus
HealthScoutNews Reporter

HealthScoutNews

Monday, July 29, 2002

MONDAY, July 29 (HealthScoutNews) -- The best bet to avoid the cancer-causing chemical acrylamide created during cooking is to boil your food, according to a report by Swedish researchers.

Of course, that impractical suggestion would leave many taste buds begging for mercy. But it underscores the pickle caused by recent revelations that much of what we eat -- especially baked and fried goods, such as french fries -- contains acrylamide when cooked at high temperatures. The substance has been linked to cancer in lab animals, though there's no agreement on what levels are harmful to humans.

Earlier this summer, a panel for the World Health Organization ( news - web sites) and the United Nations ( news - web sites) called the presence of the chemical a "serious problem" that merited further study. However, the group stopped short of advising people to reduce their intake of things like bread, potato chips, and other foods heavy in acrylamide.

That judgment was based in large part on work by environmental chemists at Stockholm University, whose study results appear for the first time in a peer-reviewed publication, the Aug. 14 Journal of Agricultural and Food Chemistry.

Until recently, scientists believed that smoking was the principal source of acrylamide exposure. But a Swedish study showed that even nonsmokers could have high levels of the substance.

So the Stockholm University group sought to learn how much of the chemical enters the body through cooked food. In one study, they showed that rats fed fried feed for one or two months had more than those on a regular diet.

The new report extends that work to address factors that influence acrylamide formation in various foods, especially cooking times and temperature.

Frying and baking brought out the most acrylamide, particularly in carbohydrate-laden and potato products like french fries, potato pancakes, and chips. And while protein-rich foods like beef and fish tended to have levels of acrylamide 10 to 100 times lower than that in potatoes, the quantity rose with cooking temperature.

Cooking for nearly 20 minutes at the boiling point of 212 degrees Fahrenheit didn't change the acrylamide content of potatoes, the researchers said. However, the chemical's concentration did rise markedly at about 250 degrees Fahrenheit.

The researchers couldn't detect acrylamide in boiled potato, hamburger, or fish, or in the broth left behind -- prompting this statement from Margareta Tornqvist, the study's lead author: "I would say that boiling at 100 degrees Celsius [212 degrees Fahrenheit] is the only safe cooking method."

Tornqvist and her colleagues shy away from recommending that people cook their food lightly to avoid acrylamide. Doing so might increase the risk of serious and potentially deadly food poisoning from germs that thorough cooking kills.

Ultimately, the scientists said, people who eat hot foods may take in acrylamide at well above the safe levels in water set by the World Health Organization.

The Snack Food Association, a U.S. snack industry group, has estimated that acrylamide may be present in up to 90 percent of the world's food supply.

Rick Jarman, vice president for food and environmental policy at the National Food Processsors Association, said he couldn't confirm that figure. However, Jarman said, "there is certainly a significant part of the food supply where acrylamide might be." But what that means, if anything, for human health isn't known, he said.

Jarman said the publication of the Swedish study, with its full methodology and the list of foods tested, will help researchers probing the issue further. "It should be very helpful as different companies and organizations try to determine what priorities and work is appropriate. But in terms of the implication for public health, at this stage that is still a looming question that is being pursued with all due diligence."

Jarman said his group's members haven't discussed any plans to start carrying acrylamide warnings on their labels.

That doesn't mean labeling hasn't become a hot issue, though.

After the Swedish team first reported their results, a California attorney demanded that McDonald's and Burger King put cancer warnings on their french fries in compliance with California's Proposition 65, a law that requires companies to list carcinogens, including acrylamide, in consumer products.

More recently, the American Council on Science and Health, a New York public health group, announced plans this month to sue Whole Foods Market for failing to comply with the California provision. The group accuses Whole Foods of neglecting to warn its customers about the acrylamide content of its whole wheat organic bread.

Jeff Stier, associate director of ACSH, said his organization doesn't believe acrylamide poses a health threat in bread or any other food product. Rather, ACSH is suing Whole Foods to point up the "absurdity" of Proposition 65. The law "doesn't take into account the number one rule of toxicology, which is that the dose makes the poison," Stier said.

ACSH also hopes to needle Whole Foods about what Stier called the "fraudulent" nature of its business plan: proclaiming the relative safety of organic foods over conventional products. "Even the most wholesome whole wheat bread has carcinogens," Stier said.

Whole Foods has hired a high-profile law firm, Gibson, Dunn & Crutcher, to fight the lawsuit. The company has threatened to sue ACSH if it doesn't drop its claim, which its lawyers say has brought "adverse and unwarranted" publicity.

What To Do

For more on acrylamide in food, visit the United Nations' Food and Agriculture Organization or the World Health Organization.

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Some Student Vaccine Rules Relaxed

By Shannon Dininny

Associated Press Writer

The Associated Press

Monday, July 29, 2002

INDIANAPOLIS (AP) - At least four states are relaxing student immunization standards at the start of the school year because of lingering shortages in vaccines for many common childhood diseases.

The Centers for Disease Control notified doctors in a July 11 bulletin that shortages were over for two vaccines, one for measles, mumps and rubella and another for diphtheria, tetanus and pertussis.

But parts of the country still lack sufficient supplies. New Jersey, Indiana, Minnesota and Nebraska are among the states that will allow students with incomplete immunizations to enroll in school this fall.

"Physicians and patients are going to have some catching up to do," said Buddy Ferguson, spokesman at Minnesota Department of Health.

The shortage for the MMR and DTP vaccines was caused by several factors, including a dwindling number of suppliers, manufacturing changes and equipment modifications that caused some production facilities to shut down longer than expected.

Indiana health officials last week pushed back a fall deadline, requiring students to be fully immunized by Jan. 31. Minnesota waived its tetanus/diptheria shot for junior high and high school students until next fall.

"Although they do have enough vaccine now, obviously they're going to go have to go back and immunize people who haven't had their booster," Ferguson said.

The New Jersey Health Department will allow students who aren't immunized to begin school as long as the child has a doctor's note indicating they are still trying to get the vaccine.

"If they can demonstrate a good faith effort and the physician is working with a family to get vaccine, we don't want to keep the child out of school," said assistant health commissioner James Blumenstock.

Children are supposed to get shots for measles-mumps-rubella at 12 to 15 months and again at 4 to 6 years. During the shortage, the CDC recommended postponing the second shot.

The DTP vaccine is usually given to children in five doses over their first 4 to 6 years. The CDC had suggested parents put off the fourth and fifth doses while supplies were low.

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Older Husbands Relied on by Wives Outlive Peers

By Suzanne Rostler

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters Health) - Elderly men who are the rock of their relationship may outlive their peers who are not cited as a source of strength by their spouse, according to researchers.

Investigators found that men aged 65 and older who were named as a source of emotional strength by their wives were more likely to be alive 6 years later, after economic and medical factors were taken into account.

A person who is relied on by a spouse may feel valued, which can improve self-esteem and feelings of usefulness, Dr. Roni Beth Tower, who conducted the study while at Yale University in New Haven, Connecticut, and colleagues suggest.

The report, published in a recent issue of Psychosomatic Medicine, adds to a growing body of research into the effects of marriage on physical and emotional well-being. Previous studies have tied marriage to longevity and lower levels of depression, particularly in men.

To investigate whether closeness within a marriage plays a role, the researchers interviewed 305 healthy couples at least 65 years old. The average length of marriage was more than 43 years and 85% of couples were in their first marriage.

Couples were deemed close if they named their spouse as a confidant or source of emotional strength, and if they were named by their spouse as a confidant or source of strength. From this definition, four patterns of marital closeness were possible: both the wife and husband naming the other; only the wife naming the husband; only the husband naming the wife; or neither naming the other as an emotional support.

The researchers found that a husband who named his wife was less likely to remain alive, possibly due to the stress of contemplating the eventual death of a wife who is a source of strength. Indeed, husbands who named their wives as sources of strength were also less likely to have faith that things would work out in the future, the study findings suggest.

This type of marriage may reflect a conflict with societal norms for gender roles, Tower said in an interview, particularly among older couples.

Wives who were cited as a confidant were less likely to die only if they did not have children. Wives who had children and were named as a source of strength were slightly more likely to die, possibly due to the burdens associated with family ties. These women tended to be involved in the lives of their children and grandchildren.

Women were equally happy and hopeful whether they had children or not, the report indicates.

"Perhaps the sheer burdens associated with presumably positive social ties took their toll through the stress associated with being relied on by loved ones," the authors suggest.

Tower and colleagues caution against generalizing the results to younger couples, since husbands and wives in the study belonged to a generation with different beliefs about marriage and the roles of men and women than younger generations may have.

"Conditions have changed during the 20th century and we are not claiming that the impact of specific configurations of marital closeness will be the same for later generations," they write.

Source: Psychosomatic Medicine 2002;64:644-659.

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West Nile Spreads Quickly in U.S. 

By Lauran Neergaard

AP Medical Writer

The Associated Press

Monday, July 29, 2002

West Nile virus ( news - web sites) is sickening people far earlier this summer than usual, and is spreading so quickly — it's hit 33 states, as far west as South Dakota — that health officials believe it will reach California this year or next.

