The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
June 10, 2003

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of April 12-18

 

FRIDAY, APRIL 18, 2003

Study Finds Insomnia May Affect Immune System

By Stephanie Riesenman
Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - People with chronic sleep deprivation may be more susceptible to illness than those who regularly get a good night's sleep, according to researchers in Canada.

Insomnia affects about nine to 12 percent of the population. Those with the condition have trouble falling asleep or staying asleep throughout the night, or they wake up early in the morning and can't fall back to sleep. Some people have a combination of these symptoms.

Recent studies have shown that insomniacs rate their lives as more stressful than good sleepers do.

It is also commonly believed that not getting enough sleep leads to vulnerability to illness, and an inability to sleep may slow recovery in those who are already sick. Dr. Josée Savard and colleagues of the Universite Laval in Quebec set out to investigate if there is truth to this belief.

They studied the immune responses of 17 people with chronic insomnia and compared them to 19 good sleepers. All were between the ages of 18 and 45..

Excluded from the study were pregnant women, anyone with a sleep disorder (such as sleep apnea), psychiatric disorder or self-reported medical problems, and those who had recently taken medication that might affect their sleep.

All 36 participants kept sleep diaries for three weeks. They recorded the times they went to bed and woke up, as well as how long it took them to fall asleep and how many times they woke up in the night and for how long.

After two weeks, the participants were interviewed and had blood drawn to measure the number of immune cells in their bloodstream.

When Savard and colleagues compared the blood tests of both groups, they found that the insomniacs had fewer CD3, CD4, and CD8 cells than the good sleepers. These cells are involved in the body's natural defense against certain infections. Other immune cells did not appear to be affected by insomnia.

The findings are published in the journal Psychosomatic Medicine.

Chronic insomnia probably increases susceptibility to illnesses like the common cold, but there is no evidence to suggest that insomniacs have an increased risk for more serious diseases, according to Savard.

"Although this data suggests that insomnia has a deleterious effect on immunity, insomniacs should not panic about this," Savard told Reuters Health. "Worrying about the potential consequences on health due to insomnia only makes the problem worse."

The conclusion from this study is that chronic insomnia seems to be associated with altered immunity, according to the researchers. But additional work is needed to determine if there is an optimal quantity of sleep to maintain good immune functioning.

Experiencing occasional sleepless nights does not qualify as insomnia, and Savard said that immune function probably goes back to normal in these individuals after getting a good night's sleep.

For chronic insomniacs the researchers recommend seeking treatment such as cognitive-behavioral therapy. Savard said the long-term results are better than those achieved with sleeping pills.

Source: Psychosomatic Medicine 2003;65:211-221.

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Cancer Risk Higher At Rocky Flats Plant

By Colleen Long
The Associated Press
Friday, April 18, 2003

DENVER - Rocky Flats employees who assembled nuclear weapons components and inhaled radioactive particles had an increased risk of lung cancer, a new study found.

The $2.5 million study, released Thursday, found workers who dealt with plutonium were about two times more likely to develop lung cancer than those who were not employed at the plant.

The study tracked 16,303 people who worked at the plant between 1952 and 1989. The study was done by the University of Colorado Health Sciences Center and the Colorado Department of Public Health (news - web sites) and Environment.

Dr. James Ruttenber, who led the study, said the research offers the first concrete information in the United States that lung cancer is linked to plutonium ingestion.

He said researchers will study the data to determine if standards (news - web sites) for handling plutonium should be changed.

"One case study is not enough," he said. "We need to make sure that we have robust findings before we make sweeping changes."

Doug Benevento, director of the state health department, said other factors have been shown to cause more of a risk of cancer.

"You have to put it into context: If you smoke, you're seven times as likely to develop lung cancer," he said.

He also said the study did not definitively link worker's cancers to their employment at the plant, noting other factors, such as exposure to chemicals at home, lifestyle differences or pure chance could explain the elevated risk results.

Arvada resident Wally Gulden, 65, who worked at Rocky Flats for 26 years, said he wasn't surprised by the findings or satisfied with the study.

"There are more of us out there with cancers not related to the ones that were studied," said Gulden, who has non-Hodgkin's lymphoma. "I worked in a hot spot and I know I ingested plutonium, and I want to know if it's related to my work."

Gulden has filed a claim under the Radiation Exposure Compensation Act program, which compensates people suffering from cancer and other illnesses as a result of their work on Cold War-era weapons projects.

"I hoped for more answers, but there aren't any," Gulden said.

The study also found that Rocky Flats workers were 2.5 times more likely to develop brain tumors than other people. Researches plan to examine those findings further.

Rocky Flats manufactured plutonium triggers for nuclear warheads for almost 40 years. It closed in 1989 because of safety and environmental problems.

The site is being cleaned up and will become a wildlife refuge.

The study was funded by the National Institute for Occupational Safety and Health.

On the Net:

Rocky Flats workers study: http://www.cdphe.state.co.us/rf/rfpworkerstudy/index.html

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Poor Moms Skimp on Own Diet to Meet Kids' Needs

By Charnicia E. Huggins
Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - Many mothers say they put their children's needs before their own, and a new study shows this to be true. Researchers found that low-income mothers in Canada often compromise their own diets so their children's nutritional needs can be met.

"The simple take-home message is that lone mothers with children do not have enough money to feed both their children and themselves," study author Dr. N. Theresa Glanville of Mount Saint Vincent University in Halifax, Nova Scotia, told Reuters Health.

"In the short term, not having enough food and the struggle to provide food impacts on quality of life," she said. "In the longer term, chronically compromised diets can lead to poor health for the mothers."

The study involved 141 low-income single mothers in Canada's Atlantic provinces, where the government has made drastic reductions in the monthly allowances for social assistance.

Almost 90 percent of the mothers, who ranged in age from 19 to 46, relied on welfare as their main source of income. They each had at least two children younger than 14.

Every week during a one-month period the mothers were asked what they and their children had eaten during the previous 24 hours.

Their responses indicated they were more likely than their children to have consumed inadequate amounts of folate, vitamin C, iron and other essential nutrients, the researchers report in the Canadian Medical Association Journal.

Further, more than three out of every four mothers said they were unable to get enough nutritious food at some point during the study period. In fact, almost one quarter of the mothers said their child had been hungry during the previous 24 hours.

Still, most mothers indicated that their children generally got adequate levels of most nutrients, except for folate and zinc. Their nutrient intake varied at certain points during the study period, however, with a significant improvement around the time the mothers received their second monthly check, the report indicates.

The mothers' nutrient intake, in contrast, did not improve at that time.

This suggests that "extra revenues available for food purchase are directed toward meeting the needs of the children, while the mother's nutritional needs continue to be compromised," the researchers report.

In light of the findings, "increases in support payments and the accessibility and affordability of healthy food staples ... are needed, as are creative, respectful and responsive strategies to help lone mothers become less dependent upon the social assistance system," the authors conclude.