Nobody knows how bad the mosquito-borne illness will get — although a rapidly growing outbreak among 32 people in Louisiana began a month earlier than West Nile has ever struck in this country, a big worry. But it's clear the virus first detected in New York City a mere three years ago has become a permanent summertime threat in most states.

Yet it's fairly easy to prevent: Spray on DEET-containing mosquito repellent when you go outdoors, and don't let puddles collect in flower pots, wading pools or other spots where mosquitoes can breed. One specialist equates the safety steps to the routine of buckling a seat belt before driving.

"That's the level of worry people should have," says Dr. Lyle Petersen of the Centers for Disease Control and Prevention ( news - web sites). "You should be concerned enough about it to do something but not have it change your whole lifestyle."

West Nile virus has struck other countries for decades, from the tip of Africa up to Europe and throughout Asia, so its move here probably was inevitable. The CDC has confirmed 161 U.S. cases, including 18 deaths, since the first Americans were diagnosed in 1999.

Officials are investigating if West Nile just killed two people in Louisiana. In addition to 32 West Nile-caused encephalitis cases there, a Mississippian is sick and health officials are investigating 10 similarly ill Texans.

The virus doesn't discriminate: A dead crow was even found on the White House lawn.

West Nile can cause a potentially fatal brain inflammation. Anyone suffering such symptoms as a high fever, severe headache, confusion or difficulty thinking, stiff neck or severe muscle weakness should see a doctor right away. It has struck Americans as young as 16, but those most at risk are over 50.

For every case of West Nile encephalitis, 150 more people are thought to be mildly infected — not sick enough to see a doctor. They get a flu-like illness, with fever, headache and muscle pains, that lasts two or three days.

How does West Nile spread? It infects numerous types of wild birds, from house sparrows to crows. Mosquitoes spread it among birds, and then to people. A spate of dead birds can be an early warning signal that the virus is circulating in a certain spot.

Aside from people, the mammals most vulnerable are horses. There is a horse vaccine but not a human one, nor is there any anti-viral treatment — victims get supportive care.

So preventing mosquito bites is important. Some health departments track bird deaths in deciding when to spray insecticides, but the CDC says consumers can do a lot on their own:

·        Wear a mosquito repellent containing DEET; those without DEET aren't nearly as effective. Follow the label's instructions carefully, especially when applying to children.

·        Stay indoors at dawn and dusk, when mosquitoes are most active.

·        Get rid of mosquito breeding grounds on your property. Don't allow water to stand for more than two days. Mosquito eggs need only a little water to hatch, and many species don't fly long distances, so West Nile-bearing mosquitoes were probably born nearby. Typical culprits are empty paint cans collecting water under decks, unused pools, blocked rain gutters, flower pots and forgotten buckets.

·        Those highly touted gadgets that catch bugs by mimicking the carbon dioxide people exhale aren't proven to reduce the number of mosquito bites. They might attract a neighbor's mosquitoes to your yard, or kill only one species instead of another type more likely to carry West Nile.

"It's a lot less expensive to rely on the old-fashioned methods," Petersen says.

The Mosquito Control Association also recommends frequently changing birdbath water, stocking ponds with mosquito-eating minnows and using larvicides in unavoidable standing water.

People can't get West Nile from each other or by touching an infected animal. Zoos with exotic birds are not considered particularly risky — wild birds spread West Nile, and exotic birds that get it usually die quickly.

But even as West Nile races across the country, there's no real predicting how big a threat it will pose each year. Abroad, West Nile hides for years between periodic epidemics — a pattern likely here, too, says Petersen.

Editor’s Note — Lauran Neergaard covers health and medicine for The Associated Press in Washington.

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Man Contracts Hepatitis A Despite Vaccination

Reuters Health

Monday, July 29, 2002

FRANKFURT (Reuters Health) - Germany's Paul Ehrlich Institute said on Monday it would investigate the case of a man reported to have contracted hepatitis A despite having been vaccinated.

The case was first reported in the journal Deutsche Medizinische Wochenschrift by a team of doctors in Bielefeld, led by Prof. Ulrich Junge. On Sunday, Germany's mass circulation Bild newspaper ran a story about the case, bringing it national attention.

The 55-year-old German man was said to have received a full immunization with Twinrix Adult, marketed by GlaxoSmithKline, but some 47 days later became ill after eating shellfish.

Junge and his team concluded that "combined hepatitis A/B vaccination according to the recommended schedule does not guarantee protection in elderly persons."

Dr. Johannes Loewer, head of licensing and inspection at Paul Ehrlich Institute, said in a statement that the agency took Prof. Junge's data seriously and would conduct an investigation. However, he said he currently sees no reason to question the use of Twinrix.

He noted that immunity in people over 40 years old can be less than in people younger than 40. Twinrix Adult was approved in 1996 by the European Agency for the Evaluation of Medicinal Products, and during the approval process it was found to be effective for older people, he said.

Loewer suggested that any older people who have been vaccinated with Twinrix Adult and are nonetheless concerned could be tested to ensure they have effective levels of antibodies against hepatitis A virus.

The Institute said it believed the vaccine to be safe and effective and saw no reason to question its use.

"We are nearly certain that this was not a quality problem," said Susanne Stoecker, spokeswoman at the Institute.

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Child Added to Nev. Cancer Cluster

The Associated Press

Monday, July 29, 2002

RENO, Nev. (AP) - A sixteenth case of childhood leukemia has been confirmed in a cancer cluster that has baffled scientists and frightened residents in the northern Nevada town of Fallon, state health officials announced.

Acute lymphocytic leukemia was diagnosed in a 2-year-old former resident of Churchill County, according to the Nevada State Health Division. The child's name and gender were not released.

"This is devastating news," Gov. Kenny Guinn said in a statement Sunday. "We are diligently working, using every resource, to find answers for the families coping with this health crisis."

Health officials have said that, given an average rate of about three childhood cases per 100,000 children, they would normally expect to see about one case every five years in the Fallon area, which has a population of 26,000.

Of the confirmed childhood leukemia victims linked to Fallon since 1997, two have died.

Floyd Sands, the father of one of those who died, called news of the latest Fallon case disturbing.

"When are these people going to do something real?" he asked the Reno Gazette-Journal. "I don't believe those people have done anything real so far."

The federal Centers for Disease Control and Prevention ( news - web sites) has been testing for potential environmental contaminants since September 2001, according to the state.

One focus of attention has been a jet fuel pipeline that serves Fallon Naval Air Station. In May, two federal agencies investigating the cancer cluster ruled the pipeline out as a public health hazard.

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Soil Bacteria Compound Potential Transplant Drug 

By Alison McCook

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters Health) - Researchers have isolated a compound from soil bacteria that may one day offer a safer, more potent way to prevent organ rejection in transplant patients.

The compound is called tautomycetin (TMC) and it acts as a specific inhibitor of the body's T cell-mediated immune response while leaving other components of the immune system untouched.

The body's immune system typically attacks all substances that it deems foreign, which includes viruses, bacteria and new organs. In the case of a transplanted organ, the body launches an immune response mediated by T cells, the key immune cells that normally destroy foreign invaders.

In order to ward off the response of T cells to the foreign organ, transplant recipients typically have to take strong drugs to suppress the immune system, such as cyclosporin. However, these drugs can leave the patient vulnerable to viral illnesses and other infections, and they can cause debilitating side effects, such as liver and kidney toxicity and increased susceptibility to cancer.

Furthermore, in many cases, the treatments do not completely work, and the body rejects the organ anyway.

However, researchers led by Dr. Sang-Kyou Lee of Yonsei University in Korea say TMC may offer stronger protection for patients with fewer side effects. When tested in rats that underwent a heart transplant, those given TMC had comparable survival to animals given cyclosporin and had less damage to other body organs.

"If we find the drug very specific to T cells, that would be a very optimal immune suppressor," Lee told Reuters Health.

Lee added that the drug is currently in the early stages of investigations into whether it will actually work as an anti-rejection therapy. It still remains to be determined if the compound is safe for humans and if so, it could take years before it becomes available.

Reporting their findings in the online Early Edition of the Proceedings of the National Academy of Sciences ( news - web sites), Lee and his team identified TMC by passing thousands of potential compounds through a screening test, designed to measure how well the compounds inhibit T cells.

TMC was the most effective compound, the investigators found. In fact, TMC was able to block the proliferation of T cells when given in a dose that was 100-fold lower than that needed to achieve a similar effect with cyclosporin.

In an interview with Reuters Health, Lee explained that the specificity of TMC results from the fact that it zeros in specifically on active T cells, ensuring that only those cells involved in the rejection of new organs will be targeted. In contrast, other anti-rejection drugs target substances that are ubiquitous in the body, thereby increasing the risk of side effects from the treatment.

In addition, other conditions also involve the activity of T cells against substances the body needs, and TMC may one day be used to treat these conditions, as well, Lee explained. For example, people with multiple sclerosis have T cells that target a protein in the sheath that surrounds nerve cells, thereby damaging nerve cells by exposing them to the outside environment.

The compound also only acts on active T cells, not those at rest, Lee added, so there is no danger of the drug destroying all of these important immune cells in the body. However, the compound could target all of the body's active T cells, which suggests that researchers will have to determine how to administer the drug to a specific region of the body.

There are also concerns that people taking the drug may be at increased risk of infections. However, with careful monitoring, Lee said that patients should be safe.

Weakened immunity "is not that difficult a problem to get around," Lee explained.

Source: Proceedings of the National Academy of Sciences 2002;10.1073/pnas.162522099.

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Teenagers' Anxiety Tracked in Real Time

By Felicity Stone
HealthScoutNews Reporter

HealthScoutNews

Monday, July 29, 2002

MONDAY, July 29 (HealthScoutNews) -- Anxiety-ridden teenagers get angry, sad and tired more frequently. They're also more likely to overeat and smoke.

Unfortunately, the problem may be more prevalent than previously thought, suggests a new study that tracked the teens' feelings in real time.

While adolescent angst is hardly a new phenomenon, the rates of teenagers' anxiety are unexpectedly high, says a report in a recent issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

In a study of 150 ninth graders, researchers from the University of California, Irvine, and the University of California, Los Angeles (UCLA), used hand-held computer diaries to measure and analyze their moods and behavior.

The investigators say the innovative method contributed to their findings.

"The electronic journals gave us greater insight into the teenage mind than the traditional questionnaire, as we were able to look at patterns and situations that couldn't be tapped very accurately before," says researcher and UCLA psychology professor Barbara Henker.

Because the students could log "as they happened" accounts of their emotions, they were more candid, Henker says. "If they felt extremely upset and we caught them in that moment, they told us that. Whereas when we asked them with the traditional pencil and paper method, 'Have you been extremely upset today?' they said 'No.'"

For two four-day intervals, the adolescents recorded their moods, activities and social settings, as well as their food, tobacco and alcohol intake in journals equipped with a specific software program.

The computers beeped them every 30 minutes, and questions appeared on screen. The first few asked things like where they were, who they were with, and what they were doing. Others were mood-related. Each question offered a range of answers. So the response to "How anxious are you?" for example, could be anything from "slightly nervous" to "highly agitated."

Their responses disappeared after they'd keyed them in -- a feature that Henker says fostered honesty and spontaneity.

"They weren't worrying about parents prying, nor could they look back and check what they'd said before," she says.

The researchers used the journal entries to classify the students into low-, middle-, or high-anxiety groups and examined when each one experienced anxiety, where and with whom.

On average, the participants reported being apprehensive in about 45 percent of their logs.

The ones who felt the most anxious tended to spend more time alone, but were less anxious when they were with their friends. The high-anxiety adolescents were seven times more likely than their less anxious peers to recount feelings of anger, and 11 times more likely to report sadness.

Moderate- and high-anxiety teens were two to three times more likely to smoke, and between 70 and 80 percent were more likely to drink alcohol and experience urges to eat.

Contrary to previous studies that have found girls more anxious than boys, this investigation revealed no gender differences.

Katharina Manassis, a psychiatrist and director of the anxiety disorders program at the Hospital for Sick Children in Toronto, says the study confirms what many in the profession have long suspected.

"Many of us have always thought that when people are anxious, particularly in their teens, they're prone to using maladaptive ways of dealing with that, like overeating, drinking or smoking," she says.

However, Henker cautions that although the results reveal anxiety and negative behaviors often occur simultaneously, it's difficult to say which comes first. "My best guess is sometimes anxiety leads kids to smoke or overeat, and sometimes smoking or overeating makes kids anxious," she says.

While the researchers suggest their findings may deter adolescents from picking up harmful habits, Manassis believes merely pointing out the relationship between anxiety and teenagers' destructive practices will have little effect on their actions.

"But if someone's there to help the adolescent identify the situations where they get anxious and to say, 'Hey, this is one situation where you said you get very anxious, so instead of picking up a cigarette or eating those doughnuts, what else could you be doing now?' That would be helpful," she says.

What To Do

For more on helping teenagers with anxiety and other mental health problems, try the Center for Mental Health Services or the American Academy of Child and Adolescent Psychiatry.

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Fast Food Chains Display Fat Content

By Vivian Chu

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters) - Ranch 1, a popular Manhattan fast-food chain, is not shy about telling customers how many calories their customers will put on if they eat their grilled chicken sandwiches.

In fact, Ranch 1 lists the calories of its food on its napkins--and compares them with the calories in a McDonald's Big Mac and a Burger King Whopper. The New York chain promotes itself as a healthy alternative to other fast foods, and its sandwiches have about half the calories of its bigger rivals.

Subway, North America's biggest sandwich restaurant chain, is doing the same. Like Ranch 1, Subway's napkins detail the nutritional information of its leaner sandwiches versus those of the 800-pound gorillas of the industry, McDonald's and Burger King.

"We try to position ourselves as a healthier alternative to fast food restaurants. I thought that napkins were the best way to get the message out," said Ranch 1 marketing director Izabela Halifax. The differences are displayed on Ranch 1's red and white napkins, reflecting the shift in fast food toward diet-conscious and away from all-American burger-and-fries fare. The chains are part of a small but growing number of quick-service restaurants starting to flaunt the nutritional content of their food on order menus and other prominent places.

It's more than a marketing ploy. A campaign led by consumer and health groups is heating up to get the nation's leading fast food chains to list calories along with prices on their menus. The move would follow the lead of many packaged foods.

"We've suggested it be required for chain restaurants, not mom and pops, but chains of 10 or more outlets," said Michael Jacobson, executive director of the Center for Science in the Public Interest, a nonprofit nutrition watchdog group. "The restaurant industry hates the idea because they might sell less food."

Threat of lawsuits could speed up the movement. Last week, a 272-pound New York City man sued four major fast food chains, claiming that their food made him obese and damaged his health. The suit--which the restaurant industry has dismissed as frivolous--seeks to have chains label individual products with fat, salt and cholesterol content, as well as warn consumers of their health effects.

The trend also could gather momentum as the government and consumers search for ways to counter obesity, which is reaching crisis levels in the United States. More than 60% of American adults are overweight, and over 25% are obese, meaning they are 20% over their ideal weight and face real health problems.

The issue has been gaining urgency, as the rising costs of being overweight add to an overburdened healthcare system. Obesity-related health costs totaled $117 billion in 2000, according to the Health and Human Services ( news - web sites) Department. The US government estimates that one-third of all cancer and heart disease and up to 80% of diabetes could be prevented if people ate less, ate healthier food and exercised more.

Washington lawmakers are on the case: The US Senate on Tuesday is expected to introduce a bill that frees up more government money for educating people about the dangers of excess weight.

A 'Mass Of Numbers'

McDonald's and Burger King contend they have long disclosed the nutritional content of their meals on their Web sites, as well as on posters and brochures available in stores. However, consumer advocates say the posters do not go far enough.

"The posters are a mass of numbers, and they're very inconvenient to read. Most people don't want to lose their place in line looking at a poster," said CSPI's Jacobson. "I suspect very few people use that information, though it allows companies to say they are providing all that information to the public."

McDonald's, which also makes its nutritional content available through a toll-free number, "strongly believes in providing customers with complete nutrition information about all our products," said a spokesman for the Oak Brook, Illinois-based company.

A visit to a McDonald's in midtown Manhattan found no brochures available, even upon request. A staffer pointed to a poster by the front counter listing in exhaustive detail the ingredients, serving size, calories, fat, cholesterol, sodium and other information for each of the items on its menu.

Burger King, the nation's No. 2 hamburger chain, said that listing all the nutritional information on napkins or food packaging would not be feasible, given the variety of ways that customers can order their food.

"There's more than 1,500 ways to order a Whopper, for example without mayo or cheese that would reduce the amount of fat and calories," said a spokesman for the Miami-based chain. "We couldn't put all that information on a napkin because there's so many different ways to have it."

Full-Flavored Taste

Despite the concern about the health risks of consuming too much fast food, most consumers don't want to know the fat content of those fries they are eating, restaurant professionals argue.

"There's a perception among many chains that consumers don't really care," notes Bob Goldin, executive vice president of food service consulting firm Technomic in Chicago. "My feeling is that consumers who eat out want full-flavored taste. They don't want the calorie content in their face."

Many healthier items launched by the fast-food industry in recent years proved to be flops --witness McDonald's McLean Deluxe hamburger and Taco Bell's Border Lites--both of which were pulled after they failed to sell well, he noted.

Still, with the fast-food industry increasingly blamed for the country's growing weight problems, restaurants that do play up their healthier attributes could end up stealing away customers from the large chains.

"It doesn't necessarily make me want to eat here more, but it sure makes me never want to eat at McDonald's," said Hugh Kojima, a 28-year old investment banker in New York, eating a Subway sandwich as he studied a napkin.

"I knew that a Big Mac had a lot of calories, but 590 calories is like, really a lot. I would definitely think twice about going there again," he said.

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Kneedy Tests

HealthScoutNews

Monday, July 29, 2002

 (HealthScoutNews) -- If you experience pain in your knees, your doctor might any of a battery of tests to diagnose the problem. In addition to a standard X-ray, CT scan, bone scan, magnetic resonance imaging (MRI) and arthroscopy are all possibilities.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases explains the differences.