Commenting on the study in a related editorial, Dr. Valerie Tarasuk of the University of Toronto in Ontario states that it "paints a disturbing portrait of the conditions of single-parent families living on low incomes, principally supported by social assistance."

She calls for a "new phase of welfare reform" that would ensure welfare incomes "are not so low as to jeopardize the nutritional health and well-being of those Canadians who must rely on these programs."

And at the societal level, Glanville said, "We need to create an attitude that does not blame the poor for being poor."

Grants from the National Health Research and Development Program and the Nova Scotia-based Capital District Health Authority funded the study.

Source: Canadian Medical Association Journal 2003;168:686-691,709-710.

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Children's Obesity Rates May Be Worse Than Thought

By Charnicia E. Huggins
Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - The prevalence of obesity may be even higher than the 10 percent previously reported among children in the U.S., according to a team of Alabama and Texas researchers.

They found that 15.5 percent of nearly 2,000 black, white and Hispanic boys and girls enrolled in Head Start programs in Alabama and Texas were overweight.

In a second group of 1,585 third-grade students enrolled in a school-based fruit and vegetable promotion program in Alabama, nearly 25 percent were found to be overweight -- a rate nearly double that previously reported among Alabama youth, report Michelle Feese of the University of Alabama at Birmingham and her colleagues.

The higher number of overweight kids in the Head Start study was similar among boys and girls of all races studied -- black, white and Hispanic. And among the third-graders, just as many children from high-income families as from low-income ones were overweight.

The findings are published in a research letter in a recent issue of the Journal of the American Medical Association (news - web sites).

Although previous studies have found that obesity and other health conditions are more prevalent among high-risk groups with lower incomes and those who live in the South, the obesity rates found in this study are even greater than one would expect, given these factors, Feese said.

She told Reuters Health that childhood obesity at such a higher rate than is normally seen in these groups suggests that the nation's obesity epidemic could be "even worse" than previously thought.

Source: Journal of the American Medical Association 2003;289:1780-1781.

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Heart Rate Training


HealthScoutNews
Friday, April 18, 2003

(HealthScoutNews) -- If you're trying to lose weight, consider using a heart rate monitor during your exercise routine. It can let you know when it's okay to safely push yourself a little harder and get that fat burning more efficiently.

The best workout is when you exercise within your target heart rate for at least 20-30 minutes three to five times a week, according to Rutland Region Medical Center in Vermont.

To calculate your target heart rate zone, subtract your age from 220. This will give you your maximum heart rate (MHR). Then keep your pulse between 60 and 80 percent of your MHR.

But remember your calculation is merely a guide; always take into account how you feel, as well.

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Few Suicidal Teens Seek Professional Help: Report

Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - Less than one-third of teens who report having suicidal thoughts say they have sought help from a counselor, according to a new study of U.S. adolescents.

"Although not all of these young people may identify a need for counseling, this finding still suggests that many of those at risk of harming themselves do not receive professional help," U.S. and Australian researchers report in the journal Pediatrics.

But on the positive side, they found, teens who do seek counseling tend to do so because they're in greatest need -- not because their parents can afford it.

In their study, suicidal teens in families with higher incomes and those who had health insurance were no more likely than others to ask for professional help.

Rather, teens who were depressed and relatively more suicidal were more likely than others to seek counseling, Dr. Jane E. Pirkis, of the University of Melbourne, and her colleagues report.

Specifically, suicidal teens who were also depressed were more than twice as likely to seek professional help than those who were not depressed, and teens who had already attempted suicide were also more likely to ask for help, relative to those who had thought but not acted.

In many cases, teens' suicidal thoughts do turn to action -- in 1999, suicide represented the third-leading cause of death among U.S. adolescents.

Pirkis and her team obtained their findings from interviews with more than 15,000 U.S. adolescents, nearly 2,500 of whom said they had seriously considered suicide within the previous 12 months.

Only 682, or 28 percent, of these teens said they had sought professional help to deal with their thoughts.

Of those who sought help, most turned to either school or a private doctor's office. The study did not measure how many of the doctors specialized in psychiatry.

Suicidal teens were least likely to seek help at a hospital.

Age appeared to play a role in whether a suicidal teen turned to professional help, as the youngest -- age 13 and younger -- were more likely to seek help than those age 18 and older.

Furthermore, students of Asian ethnicity appeared to seek help less often than their white peers, suggesting that cultural factors may influence a teen's decision to turn to counseling for suicidal thoughts, the authors write.

Besides counseling, Pirkis and her colleagues point out, teens need to have a range of services available to prevent suicidal thoughts from turning into actions -- including early education on and screening for suicide risk.

Source: Pediatrics 2003;111:e388-e393.

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Yogurt May Help Burn Fat


HealthScoutNews
Friday, April 18, 2003

FRIDAY, April 18 (HealthScoutNews) -- If you're watching your weight, don't be too quick to forgo the yogurt.

Many people on diets eliminate dairy products from their grocery list. But yogurt may actually help crank up your body's ability to burn fat, making it easier for you to lose the flab and maintain lean muscle, says a University of Tennessee study.

Researchers found people who included light yogurt in their diet program lost much more weight than people who simply reduced their calorie intake.

Yogurt eaters lost 22 percent more weight, 61 percent more body fat and 81 percent more stomach fat over 12 weeks.

The study included 34 healthy obese adults who were divided into two groups. Both groups were put on low-calorie diets that provided 500 fewer calories than their usual calorie intake.

One group consumed about 1,100 milligrams of calcium a day, including three servings of light yogurt. The other group consumed about 500 milligrams of calcium, a low level that's typical of the American diet.

After 12 weeks, the average weight loss in the group eating light yogurt was 13 pounds and they were twice as effective at maintaining lean muscle mass compared to the other group.

The study was presented at this week's Experimental Biology meeting in San Diego.

More information

Here's where you can learn more about weight loss and control.

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Smoking May Hasten Spread of Cancer: Study

Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - At diagnosis, cancer patients who are smokers are more likely than nonsmokers to have cancer that has spread beyond the original tumor, research suggests.

This seems to be true for a broad range of cancers, including prostate cancer (news - web sites). The findings do not prove that smoking causes cancer to spread but they do provide another incentive to kick the habit, according to a team led by Dr. Nathan L. Kobrinsky at the MeritCare Children's Hospital in Fargo, North Dakota.

Kobrinsky and his colleagues note that there are stacks of scientific evidence that "unequivocally" show that smoking is the major cause of a number of cancers, including cancers of the head and neck, lung and bladder. It is also a major contributing factor to cancers of the esophagus, pancreas and kidneys, according to the researchers.

However, even though smokers who are newly diagnosed with any type of cancer are advised to quit, this recommendation is "often given and received with ambivalence" since it is uncertain whether cigarette smoking promotes cancer growth once cancer has already formed, the authors write in the Journal of Clinical Oncology.