  • A CT scan (computerized axial tomography) takes pictures of the knee for fractions of a second from different angles. Unlike regular X-rays, a CT scan can show soft tissues like cartilage and ligaments.
  • A bone scan uses radioactive material injected into the patient's bloodstream that is tracked as it flows to the bone, offering a look at possible abnormalities in cell activity.
  • An MRI uses a powerful magnet to create pictures of sections of the knee. This test is particularly useful in detecting soft-tissue injuries.
  • Arthroscopy uses a lighted optical tube inserted into the knee. A doctor moves the scope inside the knee looking for problems. The scope may be used to help fix any damage found.

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Illness Prompts FDA Warning About Lettuce 

Reuters

Monday, July 29, 2002

WASHINGTON (Reuters) - US health officials on Monday warned Americans not to eat Spokane Produce brand romaine lettuce after the product was associated with an E. coli outbreak at a cheerleading camp in Washington state.

Twenty-nine people at the camp in mid-July had confirmed cases of E. coli, the Food and Drug Administration ( news - web sites) (FDA) said. A salad made with the lettuce is considered a "primary source" of the E. coli, FDA spokeswoman Ruth Welch said.

"Consumers should ask at the place of purchase in order to assure that they do not consume Spokane Produce brand romaine lettuce until this health emergency is resolved," the FDA said in a statement.

The lettuce, which is sold under several brand names, was packaged in 5-pound bags and distributed by Food Services of America, the FDA said. It also may be sold at stores in various size packages, the agency said.

"FDA urges consumers to throw out this product," an agency statement said.

E. coli causes diarrhea, often with bloody stools. Most healthy adults recover within a week, but some people, including young children and the elderly, can develop a form of kidney failure that can be deadly.

Welch said investigations were ongoing and officials were unsure where the lettuce had been distributed. In the past, Food Services of America had distributed the product to restaurants and institutions in Idaho, Montana and Oregon, the FDA said.

A woman who answered the phone at Spokane Produce, and who declined to give her name, said the company had no comment.

Gary Odegard, a spokesman for Food Services of America, said the company had stopped distributing the lettuce while the investigation continued.

"We are not distributing any more, but we don't know yet if the product is tainted at all," he said.

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Come in from the Cold

HealthScoutNews
Monday, July 29, 2002

(HealthScoutNews) -- Some people just seem to be colder than others. How often has your spouse's cold hands sent a shiver up your spine? Most people probably just ignore the problem.

The Johns Hopkins Bayview Medical Center in Baltimore says that might not be such a good idea. Cold hands can be a sign that the thyroid, the gland that regulates body temperature, is malfunctioning. The problem is called hypothyroidism. Its symptoms can be vague, so mention even mild changes to your doctor.

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Panel: Soften Rules to Increase Heart Donors 

By Alison McCook

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters Health) - Transplantation programs should relax certain requirements on donor hearts to increase the availability of the organs to those who desperately need them, according to a group of experts involved in heart transplantation.

Specifically, the experts suggested that transplantation centers consider hearts of healthy people older than 55, which are often rejected automatically. In addition, the panelists recommend that hearts be used even if they have not been thoroughly examined if the donor is in relatively good health. Currently, if no cardiologist is available to check the health of the donor's blood vessels, during a procedure called angiography, some transplant centers will not accept the donor's heart.

If these recommendations are implemented by medical centers across the country, many more hearts could become available, Dr. Jonathan G. Zaroff of the University of California, San Francisco, lead author of the report, told Reuters Health.

"We're hoping we could gain an additional 400 to 800 available hearts for transplant per year in the US," he said.

Not enough people who need hearts receive them due to chronic shortages in the number of donors. Currently, between 6,000 and 8,000 people in the US are placed on a waiting list to receive a new heart each year, during which time only 2,500 new hearts become available.

Some people are simply unable to wait, the authors write; about 17% of those placed on a waiting list die each year before their new heart appears.

Consequently, several experts in the field of organ transplantation convened to discuss how to increase the number of available hearts. The conference included medical experts, researchers, and representatives of the United Network for Organ Sharing (UNOS). Their recommendations are described in the rapid access issue of Circulation: Journal of the American Heart Association ( news - web sites).

In an interview with Reuters Health, Zaroff explained that once a donor is declared brain dead, doctors evaluate the donor's heart to see if it is healthy enough to transplant. However, often the donor is in a condition where an ultrasound can mistakenly report that the heart is not pumping well.

Consequently, Zaroff said the most important recommendation to emerge from the committee is that doctors should stabilize donors before evaluating their hearts, and try to resuscitate the heart if at first it appears weak. The message: "Don't give up if the heart looks weak--try to make it better," he said.

How resistant different transplant centers will be to these recommendations will depend on how conservative each center's doctors are about which hearts they choose to transplant, the researcher noted. In 1999, the percentage of donors who yielded hearts deemed viable to transplant varied from 19% to 62% across the country, in part due to the flexibility of different centers in which donors they chose to accept.

"It is likely that regions of the country that are already more aggressive would not find these at all controversial, but for regions conservative about using nonstandard heart donors, they will be considered controversial," Zaroff said.

Another important recommendation to emerge from the committee, Zaroff added, is that researchers should keep investigating which hearts can still be salvaged from donors.

"The panel recommended ongoing research efforts to further improve our knowledge regarding appropriate selection and management of heart donors," Zaroff concluded. "It's clear that more work needs to be done."

Source: Circulation 2002;10.1161/01.CIR.0000025587.40373.75.

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Alcohol, Mental Problems Rife in U.S. Workforce

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Monday, July 29, 2002

MONDAY, July 29 (HealthScoutNews) -- Think your co-worker is having problems?

You might be right: A new report finds 25 percent of the U.S. workforce experiences at least one mental or substance abuse disorder each year.

The most common mental disorders among workers aged 18 to 54 are alcohol abuse or dependence (9 percent), major depression (8 percent), and social phobia (7 percent), says the report.

Mental illness and addictions cost employers billions of dollars and take a staggering emotional and financial toll on workers and their families.

"The rates are extremely high," says Robin Hertz, study author and a senior director of population studies at Pfizer Pharmaceuticals Group. "As a nation, we have to be more attentive to these types of problems ... There is a mythology out there that if you are at work you are healthy. That is not really true."

The report found companies pay more than $17 billion a year in "unproductive" wages to workers with mental disorders. Of that, about $5 billion goes to pay workers who miss workdays because of their substance abuse; about $12 billion is lost because productivity declines due to the illness.

Mental illness and substance abuse are also hurting the person with the illness financially. Men and women with mental disorders earn on average 22 percent less than people without mental disorders.

The study used data from the National Comorbidity Survey and the National Mortality Followback Survey, which are conducted by academic and government researchers.

Dealing with mental illness and substance abuse disorders is especially difficult because people often try to hide their problem or aren't aware treatment is available, Hertz says.

The study found of the 28 million workers who have a mental disorder, 66 percent had never been diagnosed. Just 14 percent of workers with mental disorders had been treated in the prior year.

"It tells me people aren't seeking treatment. It's also possible when they go to a health-care provider, there is a lack of attention to their problem," Hertz says. "Many people don't realize they can be helped. Or perhaps it's a matter of stigma."

Mary Graham, senior policy advisor for the National Mental Health Association, said she's not surprised by the findings.

"We suspected the rates were high, but we didn't have any hard data," she says. "I'm very glad it's in print."

One reason the rate could be so high is that better treatment for mental disorders lets people who otherwise might not be able to get or hold a job stay in the workforce.

However, the statistics show not nearly enough of people are getting the treatment they need. Graham's organization advocates better insurance coverage for mental health disorders and better education of primary-care doctors to spot it.

"Stigma is still a big obstacle," Graham says. "There is still a lot of misperception and shame around having a mental illness or a substance abuse disorder. As a result, people hide it and don't seek care."

Hertz recommends employers establish confidential screenings and employee-assistance programs at work, and make sure workers know they are available and private.

"It makes sense to do what we can to optimize the health of the workforce," Hertz says. "It's good for the employer, and it's really good for the employee."

What To Do

For a list of the symptoms of common mental illnesses, visit the National Institute of Mental Health. For information about getting treatment for mental health disorders or substance abuse problems, try the Substance Abuse and Mental Health Services Administration or the National Mental Health Association.

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Senators Plan Bill to Combat Child Obesity

By Niala Boodhoo

Reuters

Monday, July 29, 2002

WASHINGTON (Reuters) - Lawmakers on Tuesday plan to introduce a bill that tries to tackle America's weight problem with a host of health measures aimed at helping obese children.

The World Health Organization ( news - web sites) has declared obesity a global epidemic--in the United States, 61% of adults aged 20 to 74 are considered overweight or obese. About a quarter of American youth are overweight or obese.

"There's a lot of evidence that the lifestyles we have adopted in this country have gotten us into an epidemic of overweight and obese problems," said Sen. Jeff Bingaman, who is sponsoring the bill along with Connecticut Democrat Christopher Dodd and Tennessee Republican Bill Frist, the first medical doctor in the Senate since 1928.