In the present study, the team of researchers aimed to better understand smoking's relationship with cancer that has spread beyond the primary organ to another area of the body, referred to as metastatic cancer.

Using a tumor registry for eastern North Dakota, northwestern Minnesota and northern South Dakota, Kobrinsky's team evaluated 11,716 cases of cancer. The team not only assessed the stage of cancer at the time of diagnosis but also evaluated information about the cancer patient's current and past smoking habits.

The investigators found that current smoking doubled a person's risk of having metastatic disease at diagnosis of a broad range of cancers. This risk was increased by 56 percent in previous smokers.

Current smokers, but not previous smokers, also had a 39 percent increased risk in their chance of being diagnosed with regional disease -- cancer that has spread just outside of the primary area of disease.

Prostate cancer carried the most increased risk for metastatic disease, while head and neck, prostate and breast cancer (news - web sites) were all more likely to be associated with regional disease among smokers, the study indicates.

"In summary, smoking is associated with cancer spread at diagnosis," the authors write.

"This finding has major implications for future research and offers support for the notion that, with regard to cigarette smoking, 'it 's never too late to quit,"' they conclude.

Nonetheless, the authors point out that their study does not prove that quitting smoking upon diagnosis of cancer will reduce a person's risk of metastatic disease. More research will be needed to directly answer that question, they said.

Source: Journal of Clinical Oncology 2003;21:907-913.

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New Weapon Against Cancer

HealthScoutNews
Friday, April 18, 2003

FRIDAY, April 18 (HealthScoutNews) -- An experimental drug that triggers the release of nitric oxide to fight leukemia and tumors has been developed by researchers at the University of Utah and the U.S. National Cancer Institute (news - web sites).

The drug, JS-K, reacts with a substance inside cancer cells. This reaction causes the release of nitric oxide, which kills or slows the growth of cancer cells without harming healthy cells.

Tests with the drug showed it triggered this destruction in acute myeloid leukemia (AML) cells grown in the laboratory. It also slowed the growth of AML cells in mice. AML is the most common and deadly form of leukemia.

In other tests on cell cultures, JS-K inhibited growth of AML cells and did the same, to a lesser extent, in prostate, colon and breast cancer (news - web sites) cells. It also inhibited the growth of prostate cancer (news - web sites) cells in mice.

The study appears in the April issue of Molecular Cancer Therapeutics.

"If all goes well, this would be the first cancer chemotherapeutic agent based on selective delivery of nitric oxide to tumor cells and therefore would constitute a novel class of cancer drugs," researcher Dr. Paul Shami, of the University of Utah School of Medicine, says in a news release.

Even if all goes well, JS-K would not undergo initial safety and efficacy trials in human leukemia patients until at least 2005.

More information

Here's where you can learn more about leukemia.

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Risk of Down Syndrome Linked to Other Birth Defects

Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - Families who have a child with Down syndrome appear to have a higher-than-average risk of having another child with neural tube defects, and vice versa, researchers said Friday.

Neural tube defects, such as spina bifida, are a type of birth defect affecting the brain and spine. It is known that low folate levels in the mother can result in neural tube defects, and that taking folic acid can prevent such problems.

Consequently, Dr. Gad Barkai of Tel Aviv University in Israel and colleagues suggest that some cases of Down syndrome may also result from low folate, and supplements of folic acid may also help prevent Down syndrome in babies whose family history includes a risk of neural tube defects.

However, they and other experts caution that more research is needed before doctors should recommend folic acid -- which becomes folate in the body -- to prevent Down syndrome in families at risk.

Down syndrome is the most common genetic cause of mild to moderate mental impairment, and occurs in about 1 in 800 live births.

Most cases of Down syndrome occur when chromosomes fail to separate properly during cell division, resulting in an extra chromosome being transmitted to one of the resulting cells.

Folate is responsible for certain changes that enable the chromosomes to separate properly, and previous research has suggested that Down syndrome risk increases in mothers who do not properly metabolize folate.

During the current study, reported in the British journal The Lancet, Barkai and colleagues reviewed the medical history of children born to families at risk of having children with Down syndrome or neural tube defects.

All of the families featured in the study had one pregnancy that had resulted in either a neural tube defect or Down syndrome and at least one other pregnancy. The researchers noted the rate of either condition in those other pregnancies.

Among 493 families in Israel with one pregnancy resulting in a neural tube defect or hydrocephalus -- also known as water on the brain -- 11 of their 1,492 other pregnancies resulted in Down syndrome.

The risk of Down syndrome increases with age of the mother. The rate of Down syndrome in the families studied, however, is five times higher than one would expect from mothers of similar ages, the researchers note.

Among the 516 Ukrainian families with a pregnancy resulting in Down syndrome, seven of the 1,847 other children had a neural tube defect, a rate that is slightly higher than that seen in the general population.

In an accompanying editorial, Jorgen H. Olsen and Jeanette Falck Winther of the Danish Cancer Society in Copenhagen write that one study is not enough to convince experts to start recommending folic acid supplements to prevent Down syndrome.

Furthermore, seeing a higher rate of each condition in families with an already affected child does not prove that a family history of one condition raises the risk of the other, they add.

Experts already recommend that women who are trying to get pregnant take a folic acid supplement to help prevent the risk of neural tube defects.

Source: Lancet 2003;361:1331-1335,1316.

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Cancer Strikes Blacks Harder than Whites

By Janice Billingsley
HealthScoutNews Reporter
HealthScoutNews
Friday, April 18, 2003

FRIDAY, April 18 (HealthScoutNews) -- Despite a substantial decrease in cancer among blacks over the last decade, this racial group still has consistently higher rates of almost all cancers than do whites, and their death rates are higher.

Statistics comparing incidences of colon, prostate, lung and breast cancers, the most common cancers for both whites and blacks, show the latter group's chances of developing certain types of cancer -- as well as dying from them -- are much higher than whites, says Dr. Mark Clanton, first national vice president of the national board of the American Cancer Society (news - web sites).

"Prostate cancer occurs in African-American men 60 percent more often than in white men, and they die from it 1.3 times more often, and African-American women have a 20 percent higher incidence rate of colon cancer and a 40 percent higher mortality rate than do white women of the same ages," Clanton says.

Further, while the incidence of lung cancer among black men has decreased 1.6 percent annually since 1995, their chances of contracting lung cancer are still 50 percent higher compared to the risk to white men.

These are among the sobering statistics released by the American Cancer Society in its latest report on the incidence of cancer among the 37 million Americans of black and Hispanic descent in the United States. The report is published in conjunction with National Minority Cancer Awareness Week, from April 20-26.

"Even without new advances in treatment and diagnosis of cancers, if we can engineer among African-Americans a similar reduced rate of cancer as that of whites, then tens of thousands of lives would be saved," Clanton says.

Dr. Harry Harper, an oncologist at the Hackensack University Hospital Medical Center, says oncologists are very aware of this discrepancy in cancer incidence.

"This information is out there among oncologists, but we haven't really taken a global approach to the problem," he says. "This report provides very helpful information so we can take the knowledge and start to use it to reach out to the communities that haven't shared in the benefits of cancer research and treatment."

The report is not all bad news. The overall incidence of cancer and mortality from the disease has dropped by 1.2 percent a year since 1993 for blacks. For black men, in fact, the drop in cancer rates was more than for white men during that same period, 2.1 percent a year versus 1.4 percent for white men. For black women, there has been a 0.4 percent drop annually since 1991, compared to a 0.8 percent drop for white women.

Also, five-year survival rates have also improved for blacks, more black women are getting regular mammograms -- 67 percent now compared to only 30 percent 10 years ago -- and black men, though not women, are smoking less.

But these improvements still leave a huge gap between cancer rates for blacks and whites, Clanton says, who points to economic disparities and lifestyle differences between the two groups.

While blacks make up only 12 percent of the population, they account for a third of the poor in this country, the report states.

Twelve percent of blacks have no health insurance, Clanton says, "which means they have considerably less access to screening and prevention advice."

Difficulty in geographical access to health care and less education about the importance of early screening for cancers are also factors, leading to later diagnoses of illness and thus lower rates of survival from cancers, Clanton says.

"Further, health-related behavior may predispose African-Americans to increased cancer risk, with smoking and exercise rates being the most important," Clanton says. "Exercise is emerging as a powerful way to reduce cancer, diabetes and heart disease."

While smoking rates between the two ethnic groups are not too dissimilar, black men and women have lower rates of exercise than do whites -- 48 percent of whites report engaging in regular, sustained exercise compared to 39 percent of blacks.

In addition, blacks are heavier. In 2000, 77 percent of black women were overweight, a jump from 59 percent in 1962. They also have a higher rate of obesity than do whites -- 30 percent versus 20 percent, according to the U.S. Centers for Disease Control and Prevention (news - web sites).

Obesity is associated with an increased risk for diabetes, heart disease and several types of cancer including those of the breast, colon, uterus and esophagus.

Clanton says that focus on disparities in cancer incidences between racial and ethnic groups is beginning to get the attention it deserves.

"The National Institutes of Health (news - web sites) is creating a major focus on studying and trying to understand these disparities," he says. "We have to equalize the progress and improve the progress for the whole population."

More information

To read more about the discrepancies in cancer rates among ethnic groups, you can visit the American Cancer Society. Learn about cancer prevention from the National Cancer Institute.

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Uninsured with Cancer May Not Get Adequate Care

By Charnicia E. Huggins
Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - About one in 10 cancer patients in the U.S. younger than 65 do not have health insurance and may not be getting the care they need, according to researchers.

Their study found that these uninsured patients, many of whom are Hispanic, receive about half the number of prescription drugs, hospital services and other services as those with health insurance -- and pay almost twice as much in out-of-pocket expenses.

"We didn't expect to see as big of a difference" in the use of services among cancer patients, study co-author Dr. Kenneth E. Thorpe told Reuters Health.

"It painted a pretty disturbing picture of large numbers of people that don't have coverage," he said. "And whether you have coverage or not makes a very substantial difference with respect to the nature of services you receive and how much."

"Our sense is that (uninsured patients) are not getting the treatment that they likely need," he said.

Thorpe and Dr. David Howard, his colleague at Emory University in Atlanta, evaluated spending among cancer patients by analyzing results of a national survey on insurance status and health care spending.

According to the researchers, few previous insurance-related studies have looked at cancer patients who are ineligible for Medicare -- the federal health insurance program for older adults -- and little is known about health insurance coverage among people with cancer.

Thorpe and Howard found that the differences in health coverage between uninsured and insured cancer patients was largely due to the age at which a given cancer is commonly diagnosed.

For example, they found, lack of insurance was more common among patients with breast or cervical cancer, compared with other cancers analyzed.

This is not surprising, according to the researchers, because "many breast cancer (news - web sites) cases are diagnosed before age sixty-five." In contrast, lack of insurance was less common among patients with prostate cancer (news - web sites), a disease typically diagnosed in later years, they note.

Overall, five percent of the 1,383 cancer patients studied lacked insurance, the researchers report in the April issue of the journal Health Affairs.

When restricted to people younger than 65, however, that proportion rose to 11 percent, including 20 percent of Hispanics, 14 percent of blacks and 10 percent of whites.

These uninsured patients had less than half as much money spent on their cancer care as their privately insured peers, the report indicates.

During a six-month period, the under-65 group, for example, had an average of $4,806 put toward their cancer care, in comparison to the average of $8,419 among privately insured cancer patients.

When it came to using their own money, though, uninsured patients younger than 65 paid out the most. The researchers put the average out-of-pocket costs to these uninsured patients at $1,343, compared with $576 for the under-65 group as a whole.

"They're paying directly out of their pocket for the limited services that they get," Thorpe said, adding that the uninsured do not have access to some of the cancer specialists that are typically available to insured patients.

The current findings show that we are engaged in "an incomplete war on cancer," Thorpe said, asserting that while new cancer discoveries are continually being made, there are many patients who are not getting state-of-the-art treatments.

There are about 41 million uninsured people in the U.S., including approximately 200,000 cancer patients undergoing treatment, Thorpe said.

"Extending health insurance to the remaining cancer patients without health insurance could result in earlier treatment and improved survival," he and Howard conclude in their report.

Source: Health Affairs 2003.

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Antidepressants Don't Affect Infant Weight Gain

By Jennifer Thomas
HealthScoutNews Reporter
HealthScoutNews
Friday, April 18, 2003

FRIDAY, April 18 (HealthScoutNews) -- Taking antidepressants while breast-feeding has no effect on the weight gain of infants.

But maternal depression does.

The babies of mothers who took antidepressants but still suffered from major depression weighed less than the babies of non-depressed mothers, a new study says.

"Women should not hesitate to get treated for postpartum depression, even if it involves the use of antidepressants," says Dr. Victoria Hendrick, study author and director of the University of California, Los Angeles Neuropsychiatric Institute's Pregnancy and Postpartum Program.

"Our study showed no evidence that the children's physical development is harmed by exposure to antidepressants through breast milk, whereas there is evidence that children are harmed by exposure to maternal depression," Hendricks says.

The research appears in the April issue of the Journal of Clinical Psychiatry.

Hendrick and her colleagues looked at the medical records of 78 breast-feeding mothers and their children.

All of the mothers had started taking a selective serotonin reuptake inhibitor (SSRI) either during pregnancy or within four weeks of giving birth. The women had given birth to full-term infants, had no substance abuse or alcohol problems and were nonsmokers.

The average weight for all of the infants in the study was 7.26 kilograms for girls and 7.93 kilograms for boys. This was virtually identical to infant growth data recently published by the U.S. Centers for Disease Control and Prevention (news - web sites).