The Improved Nutrition and Physical Activity Act, IMPACT, proposes to give health professionals more training on weight issues, fund new parks, bike paths and recreational centers and provide more money for already-existing exercise and nutrition programs in US schools.

The bill would spend more than $200 million to fund new and existing programs.

"This was the result of concern that all of us have shared about the rising incidence of obesity among children, and adolescents," Bingaman, a New Mexico Democrat, told Reuters in a recent interview.

In the United States, over 34% of people are overweight and 50 million Americans, 27%, are considered obese, according to the National Institutes of Health ( news - web sites).

Obesity is determined by body mass index (BMI), a calculation that takes into account a person's height, weight and age. According to the US Surgeon General's guidelines for adults 20 years or older, a six-foot tall adult 20 years or older with a weight of 140 to 180 lbs. would be considered healthy, 190 to 210 lbs. overweight and 200 lbs. or more obese.

The Surgeon General's report on weight released last December said that the number of overweight adolescents has tripled over the past two decades. Former Surgeon General David Satcher, who issued the report, said children are weighing more because they are eating higher-fat, lower-nutrition food and exercising less.

Bingaman said he is also co-sponsoring a bill with Vermont Democrat Patrick Leahy that would try to limit the sale of soft drinks and other junk food in schools during mealtime.

Texas and California have already proposed legislation that would also limit the sale of snacks in schools.

A Good Start

Food industry groups, who have fought those efforts and the numerous lawsuits that have been filed against the fast food industry recently, applauded the bill as a "good start."

"It falls in line with a lot of other organizations and people in the food industry are recommending--promotion of exercise and a balanced diet," said Mike Burita, a spokesman for the Center for Consumer Freedom, which represents 30,000 restaurants and food and beverage suppliers across the country.

But the bill has raised the ire of others who said lawmakers have succumbed to an overblown "obesity hysteria."

"We're fat by choice, not because we're stupid or ignorant. Some of us enjoy stuffing our faces with double-burgers, extra cheese," wrote Sam Ryan in a Chicago Tribune editorial published on Friday.

"We know that fruits and vegetables are healthier for us than ice cream and Cheetos. And we don't need some million-dollar public awareness program to tell us so. We'd rather use that taxpayer money to super-size our Happy Meals."

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A Sunny Outlook on Aging Lengthens Life

By Robert Preidt
HealthScoutNews Reporter

HealthScoutNews

Monday, July 29, 2002

MONDAY, July 29 (HealthScoutNews) -- Starting to notice a few gray hairs? Don't worry, be happy.

A positive attitude about aging may actually help you live longer. On the other hand, if you have a tarnished view of your golden years, you may cut your life short, says a study in the August issue of the Journal of Personality and Social Psychology ( news - web sites).

The study found that older people with positive self-perceptions of aging lived 7.5 years longer than people with negative self-perceptions about getting older.

That negative attitude may shorten your life by affecting your will to live, says lead author Becca R. Levy, an assistant professor of epidemiology and public health at Yale University.

Levy says she wasn't surprised by this study's finding that aging self-perception affects a person's lifespan. Her previous research indicated that's the case. But she hadn't expected to find such a significant impact.

The study included 660 people (338 men and 322 women) from a small Ohio town who in 1975 gave responses to questions asked as part of the Ohio Longitudinal Study of Aging and Retirement. At the time they gave their responses, all the people were 50 or older. They were asked to agree or disagree with statements such as, "As you get older, you are less useful."

"In this study, we did a snapshot of their perception of aging," Levy says.

She and her co-authors compared the participants' responses to their death rates over the past 23 years and found that people with more positive attitudes toward aging had 7.5 years higher longevity.

That finding takes into account other factors such as age, gender, overall health, loneliness, and socioeconomic status.

While the effect of negative attitudes about aging on the will to live does have an impact on longevity, it isn't the only influence, Levy says. Her research indicates that those negative stereotypes of aging may also have an adverse influence on older people's cardiovascular response to everyday stress.

Where do we get these pessimistic thoughts about growing old?

Levy says we pick them up from society and we may not even be aware it's happening.

"Stereotypes of aging are probably internalized in childhood or adulthood and carried through into old age," Levy says.

She suggests people consciously challenge gloomy views about aging.

"I think older adults can think about ways to question some of the negative stereotypes that they encounter in everyday life. I think there is reason to believe that that may have a positive impact over time," Levy says.

A leading psychologist who promotes mental and emotional health as a key to longevity praised the research, even if he didn't find the conclusion earth-shattering.

"I think the study was very well-defined and very well done," says Michael Brickey, author of the book Defy Aging. "I don't find the results all that surprising. To me, they kind of fit with common sense."

Brickey says the findings remind him of research on optimism by University of Pennsylvania psychology professor Martin E.P. Seligman.

"He found that optimists live longer, healthier, happier, they're more successful, they earn more money -- on and on," Brickey says.

The study's focus on the connection between the will to live and longevity impressed Brickey.

"It's what I'd normally call sense of purpose in life. I think that having a sense of purpose is one of the real keys, and it's become trickier and trickier," he says.

Fifty years ago, the typical American grew up and lived his entire life in the same town, stayed married to one person, and worked for the same company until he retired.

"There weren't as many choices and options. Now, we have so much change and so much choice that it's easy to lose your footing," Brickey says. "So we need to periodically take a look at our sense of purpose and make sure that we haven't lost our footing."

Brickey suggests negative stereotypes of aging can be countered by promoting role models of vital, active older people and by encouraging people to blaze their own trails as they grow older instead of succumbing to negative ideas and expectations.

What To Do

To help keep your outlook positive, Michael Brickey offers 36 defy-aging beliefs. Older Americans can find information about health and wellness at the AARP.

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Football Deaths May Be Linked to Supplements

 

By Suzanne Rostler

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters Health) - A surge in the use of two popular dietary supplements over the past 7 years may have helped to fuel the rate of death from heatstroke among professional football players, according to a team of scientists.

Ephedrine, sold as a weight-loss supplement and energy enhancer; and creatine, promoted to build muscles, can both increase the risk of dehydration, particularly during the hot summer season.

Campaigns to raise awareness about the dangers of dehydration helped to reduce deaths from heatstroke among American football players in recent years. Six athletes died of heatstroke between 1985 and 1994, compared with 44 between 1965 and 1974. But 15 deaths from heatstroke were recorded between 1995 and 2001--all during the summer pre-season period, researchers report in the August issue of Neurosurgery.

"Dehydration and programmed drinking and electrolyte replacement are all appreciated among athletes and coaches," Dr. Julian Bailes, the article's lead author and chairman of neurosurgery at West Virginia University in Morgantown, said in an interview with Reuters Health.

"So the most obvious thing to us is changes in athletes' behavior, and there is no bigger change that we're aware of," said Bailes, who also works as a health consultant to the National Football League Players Association.

The popularity of ephedrine has spurred the National Football League (NFL) and the National College Athletic Association (NCAA ( news - web sites)) to ban the use of these products. Professional players who are found to be taking ephedrine or pseudoephedrine, found in over-the-counter cold remedies, can be suspended for four games during the 2002 football season.

Nonetheless, many athletes continue to take ephedrine and related compounds to get an edge over their competitors.

"There is a lot of pressure to comply with what everyone else is doing, to get a competitive edge," Bailes explained.

He said studies have shown that more than 70% of college athletes and up to 50% of high school athletes are taking some type of performance-enhancing supplement, including steroids. These figures may actually be higher, he said, since they are based on numbers of athletes who admitted to taking supplements.

Ephedrine, also known as Ma-huang or "herbal energy," has amphetamine-like effects and has been linked to a series of deaths among both athletes and regular people trying to shed a few pounds.

The compound stimulates the central nervous system and causes an increase in heart rate. However, it can also raise the body's core temperature and lower the ability to sweat--the body's cooling mechanism. What's more, the energy-boosting effects of ephedrine can mask signs of fatigue and dehydration, causing an athlete to push on.

Creatine monohydrate is marketed as an energy enhancer and muscle-building supplement, but its purported effects have not been backed up by scientific studies. The supplement may also cause a shift in body fluid to muscles from the blood, increasing the risk of dehydration, especially when the risk is already high, such as during the summer.

Indeed, there have been several reports of diarrhea, muscle cramps and heat intolerance among athletes who took creatine, Bailes and colleagues note.

The report is based on a review of data from the National Center for Catastrophic Sports Injury Research, a group that issues annual reports on deaths and injuries from amateur and professional sports.

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Study: Retiring drivers lack alternatives

From the Science & Technology Desk
United Press International

Monday, July 29, 2002

BETHESDA, Md., July 29 (UPI) -- Older people in America are driving longer than ever before, but a new study suggests men and women who give up driving might have to depend on alternative transportation for a decade or more.

According to the study, by the National Institute on Aging, hundred of thousands of older people quit driving voluntarily each year in the United States. This requires them to rely on alternative transportation, which "can create unforeseen economic and social burdens that need to be addressed in the same way we have encouraged people to think about planning for retirement and end-of-life care," said Dan Foley, the study's lead author.

"I think it leaves us with the need to understand that older people's demand for alternative transportation can't be confined to the bus or the subway," Foley told United Press International. "We must encourage community-based organizations, such as church groups, to pull together to meet the needs of their elder members who have given up driving but still require transportation."

The problem, Foley explained, arises from the fact that although elder drivers begin to stop driving in their seventies, those who reach that age range can expect to live another 14 years to 20 years, depending on gender.

Foley and colleagues analyzed data collected in 1993 and 1995 by a previous NIA-supported study. It involved a nationwide sample of people ages 70 or older and included 4,996 men and women who were able to drive and had access to a car. These drivers represented statistically the 13.7 million Americans aged 70 or older who were driving at the time. Overall, 82 percent of men and 55 percent of women in this age group drove that year. Within the group, driving declined with age, ranging from 88 percent of men in their early 70s to 55 percent of those 85 or older. Among women, about 70 percent drove in their early 70s compared with 22 percent still driving at age 85 or older.

By 1995, the figures showed, 7 percent of the drivers had died. Another 9 percent were alive, but had quit driving for other reasons. The findings suggest more than 600,000 people ages 70 or older stop driving each year and become dependent on others to meet their transportation needs. About 400,000 older drivers die of all causes annually. Poor vision, memory impairment and an inability to perform daily living activities were common reasons older people stopped driving.

"Driving skills are dependent on three areas of wellness: physical fitness, thinking clearly and seeing well," Foley said. "Whether a person can continue driving hinges on the severity of the disability or functional loss in one or more of these three areas. Over time, people seem to reach thresholds where they believe they can no longer safely drive."

The analysis showed the average number of years a person continued to drive was significantly less than overall life expectancy, Foley said. Men and women who still drove at ages 70 to 74 were expected to drive, on average, another 11 years. But these men were expected to live about 17 more years, and the women nearly 21 more years. Therefore the gap between driving expectancy and overall life expectancy means men in this age group who stopped driving could be dependent on alternative transportation for an average of six years. For women, the gap translated into about 10 years dependence on other transportation modes.

At age 85, those still driving had a driving expectancy of about two years. But even at this age, men would have four non-driving years of life remaining and women nearly six years. Researchers found no differences in driving expectancy between urban and rural areas.

"Driving has an essential role in helping older men and women live independently, Foley said. "However, with age, a person's competence and confidence behind the wheel may erode to the point that quitting becomes an unfortunate necessity and dependence on other means of transportation becomes an inevitable reality. If we, as a society, fail to take steps to help older people prepare for and cope with this transition, then the goal of improving the quality of life in old age will be greatly compromised, both now and in the foreseeable future."

Audrey Straight, a project manager at the American Association of Retired Person's Public Policy Institute in Washington and a specialist in senior transportation issues, said the standard measure of mobility among seniors is the number of trips they make away from their homes.

In a recent report by AARP on senior mobility, Straight and colleagues found a considerable drop in trip making by age 75. "This reduction in the number of trips may indicate social isolation and an inability to maintain independence," she said. "However, little research has been done on how older persons themselves perceive their transportation options or the reduced mobility that accompanies old age."

The report found the median number of trips by older drivers is three times that of older non-drivers. "Regardless of age or sex, older drivers report taking more trips than older non-drivers," the report said.

The NIA study appears in the August 2002 issue of the American Journal of Public Health.

 (Reported by Phil Berardelli, UPI Deputy Science & Technology Editor, in Washington)

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Drug Suggests Promist for Heart Failure

From the Science & Technology Desk
United Press International

Monday, July 29, 2002 

NEW YORK, July 29 (UPI) -- A new type of drug to treat heart failure is more effective than a current common medication because it also improves blood pressure levels, an international study to be released Tuesday suggests.

Dr. Milton Packer, of Columbia University's College of Physicians and Surgeons, and colleagues compared the effects of the new drug omapatrilat to those of a drug called enalapril, one of a standard class of heart failure drugs called ACE inhibitors. Enalapril works by blocking the body's angiotensin-converting enzyme, which breaks down protein components called peptides that benefit heart function. Omapatrilat also blocks the angiotensin-converting enzyme, but it also blocks NEP, another enzyme that breaks down heart-benefiting peptides.

In the study, 5,770 heart failure patients at 704 institutions in 42 countries were assigned randomly to receive either omapatrilat or enalapril. The average age of each group was 63 and about 80 percent of the study group was male. Researchers evaluated patients every one month to four months for an average of 14.5 months to see how the treatment was doing.

The results showed 914 patients died or were hospitalized for serious heart failure among the omapatrilat group compared to 973 patients in the enalapril group -- a 6 percent difference. However, researchers said, further evaluation showed in some cases omapatrilat worked better than enalarpil because patients with both hypertension and heart failure showed greater improvements from omapatrilat. They said omapatrilat's dual action against the two damaging enzymes and its benefits in lowering blood pressure appear to be the key.

Enalapril patients also were more likely to experience declining heart and kidney function. Angioedema -- severe swelling of the neck and head that can cause breathing problems -- occurred in both groups, though this side effect was rare, researchers said, and never serious.

"Obviously these are interesting results and it seems because of dual action of the medication, the study suggests (omapatrilat is) beneficial to patients who have a combination of high blood pressure and heart failure," Dr. Nieca Goldberg, chief of cardiac prevention and rehabilitation at Lenox Hill Hospital in New York and a spokeswoman for the American Heart Association, told United Press International. "But you have to caution that this particularly needs further study."

Not everyone agrees omapatrilat is promising, however.

Dr. Christopher Granger, director of the cardiac care unit and a professor at Duke University Medical School in Durham, N.C., said 6 percent is too small a figure to indicate omapatrilat could have more to offer than standard ACE inhibitor drugs.

"There did look like there was a small benefit, but the primary endpoint did not reach statistical significance and therefore it was disappointing," Granger told UPI. "This is a good example of a drug that had tremendous enthusiasm that might be a real breakthrough ... there's now even less enthusiasm than there were even a few weeks or a few months ago."

Granger added, "I don't think the class of (this) drug is dead, but it certainly is a setback." Proving this drug's promise is "more now in a salvage mode."

The findings were fast-tracked to be published in the July 30 issue of Circulation, a journal of the American Heart Association. Dr. Packer was unavailable for comment.

(Reported by Katrina Woznicki, UPI Science News, in Washington)

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Med Students May Be Tested for Bedside Manner

The HealthScout News Service
Monday, July 29, 2002

If you think your doctor lacks any bedside manner, take solace in knowing that your children or grandchildren may be more fortunate. A pilot program that essentially has med students "playing doctor" with pretend patients may soon be a requirement for a medical license, reports the Associated Press.

The clinical skills program is being tested at three Philadelphia hospitals, and other cities are likely to follow. The National Board of Medical Examiners could make the program a licensing requirement as early as 2004, the AP says.

The American Medical Association (AMA), however, says the current $1,000 price tag plus any travel expenses may be too steep for already overburdened medical students to afford. The AMA has asked the board to hold off on making the test a requirement until the effectiveness of the test is proven and published in a peer-reviewed medical journal. Presumably by then, the price would also come down.

Some medical schools already have a clinical skills test, but the pilot program would set a national standard, according to experts quoted by the AP. Such a test was once required nationwide for a medical license, but the test was dropped in 1964 amid questions about its reliability.

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Whole Grains Can Help Cut Insulin, Cholesterol

By Suzanne Rostler

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters Health) - Whole-grain foods, such as fiber-rich bread and bran cereal, may lower the risk of heart disease, type 2 diabetes and certain types of cancer by reducing cholesterol and making the body more responsive to insulin, researchers suggest.

In their study of close to 3,000 middle-aged adults, these foods were associated with lower levels of total cholesterol and LDL (the so-called "bad" cholesterol) and improved insulin sensitivity. Insulin, the body's key blood-sugar-regulating hormone, tends to be elevated in those at risk of type 2 diabetes.

People who consumed the most whole-grain foods also had a lower body mass index (BMI), a measure of weight in relation to height that is considered a more reliable gauge of overweight than weight alone. Indeed, adults who were overweight or obese had the highest insulin levels and consumed the least amount of whole-grain foods, researchers report in the August issue of the American Journal of Clinical Nutrition ( news - web sites).

The findings help to explain how whole-grain foods may protect against several chronic disorders and point to the importance of including several daily servings of these foods in the diet. Current dietary guidelines recommend about nine daily servings of carbohydrates for adults, mostly in the form of whole-grain foods.

However, more research is needed into how carbohydrates affect insulin levels and obesity and the subsequent risk of type 2 diabetes and heart disease, Dr. Paul Jacques, the study's lead author, told Reuters Health.

Some health experts blame America's obesity epidemic on carbohydrates, pointing out that rates of obesity have risen in tandem with carbohydrate consumption over the past 30 years. Others argue that whole-grain foods, which are high in fiber, vitamin E and magnesium, do not have the same effect on insulin as refined carbohydrates that have been stripped of many nutrients.

"The importance of understanding the role of different carbohydrate sources in the development of insulin resistance is becoming even more critical because Americans appear to be increasing their intake of dietary carbohydrates," Jacques explained.