Despite taking medicine for their anxiety or mood disorder, 11 of the women suffered major depression for two months or more after the birth of their child.

Their babies weighed less. The average six-month weight gain was 6.69 kilograms for girls and 7.25 kilograms for boys.

That's still within the normal range, but of concern nonetheless, Hendrick says. "The children of the mothers who were depressed weighed significantly less at six months than the mothers who'd been treated and were not depressed."

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

Paula Caplan, an adjunct professor of psychology at Brown University, says the study is too small to be conclusive.

"That's a very small difference and a very small number of people in the study. I would be very careful from drawing conclusions from this," Caplan says.

Caplan says there could be other adverse affects from SSRIs that are not yet known. She cautions women against turning to antidepressants without seeking other help first from family, friends and health professionals to ease the strain of having a baby.

"Women who are depressed absolutely should get support and attention and care. They should be fully informed about what other things can help," she says. "Thanks to the medical mindset of this culture and the power of the drug companies, postpartum depression is presented as this chemical thing that we need drugs to fix. Instead, we should look harder as a society at what we can we do to make their lives easier."

No one, however, is disputing that a mother's depression can be bad for the baby.

About 12 percent to 15 percent of women suffer depression in the first six months after giving birth. Symptoms include low self-esteem, feelings of inadequacy as a parent, inability to enjoy the baby or usual activities, insomnia even when the baby is sleeping, problems with concentration and irritability.

It's possible maternal depression may influence how often or for how long the mother is willing to breast-feed. It's even possible depression may influence the biology of the breast milk itself, Hendrick says.

More information

For help with postpartum depression, visit the National Women's Health Information Center. Read more about pregnancy and SSRIs at Massachusetts General Hospital's Center for Women's Mental Health.

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Surgery Technique May Not Help Chronic Gut Pain

Reuters Health
Friday, April 18, 2003

LONDON (Reuters Health) - Surgery to remove bands of scar-like tissue inside the abdomen is no better at relieving chronic abdominal pain than surgery to see if these bands of tissue, known as adhesions, are present, according to Dutch physicians.

A group of patients with chronic pain underwent surgery to see if they had such adhesions, which are a common side effect of surgery. Half of the group had a second procedure to remove them while the other half had no further treatment.

However, one year later, both groups were equally likely to say they were free from pain.

The findings suggest that the tissue removal technique, known as laparoscopic adhesiolysis, may offer no additional benefit to simply diagnosing the lesions in the first place.

"In view of our findings, we recommend that clinicians consider abandoning laparoscopic adhesiolysis as a treatment for adhesions in patients with chronic abdominal pain," conclude researcher Dr. Dingeman Swank, of Groene Hart Hospital, in Gouda, and colleagues.

Laparoscopic adhesiolysis is a controversial treatment for chronic pain because not all doctors agree that such adhesions -- found in many patients after abdominal surgery -- are the actual cause of lingering pain.

While many patients say that the procedure helps relieve their pain, it's not clear if this is due to a placebo effect, according to the report in Saturday's issue of the British medical journal The Lancet.

The team looked at 116 patients who had chronic abdominal pain for at least six months, most likely due to a previous surgery. All the patients underwent a diagnostic laparoscopy, in which instruments and a tiny camera are inserted into small incisions to try to determine the cause of the pain.

Of the 100 patients who continued in the study, 52 underwent a second laparoscopy to have the adhesions removed and 48 had no further treatment. The patients and the doctors who assessed their pain did not know which patients had their adhesions removed and which did not.

They were assessed for a year according to their pain scores, use of analgesics, and quality of life.

Patients in both groups reported substantial pain relief and improved quality of life one year later, but there was no statistical difference in pain scores between the two groups. Overall, 27 percent of patients in both groups said they were free from pain or that their pain had greatly improved and 43 percent of patients in the adhesiolysis group said their pain was the same or worse.

"Although laparoscopic adhesiolysis relieves chronic abdominal pain, it is not more beneficial than diagnostic laparoscopy alone," the researchers write.

While they don't recommend adhesiolysis, they note that a diagnostic laparoscopy does seem to be helpful for patients.

"Diagnostic laparoscopy is a safe procedure and reveals curable disorders in patients with chronic abdominal pain," they write. Four patients in the study were successfully treated for disorders other than adhesions and nine patients were found to have no adhesions at all.

As for laparoscopic adhesiolysis, that technique has clearly been shown to help people who have adhesions that are blocking or obstructing the bowels, a condition that has a mortality rate of 10 percent, according to the report.

Source: The Lancet 2003;361:1247-1251.

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Low-Carb Diets Work Without Boosting Heart Risk

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
Friday, April 18, 2003

FRIDAY, April 18 (HealthScoutNews) -- Obese women who are otherwise healthy can lose twice the weight on a low-carbohydrate diet plan as on a traditional low-fat plan.

And they can do so without compromising their cardiovascular health, at least in the short term, new research concludes.

The new report, published in the April issue of The Journal of Clinical Endocrinology and Metabolism, promises to refuel the diet debate over whether low-carb or low-fat is the better approach.

The controversial low-carbohydrate approach to weight loss was popularized by Dr. Robert Atkins, who died Thursday from injuries sustained in a fall during a recent snowstorm.

Because low-carbohydrate plans include a high percentage of calories from fat and protein, concern has been expressed over the potential cardiovascular damage such a diet might do.

Study author Bonnie Brehm, an assistant professor in the college of nursing at the University of Cincinnati, says the results surprised her: "We had hypothesized that this [low-carb plan] would harm their cardiovascular health."

"This was funded by the American Heart Association (news - web sites) [as well as other sources]. Our hypothesis was that the low-fat group would lose more weight and body fat for sure."

In fact, after six months, the 22 women on the low-carb plan averaged an 18.7-pound loss, while the 20 women on the low-fat plan averaged an 8.5-pound loss.

Both groups also showed improvement in markers of cardiovascular health, such as blood pressure, blood lipids and blood cholesterol levels, Brehm says. The women ranged in age from 29 to 58, but most were in their 40s. Their body mass index (BMI) ranged from 29.5 to more than 37. A BMI of 30 marks the beginning of obesity.

The low-carbohydrate group, at the three-month mark, was averaging 15 percent of calories from carbohydrates, 28 percent from protein and 57 percent from fat. At the six-month mark, they were eating 30 percent carbs, 23 percent protein and 46 percent fat.

The low-fat group was averaging 54 percent of calories from carbohydrates three months into the study, 18 percent from protein and 28 percent from fat. At six months, the totals were 53 percent carbs, 18 percent protein and 29 percent fat.

Average calorie intake was similar for both groups -- 1,302 a day for the low-carb group after six months and 1,247 for the low-fat group.