"Our results suggest that higher whole-grain intakes might help prevent development of insulin resistance, and the influence of whole grains may be strongest in those who are overweight and have the greatest risk of insulin resistance," he said.

The researchers analyzed detailed dietary information and blood samples from study volunteers over a 4-year period, and divided individuals into four groups according to their intake of whole-grain foods. Those with the highest intake of whole grains also tended to have healthier lifestyle habits such as moderate alcohol and meat consumption, not smoking, taking a multivitamin pill and eating lots of fruits and vegetables.

Source: American Journal of Clinical Nutrition 2002;76:390-398.

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Infected Moms May Transmit H. Pylori to Children

Reuters Health

Monday, July 29, 2002

NEW YORK (Reuters Health) - Children whose parents are infected with Helicobacter pylori (H. pylori), the bacterium associated with stomach ulcers, have a higher risk of becoming infected, according to German researchers.

Their study shows that the risk of infection among a group of children aged 5 to 7 years rose fourfold when the mother was infected and increased twofold when the father was infected.

While the precise route of transmission is still unclear, the findings support previous research demonstrating that H. pylori-infected mothers are a major risk factor for H. pylori during childhood, when most people tend to be infected.

"This makes sense given that the peak incidence of the infection seems to occur during the first few years of life when the mother has closer contact to the child than the father in most societies," Dr. Dietrich Rothenbacher from the German Center for Research on Aging in Heidelberg, Germany, and colleagues write.

"Whether the route of infection is oral-oral, gastro-oral or fecal-oral, however...must be determined by further research," they add.

The researchers screened 305 schoolchildren for H. pylori using a breath test, and they measured antibodies for the bacterium in the saliva of their parents. Parents were also interviewed about living conditions, economic status and demographic factors.

About 10% of children were infected overall, according to the report in the July issue of the Pediatric Infectious Disease Journal. Nearly 42% of mothers and 28% of fathers were infected.

A child's gender, the number of siblings and the parents' education were not associated with increased risk of infection among children. However, children who lived in crowded homes and had not used antibiotics in the past were more likely to be infected, the investigators found.

"This study strengthens previous evidence that infected parents, especially infected mothers, play a key role in transmission of H. pylori to the child," Rothenbacher and colleagues conclude.

Source: Pediatric Infectious Disease Journal 2002;21:674-679.

SUNDAY, JULY 28 , 2002 

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Enzyme Works as 'Tool Kit' to Repair Gene Damage: Study

The HealthScout News Service
HealthScout News
Sunday, July 28, 2002

 Mutated genes can be the culprits behind diseases ranging from cancer and cystic fibrosis to hemophilia, but British researchers say they've identified a natural enzyme that appears to correct such mutations.

Laboratory tests show that mice that lack the enzyme, called MBD4, are as much as three times more likely to have gene mutations, reports the BBC.

While environmental factors like smoking and exposure to sunlight can cause genetic mutations, as many as one in three disease-causing mutations occur naturally when the body tries to prevent genes from over-producing by shutting them down.

But in the study, published in the journal Science, the researchers say the MBD4 enzyme represents a "tool kit" the body uses to repair damage to genes, and without part of that tool kit, the risk of diseases such as cancer increases.

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Growing Your Own Cartilage

HealthScout News
Sunday, July 28, 2002

SUNDAY, July 28 (HealthScoutNews) -- A new cartilage repair technique developed by Massachusetts Institute of Technology ( news - web sites) (MIT) engineers could offer significant advantages over the current method used to treat people disabled by osteoarthritis, sports injuries and other accidents.

In this new procedure, cartilage cells are grown in a special gel. Once the cartilage cells have "seeded" in the gel, the gel is placed in the damaged joint. The MIT researchers believe the cells will grow and integrate with the normal cartilage and the gel will slowly degrade.

Their research appeared in a recent online edition of Proceedings of the National Academy of Sciences ( news - web sites).

The technique hasn't been tested on animals, but the MIT researchers say their engineered cartilage has mechanical and biochemical properties similar to natural cartilage.

Only one procedure to repair defective or damaged cartilage has U.S. Food and Drug Administration ( news - web sites) approval. In the approved method, cartilage cells are taken from a person and made to multiply. These new cells are then implanted back into the area of damaged cartilage.

But the MIT researchers say this is expensive -- about $30,000 -- and doesn't lead to the generation of true articular cartilage.

They say their cartilage gel method could be implanted using a small external incision. That kind of surgery is less expensive and reduces patient recovery time.

More information

To learn more about cartilage disorders, visit the U.S. Government's MEDLINEplus health database.

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Virtual Doctor Visits Are a Virtual Reality

By Felicity Stone
HealthScoutNews Reporter

HealthScout News

Sunday, July 28, 2002

SUNDAY, July 28 (HealthScoutNews) -- Heart patients with implantable cardioverter defibrillators (ICDs) now only need to pick up the phone for a check of their lifesaving device.

New technology has made "virtual office visits" an option for the 200,000 Americans with ICDs. Instead of making the standard three monthly trips to their doctors, they can relay information about their defibrillators via phone lines.

ICDs are mechanical heart aids ( news - web sites) prescribed for people who suffer abnormally rapid and potentially life-threatening heart rhythms.

The device is implanted under a patient's skin in the upper chest area and when an irregular rhythm is detected, the ICD administers an electric shock that returns the heart to its normal rate.

With a "virtual office visit," doctors retrieve and review their patients' defibrillator data via the Internet.

The transmitted data provides readings on the device's mechanics and how a patient's heart has functioned since the last check-up.

"I think at some point this will become the standard way to follow defibrillators," says Dr. Ken Riff, a physician with Medtronic Inc., the company that developed the technology.

While the system won't make office visits obsolete, Riff predicts it will decrease them: "We anticipate doctors seeing patients once a year, with in-between visits done over the Internet."

The new technology means almost everything that takes place during a face-to-face ICD consultation can occur even when the doctor and patient are miles apart.

Here's how it works: Patients collect information by holding a cell phone-like wand over their defibrillator. The wand is wired to a monitor plugged into a standard home phone line. Once the monitor receives the information, it automatically dials up the Medtronic CareLink Network and sends the data. It takes about 10 minutes from the time the wand scans the implant until the readings appear.

By logging on with a secure password, doctors and nurses can read patients' data off the system's Web site.

The system has been running for about six weeks. People who are already hooked up have been advised to prearrange times for their cyber check-ups, Riff says: "They can't merely transmit the information because the doctor may not pick it up for a while."

According to Dr. Masood Akhtar, a physician with Wisconsin Electrophysiology Group Heart Care Associates in Milwaukee, certain problems will make some office visits unavoidable.

"If the data tells you the patient got two or three shocks because the first one didn't work, you may want to increase the energy for the first shock. There are multiple things you may have to do depending on what information you get, but you have to reprogram the device in the office," he says.

Although the technology for remote programming is available, "until everyone's comfortable it can be done remotely, we won't do that," Riff says. "We first have to build up patients' and doctors' confidence in the system."

Akhtar believes patients will welcome this development, especially those who travel long distances for check-ups. Still, he adds, technology will never replace the gut feeling a doctor gets when he sees a patient personally.

"When people come in they might not volunteer information, but when you look at them they appear pale and unwell. You won't pick that up by remote control," he says.

What To Do

To learn more about the remote monitoring of ICDs, visit Medtronic Inc. For more information on heart arrhythmias, go to National Heart, Lung, and Blood Institute.

SATURDAY, JULY 27, 2002

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First W. Nile Case Found in S.D.

The Associated Press

Saturday, July 27, 2002

SIOUX FALLS, S.D. (AP) - A dead crow was found infected with the West Nile virus ( news - web sites) in South Dakota, the farthest west the disease has been detected, officials said Friday.

The bird was found Monday in Aberdeen in northeastern South Dakota, said Dr. Lon Kightlinger, state epidemiologist. The virus has now been detected in 32 states and the District of Columbia.

The virus is transmitted by mosquitos. Since its detection in New York City in 1999, more than 150 people have been infected with the virus and 18 have died nationwide, according to the Centers for Disease Control and Prevention ( news - web sites).

The virus has spread south and west over the past three years. Authorities advise people to use mosquito repellent and wear long-sleeved clothes.

On the Net:

Centers for Disease Control West Nile virus page: http://www.cdc.gov/ncidod/dvbid/westnile

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Wine, Cheese and a Bit of Botox

By Jennifer Thomas
HealthScoutNews Reporter

HealthScoutNews

Saturday, July 27, 2002

SATURDAY, July 27 (HealthScoutNews) -- Remember when Tupperware was all the rage for themed get-togethers at home?

Oh, how times have changed.

Hip hostesses today are inviting their closest friends over for Botox injections.

Ever since the U.S. Food and Drug Administration ( news - web sites) approved the toxin's use for certain cosmetic procedures this spring, Botox parties have become a big hit in many parts of the nation. Doctors offer their services in homes for groups of mainly women, who make the occasion festive with hors d'oeuvres and chardonnay.