Under current recommended guidelines set by the National Academies of Sciences, Americans are advised to take in 45 percent to 65 percent of calories from carbohydrates, 20 percent to 35 percent from fat and 10 percent to 35 percent from protein.

Brehm isn't sure why the low-carb group lost more weight. The women agreed they would not change their exercise habits during the study.

"I told them, if you are a couch potato today [at the start of the study], you must remain a couch potato for six months," Brehm says. "If you walk four times a week, continue."

She plans to research the matter further.

Another dietary expert familiar with the new study says she wouldn't advise women to go the low-carbohydrate route to lose weight.

"The study was only six months," says Evelyn Tribole, a dietitian and author of numerous nutrition books, including the revised "Intuitive Eating," due out from St. Martin's Press later this year.

She points out the pitfalls of low-carbohydrate diets.

"When you go on such a low-carb diet, there's not much food left to select from," she says. And exercising for an hour or 90 minutes at a stretch may be more difficult on such a diet, she says, because the body depends on carbohydrates for energy.

More information

For the updated National Academies of Sciences' report on recommended intake of proteins, carbohydrates and fat, click here. The U.S. Department of Agriculture (news - web sites) offers these dietary guidelines.

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Doctor's Office Counseling Boosts Veggie Intake

Reuters Health
Friday, April 18, 2003

LONDON (Reuters Health) - People who attend two short counseling sessions at the doctor's office are likely to boost their intake of fruit and vegetables, British researchers reported Thursday.

Eating adequate amounts of fruit and vegetables is thought to protect against diseases like cancer and heart disease. Health groups recommend eating at least five portions a day, but many people consume far less. This is particularly true of low-income populations, who are also more likely to suffer a range of health problems.

Dr. Andrew Steptoe of University College London and colleagues wanted to see if a relatively cheap intervention in primary care could make a lasting impact in a low-income, inner-city population.

At the start of the study, they surveyed 271 people about their average daily fruit and vegetable intake. They then assigned them to two sessions with a nurse who used one of two types of counseling -- nutritional counseling, where participants were told about how certain foods can maintain health; or behavioral counseling, which tailored goals and advice to the needs of the individual.

One year later, 208 people who were still taking part in the study were surveyed again about their fruit and vegetable intake.

On average, daily consumption levels were 1.5 portions higher in the behavioral counseling group, and almost one portion higher in the nutritional group, the researchers report in the April 19th issue of the British Medical Journal.

"The proportion of participants eating five or more portions a day increased by 42% and 27% in the two groups," they write. These findings were supported by measurements of beta-carotene (vitamin A) and vitamin E in the blood.

The researchers saw similar improvements when they analyzed just the 177 participants with low incomes.

"The implication," Steptoe's team writes, "is that individual counseling in primary care may be an effective means of increasing consumption in less affluent adults, so targeting low income groups may help redress social inequalities in health."

Source: British Medical Journal 2003;326:855-856.

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Parents of Kids With Cancer Lash Out at Study

By Jennifer Thomas
HealthScoutNews Reporter
HealthScoutNews
Friday, April 18, 2003

FRIDAY, April 18 (HealthScoutNews) -- Sharon Wells couldn't believe what she was reading.

Researchers from Children's Hospital of San Diego had published a study earlier this month that said obese children were so unhealthy and unhappy that their quality of life was worse than that of children undergoing chemotherapy.

Wells was shocked. She thought back to the misery her son, Tony, endured when he was diagnosed with non-Hodgkin's lymphoma.

High fevers and nausea and such weakness that he couldn't stand on his own. Rounds of chemotherapy, radiation and steroids. Birthdays and holidays in the hospital. Loneliness as friends drifted away.

His suffering was almost more than Wells could bear.

So when she read the news report on the study's comparison of children with a weight problem to children with cancer, she was furious.

"Are they [obese children] so sick from radiation that they can't play or even talk, they can't get to the bathroom by themselves, they can't take a bath or shower by themselves?" says the 36-year-old Mesa, Ariz., woman. "There is no comparison between what my son went through and what an obese child goes through."

Wells is not alone in her outrage.

HealthScoutNews received numerous e-mails from parents of children who had died from cancer. They expressed disbelief at the study's findings and outrage that such a comparison could even be made.

"Overweight children's parents aren't sat down in a conference room and told there are no known survivors of childhood obesity," wrote one woman who signed her name, "Jenny, Sarah's mom forever."

"Nothing can compare," wrote Laura Duty, whose son, Ben, died at age 17 from brain cancer. "The cancer kids wait and watch as their hair falls out from the chemo, the pain of blood draws for testing, the weight gain of steroids, sometimes (in my son's case) loss of the use of their limbs due to drugs that are supposed to save them."

But the researchers who authored the study say there's been a misunderstanding.

"Certainly, it was not our intent to offend anybody," says Dr. Jeffrey Schwimmer, an assistant professor of pediatrics at University of California, San Diego. "As a pediatrician, I am well aware of the tragedy of a child who loses their life to cancer."

In the study, published in the April 9 issue of the Journal of the American Medical Association (news - web sites), Schwimmer and his colleagues surveyed 106 children, aged 5 to 18, who were treated at a hospital for obesity.

The questionnaire, designed to measure quality of life, included queries on such issues as physical functioning, emotional state and social relationships, Schwimmer says.

The children were asked if it was difficult for them to run, if they hurt or ached, if they felt angry, sad or fearful, or if they were ever subjected to teasing at school, among other things.

On a 100-point scale, the obese children rated their quality of life a 67, compared to 83 for healthy, non-obese children. Parents of obese children rated their child's quality of life a 63, compared to 88 for parents of non-obese kids.

Schwimmer says that same survey has been used before to assess a variety of health problems affecting children, including liver disease, congenital heart disease, Type 1 diabetes, and juvenile rheumatoid arthritis.

For his research, Schwimmer compared his findings to a study published last year in the journal Cancer that found children undergoing chemotherapy rated their quality of life a 69, while their parents rated their children's quality of life a 69 --- slightly better than the obese children.

Schwimmer says neither study was an objective measure of cancer or obesity. Instead, his survey gets at the perceptions of obese children and their parents about their quality of life -- a subjective measure, he says.

"We are not trying to say that obesity is worse than cancer," Schwimmer says. "We made no conclusions nor made any comparison about which condition is better or worse than the other."

Wells says there is no comparison.

Her 18-year-old son's cancer spread to his lungs, liver and spleen. The last time he went into the hospital, he told her he didn't want to be resuscitated.

Before doctors sedated him, Wells held her son's hand and promised him she'd be there when he woke up. He never did.

It's been nine months since Tony died. That he's no longer in pain is of little solace. Wells has contemplated suicide.

"I have to hold on because I promised Tony," she says. "He held on for me, so now I have to hold on for him."

More information

For information and support for children who have cancer, visit the National Children's Cancer Society or the National Childhood Cancer Foundation.

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High Blood Pressure in Pregnancy Tied to Later Ills

By Alison McCook
Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - Women who develop high blood pressure in pregnancy appear to have an elevated risk of high blood pressure and stroke later in life, according to study findings released Thursday.

UK researchers found that women with a history of high blood pressure in pregnancy, known as gestational hypertension, were more likely than women with no history of hypertension to develop high blood pressure years later.

The risk of later high blood pressure increased even further in women who had both high blood pressure and protein in their urine during pregnancy, a condition known as pre-eclampsia.

These women also had a higher risk of stroke, according to findings published in the April 19th issue of the British Medical Journal.

These findings suggest that doctors should be aware that a history of hypertension in pregnancy may increase women's cardiovascular risk years later, study author Dr. W. Cairns S. Smith of the University of Aberdeen in Scotland told Reuters Health.

"High blood pressure is very treatable, and so I would like to see greater awareness of the possibility of high blood pressure in later life in such women, (and) better detection of the hypertension and treatment," Smith said.

It is better to diagnose high blood pressure in older women sooner rather than later, the researcher added.

"Detection and treatment of high blood pressure will reduce the risk of stroke and, to a (lesser) extent, heart disease, in these women," Smith noted.

Research suggests that almost 30 percent of first pregnancies can result in gestational hypertension or pre-eclampsia.

In the case of pre-eclampsia, the condition can strike without warning, causing blood pressure to rise to dangerously high levels. Pre-eclampsia may progress to eclampsia, in which high blood pressure and convulsions could be fatal to the mother or child.

Pre-eclampsia is a leading cause of maternal death. It strikes about five percent of first-time mothers and one to two percent of mothers during subsequent pregnancies.

During the current study, Smith and colleagues reviewed health questionnaires, hospital records, and results of medical examinations of 3,593 women who delivered their first child in Aberdeen between 1951 and 1970.

At the time of the study the women were, on average, more than 60 years old.

The researchers found that women who had developed gestational hypertension or pre-eclampsia were more likely to report having high blood pressure and to be taking blood pressure medications.

Women with high blood pressure in pregnancy were also more likely to later be admitted to the hospital as a result of hypertension up to five decades later, the authors report.

Women who developed pre-eclampsia were also almost four times as likely as those without any history of high blood pressure to die of stroke.

According to Smith, the reason for the link between pregnancy-related blood pressure problems and later-life hypertension is not fully clear.

It's possible, he noted, that women who are susceptible to developing high blood pressure later in life are also at greater risk during pregnancy.

Source: British Medical Journal 2003;326:845-849.

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Targeting Most Likely Candidates for Staph Infections

HealthScoutNews
Friday, April 18, 2003

FRIDAY, April 18 (HealthScoutNews) -- People who have HIV (news - web sites) and others with compromised immune systems, as well as those undergoing dialysis, are much more susceptible to deadly staph infections.

The Michigan State University study, published in the April 15 online issue of the Journal of Infectious Diseases, is the first to identify the people most at risk for the infection, believed to kill thousands of people in the United States each year.

Identifying those most at risk lets doctors target them for therapy or prevention of staph infections.

The study included more than 250 people with invasive Staphylococcus aureus (ISA) infections. It found people undergoing hemodialysis are 257 times more likely to contract ISA than the general population.

Other people at high risk include those undergoing peritoneal dialysis, solid organ transplant recipients and people with HIV, cancer and heart disease.

Elderly patients, and those with renal failure, diabetes and lung problems were more likely to die from ISA, the study found.

Each year, more than 2 million hospital patients in the United States contract an ISA infection. The effects can be minor, but they can also be fatal. A vaccine for ISA is currently being tested. This study helps identify the people who should be at the top of the list for such a vaccine.

More information

Here's where you can learn more about staph infections.

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Many Outpatients Experience Drug-Related Injuries

By Charnicia E. Huggins
Reuters Health
Friday, April 18, 2003

NEW YORK (Reuters Health) - While adverse drug events, or injuries caused by drugs, are known to occur among hospitalized patients, such incidents are also common among outpatients, researchers reported this week.

In a study of over 600 adult outpatients, investigators found that one out of every four experienced a detrimental health effect from a drug. What's more, nearly 40 percent of these events could have been prevented or greatly reduced in severity or duration.

Few studies have been conducted about drug-related injuries occurring outside the hospital, despite the fact that most people receive prescriptions for drugs to take at home, the researchers note.

In a previous study of hospitalized patients, researchers found that 6.5 percent of patients experienced a drug-related injury -- 28 percent of which were preventable. Another study estimated that more than 1 million people were hospitalized in 1994 due to drug-related injuries.

Among outpatients, annual estimates of the proportion affected by drug-related injury have ranged from as low as five percent to as high as 35 percent.

In the current study, a team of Massachusetts researchers surveyed and reviewed the medical records of 661 people who visited two hospital-based and two community-based centers between September 1999 and March 2000. Prescriptions were computerized at one hospital center and one community center and handwritten at the other two centers.

"Our goal was to understand how these events might best be prevented, focusing on systems rather than individuals," study author Dr. Tejal Gandhi of Brigham and Women's Hospital in Boston told Reuters Health.

Altogether, 25 percent experienced a drug-related injury, 11 percent of which were preventable, Gandhi and colleagues report in Wednesday's issue of The New England Journal of Medicine (news - web sites).

Thirteen percent of the injuries were serious, including cases of gastrointestinal bleeding and a slowed heart beat. Two of the serious events were preventable, including the case of an elderly patient who was prescribed an antibiotic to which he or she was known to be allergic.

In fact, 35 percent of the preventable injuries could have been avoided if all of the centers used advanced systems of computerized medication ordering. Such systems perform error-reducing functions including checking the dose of each drug, the report indicates.

"Our systems of outpatient prescribing could be substantially improved," Gandhi said.

Twenty-eight percent of the problems were ameliorable, meaning that they could have been substantially reduced in severity or duration if different actions had been taken, the report indicates. The majority (63 percent) of these injuries occurred when doctors did not respond to medication-related symptoms, but in 37 percent of cases patient were faulted for not telling their doctor about their symptoms.

"We were surprised by how high the rates were, as compared to the inpatient studies," Gandhi said. "We think this is because we spoke with patients directly rather than relying on the medical chart or administrative data."

Depression and high blood pressure drugs, such as serotonin-reuptake inhibitors and beta-blockers, respectively, were often involved in the adverse drug events. Among inpatients, however, sedatives and antibiotics tend to be the drugs most commonly implicated in drug-related injuries, the report indicates.

The medications themselves were not to blame for drug-related injury, the researchers note. Rather, patients who were prescribed more medications were more likely to experience an adverse drug event.

To reduce the high rates of drug-related injury, Gandhi calls for "strategies to improve patient-doctor communication, education about side effects, and implementing computerized prescribing."

"Patients should be knowledgeable about their medications, make sure their doctors know all of the medications they are taking, and patients should understand side effects," Gandhi said.