However, the trend is causing some physicians to furrow their own brows with worry. They warn the procedure should be taken more seriously. Not only can there be unwanted side effects from poorly done Botox injections, doctors are walking a fine line of medical ethics, critics contend.

"It heralds a real degeneration of ethics in medicine," says Dr. Lisa Donofrio, an assistant clinical professor of dermatology at Yale University School of Medicine. "What's next? At-home liposuction? If we don't draw the line, this could become more and more pervasive until patients are really being put at risk."

Botox is no mere anti-wrinkle cream. Botulinum Toxin Type A -- popularly known as Botox -- is derived from the bacterium that causes the illness botulism. For the cosmetic procedure, small doses of Botox are injected into a facial muscle, blocking the nerve impulses that cause the muscle to contract.

By essentially paralyzing the muscle, Botox can decrease the appearance of wrinkles around the eyes and forehead. The American Society of Plastic Surgeons estimates 1.6 million Botox procedures were done last year, making it the No. 1 non-surgical cosmetic procedure performed in the United States.

To solicit clients, some physicians are sending out invitations advertising the Botox party concept. A Botox treatment on one area of the face typically involves four to 15 injections and costs from $300 to $600, although some doctors offer group rates for women at parties. The effect lasts about three months.

While Botox injections at home are becoming more common, many plastic surgeons and dermatologists refuse to do them anywhere than their medical office.

"When you take something out of the office setting, you're setting yourself up to be more casual and less safe," says Dr. Melanie Grossman, a clinical assistant professor of dermatology at Columbia University in New York City. "And I would never mix alcohol with any medical procedure."

In rare cases, people can faint at the sight of a needle or have a dangerous allergic reaction to the procedure, she says.

Only a physician can legally buy Botox. However, Donofrio says she knows of cases in which physicians buy it, and then permit nurse practitioners and even medical assistants to do the injections.

"They're using their office as a money-making factory," Donofrio says.

For example, she says, spas often have a medical director. However, the doctor may rarely be there and, instead, medical assistants do the injections.

Improperly done, Botox injections can cause partial facial paralysis and drooping eyelids.

Some plastic surgeons have different reasons for objecting to the Botox-and-brie trend.

Botox is being over-hyped as a cure for facial wrinkles, says Dr. Gustavo Colon, chief of the division of plastic surgery at Ochsner Clinic Foundation in New Orleans.

"Botox is not the end all be all," Colon says. "It's just one more arrow in the quiver of rejuvenation. The ultimate thing to remove facial lines and wrinkles is surgical procedures such as face-lifts. It's the only thing that will correct sagging skin and take away lines."

"For facial wrinkles around the mouth, Botox won't work," Colon adds. "It only works in certain areas of the face, and is only good for some people. A woman who comes in with a lot of wrinkles and a lot of sagging skin, she may not be a good candidate for Botox."

Donofrio says patients should carefully check the credentials of the physician doing the injections, and receive an individual evaluation before the procedure. People with certain neurological disorders should not receive Botox injections, she adds.

What To Do

To read more about Botox and to see before-and-after pictures, visit Dermnet. Or read this American Academy of Dermatology Patient Alert that includes questions to ask before you have the procedure.

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Lactose Lore

HealthScoutNews Reporter

HealthScoutNews

Saturday, July 27, 2002

SATURDAY, July 27 (HealthScoutNews) -- Too many people are having a cow about lactose intolerance and needlessly avoid dairy products, says a new poll sponsored by McNeil Nutritionals, maker of the lactose supplement Lactaid.

The poll of 1,088 adults finds that while a majority of Americans claim to know about lactose intolerance, more than half mistakenly believe the only way to deal with the condition is to shun all dairy products.

Perpetuating myths like these means that Americans often wind up depriving themselves of the health benefits of dairy products, says Laura Brainin-Rodriguez, a nutritionist for the San Francisco Department of Public Health ( news - web sites).

"Dairy in the diet is essential to fend off osteoporosis and possibly other diseases," she says.

The survey found that 81 percent of respondents say they know what lactose intolerance is and 57 percent believe that a person with lactose intolerance can't consume any dairy products. Only 31 percent correctly answered that lactose intolerance and difficulty digesting dairy products are synonymous.

Lactose intolerance affects 3 out of 10 Americans, including 50 percent of Hispanics, 80 percent of blacks and more than 90 percent of Asian Americans.

The condition occurs when a person doesn't produce enough of the lactase enzyme needed to digest milk sugar (lactose). It can cause bloating, cramps, gas or diarrhea.

Brainin-Rodriguez says the symptoms can be controlled without having to give up dairy products. Here are some tips:

·         Consume small amounts of dairy products several hours apart.

  • Eat other foods along with those that are milk-based.
  • Choose hard or aged cheeses, like cheddar or Swiss. They contain less lactose than other cheeses.
  • Choose yogurt with active cultures. These active cultures contain enzymes that digest lactose on their own.
  • Use lactose-free milk and supplements, which make lactose easier to digest.

More information

For details about lactose intolerance, visit the National Digestive Diseases Information Clearinghouse.

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Nuts Over Pecans

HealthScoutNews Reporter

HealthScoutNews

Saturday, July 27, 2002

SATURDAY, July 27 (HealthScoutNews) -- Feel free to go nuts for pecans.

University of Georgia (UGA) researchers say pecans are a consistent, rich source of the antioxidant vitamin E, no matter where they're grown in the United States.

"This study helped to demonstrate that basically all pecans are created equal when it comes to this important antioxidant," says study author Ron Eitenmiller, a food scientist at the UGA College of Agricultural and Environmental Sciences.

He analyzed pecans grown in two different years in several states, finding that their vitamin E content was stable, regardless of the year, variety or region. The study was published in the latest issue of the Journal of Food Science.

Eitenmiller says pecans have both the alpha and gamma tocopheral forms of vitamin E. The alpha form has been most studied for its health benefits but the gamma form is now also receiving close scrutiny.

"Vitamin E is the primary antioxidant we use. It protects our bodies when chemical reactions produce oxidation in the body, which can be dangerous. Antioxidants, in essence, serve as a tool that inhibits oxidative stress that can be detrimental to many cellular functions," Eitenmiller says.

But humans don't make their own vitamin E, so we have to get it from plant sources. They include: pecans and other tree nuts such as walnuts, cashews, almonds and pistachios; peanut products; and liquid vegetable oils.

Vitamin E isn't the only benefit offered by pecans. They're a good source of fiber and contain more than 19 vitamins and minerals. They may even be good for your heart.

Now for the bad news. While pecans themselves are beneficial, there's nothing here that says you can actually consider pecan pie a health food.

More information

For details on the health benefits of pecans, visit Texas A&M University.

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Study Links Autism with Smoking in Early Pregnancy

HealthScoutNews Reporter
HealthScoutNews
The HealthScout News Service
Saturday, July 27, 2002

A new report shows that women who smoke regularly during the early stages of pregnancy can increase the risk of their child developing autism by as much as 40 percent.

The findings, published in the journal Epidemiology, come from a Swedish study of more than 2,000 children.

The researchers, with the Karolinska Institutet, in Stockholm, note that previous research on animals has shown that exposure to nicotine while in the womb can cause physical and behavioral effects and that smoking in early pregnancy is known to influence fetal grown and a child's birthweight.

Still, the researchers say they were surprised to see smoking in early pregnancy as an independent risk factor for autism, which has not been seen before, reports the BBC.

Autism is a developmental condition that can cause learning disabilities and adversely affect how people communicate and interact with others.

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Meat Recall Delay Jeopardized Public, Lawmakers Charge

HealthScoutNews Reporter
HealthScoutNews
The HealthScout News Service
Saturday, July 27, 2002

Thousands of consumers were exposed to potentially deadly bacteria because the Agriculture Department was slow to investigate evidence that tainted meat had entered the U.S. marketplace, which possibly contributed to some illnesses, members of Congress said yesterday.

Though federal law requires daily inspections, there was an almost-100 day lapse between the time ConAgra Beef meat was found to be contaminated with E. coli in mid-April and last week, when the department announced the second-largest meat recall in U.S. history, Democrats in the House and Senate said.

"The long delay between contamination and recall is striking," the Democrats, including Sen. Richard J. Durbin of Illinois and Rep. Henry A. Waxman of California, wrote in a letter to Agriculture Secretary Ann M. Veneman.

According to The New York Times, the lawmakers characterized the delay as a "red flag for our nation's food safety system."

The criticism was issued as the scope of the E. coli outbreak continued to expand. At least 28 people in seven states have fallen ill from the meat, 9 more than initially reported when the 19-million-pound recall was announced, the Times reports. Seven people have been hospitalized.

Meanwhile, Colorado state officials confirmed that prison inmates had been fed ground beef that authorities knew had been recalled.

Department of Corrections officials say the reason why hundreds of inmates were fed the estimated 2,500 pounds of meat was because they felt that by properly cooking and serving the meat, it could be safely consumed, reports the Associated Press.

There were no reports of any of the inmates becoming ill after eating the beef. The meat was reportedly served to prisoners and possibly some guards at the Buena Vista Correctional Complex, the Delta Correctional Center and the Rifle Correctional Centers, all state prisons.

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