Also, the researcher added, "if patients are having problems with their medications, they should know how to contact their physician or doctor's office to report the problem."

Source: The New England Journal of Medicine 2003;348:1556-1564.

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THURSDAY, APRIL 17, 2003

Alcohol Damage Continues After Drinking Stops

HealthScoutNews
Thursday, April 17, 2003

THURSDAY, April 17 (HealthScoutNews) -- Even after alcoholics stop drinking, they continue to experience motor problems.

A Vanderbilt University Medical Center study also found the brains of abstinent alcoholics seem to compensate for alcohol-caused brain damage by using other brain regions.

The study, published in the April issue of Alcoholism: Clinical and Experimental Research, included seven males and one females, all of whom were alcohol-dependent but didn't have any alcohol for two weeks. They were compared to seven female and two male healthy volunteers in a control group.

All the participants performed finger-tapping exercises while the researchers used functional magnetic resonance imaging (fMRI) to observe the brain regions that were used in the exercise.

Both groups alternated between their dominant hands and non-dominant hands to do the finger-tapping.

The alcohol-dependent people performed the finger-tapping much more slowly than those in the control group. However, that slower finger tapping wasn't accompanied by proportionately decreased fMRI brain activity in the cerebral cortex and cerebellum, the brain regions involved in this kind of motor function.

Instead, the researchers observed that the alcoholic-dependent people showed a significant increase of activity in the cortical brain region on the same side as the hand that was doing the finger-tapping.

That means the alcoholics had to use more of their brains to do less in terms of performing a simple motor skill, compared to the control group.

The study findings pose new questions.

"If we study patients as they progress with the abstinence, do these abnormalities get better? It may be that the brain gets better at compensating, but it doesn't normalize. It just learns how to bring in even more parts of the brain. You could say it learns to rewire itself," Peter R. Martin, a professor of psychiatry and pharmacology and corresponding author for the study, says in a news release.

"Another possibility could be that as the brain heals, less activation is required, and that's a real form of recovery. The answers rest with understanding not the tapping itself, but the mechanisms behind the tapping," Martin adds.

More information

Here's where you can learn more about alcohol abuse and alcoholism.

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CDC Announces New Strategy to Fight HIV in U.S.

Reuters Health
Thursday, April 17, 2003

NEW YORK (Reuters Health) - Federal health officials at the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC) announced on Thursday an initiative designed to refocus their HIV (news - web sites) prevention efforts.

"An estimated 200,000 people in the United States do not know they are infected with HIV and, tragically, are not getting appropriate treatment. This is an intolerable situation," CDC director Dr. Julie Gerberding told reporters.

"Our prevention efforts have stalled -- we are not making the kinds of ongoing progress that you would expect given the recent advances in HIV testing," she said.

The new initiative takes advantage of the Food and Drug Administration (news - web sites)-licensed rapid HIV test that can easily be performed at sexually transmitted disease clinics, shelters, drug treatment centers and correctional facilities.

The fact that results are available in roughly 20 minutes, Gerberding said, means patients don't have to come in for a follow-up visit to get the test result.

The rapid HIV test provides a way to "speed up access to the test but, more importantly, speed up access to the result. But that will only be useful if then the infected people are referred or linked to the appropriate medical follow-up services," Gerberding said.

Importantly, she announced that CDC guidelines would no longer include a requirement that calls for extensive counseling as a prerequisite for getting the HIV test.

"Behavioral counseling is still critically important," Gerberding said, "but in the medical environment, this has been a barrier to getting the test done because many clinicians don't know how to do that kind of counseling or simply do not have the time. So we are removing that requirement as a condition for testing."

As part of the initiative, the CDC will work with doctors to make HIV testing a routine component of medical care. This means getting physicians to ask "simple questions about injection drug use and unsafe sex, and offer the HIV test," Gerberding said.

The CDC also wants to encourage HIV testing for pregnant women. Treating an HIV-infected pregnant women can dramatically cut the risk that her baby will become infected either before, during or after birth.

"We believe very strongly that a case of perinatal transmission really represents a failure of our public health system, and we want all mothers tested for HIV infection," Gerberding said.

The CDC is recommending the opt-out approach, in which all pregnant women who have not been tested for HIV are offered the test.

The goal is to make HIV testing a "routine part of perinatal care," Gerberding said, adding that "we are going to do everything we can to ensure that children born to infected mothers have access to antiretroviral therapy."

Gerberding emphasized that the CDC is not recommending mandatory HIV testing of any group of people, under any circumstances. "We are simply treating an HIV test like any other test that would be a normal part of routine care," she said.

As part of the initiative, the CDC will also put more focus on the HIV-infected population. In the past, most of the prevention efforts were aimed at behavior of uninfected people that put them at risk for exposure.

"That needs to continue," Gerberding said, "but we haven't put as much emphasis on HIV-infected people as a component of our prevention paradigm as perhaps we should," she said.

It's "very important" to make sure partners of HIV-infected patients have access to testing, she noted.

The CDC outlines the HIV prevention initiative in the April 18th issue of the Morbidity and Mortality Weekly Report.

Source: Morbidity and Mortality Weekly Report 2003;52:330-332.

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Cholesterol Drug OK'd for Heart Problems

THURSDAY, April 17 (HealthScoutNews) -- The anti-cholesterol drug Zocor (simvastatin) is effective in reducing the risks of heart attacks, strokes and the need for bypass surgery and angioplasty -- even in people whose cholesterol isn't above normal levels, the U.S. Food and Drug Administration (news - web sites) says in approving new labeling for the drug.

Approval was based on a 20,000-person clinical trial known as the Heart Protection Study. Participants' risk of death from coronary heart disease fell by 18 percent; the risk of having a non-fatal heart attack was reduced by 38 percent; and the risk of stroke dropped 25 percent. The need for procedures to unblock clogged arteries fell by as much as 30 percent, the FDA says.

The decreases were seen among people of all ages and baseline cholesterol levels, the agency adds. And it didn't matter if participants had heart disease or diabetes.

The FDA reminds people who take Zocor to be aware of any muscle pain, which may indicate a serious side effect called rhabdomyolysis, a muscle breakdown disorder. Symptoms can begin as fatigue, fever, nausea and vomiting, severe muscle pain, weakness and tenderness, and end up as cardiac arrest or heart attack.

Here is the FDA Talk Paper about the approval. For more information about Zocor, visit the National Library of Medicine.

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U.S. Says Salmonella Prevalence Lower

By Emily Gersema
Associated Press Writer
The Associated Press
Thursday, April 17, 2002

WASHINGTON - The prevalence of harmful salmonella has declined across the board for meat and poultry products over the past two years as government inspectors increased testing, the Agriculture Department says.

Of 58,085 samples of meat and poultry taken last year, 4.3 percent had the germ that can cause food-poisoning, the department says. That compares with 5 percent of 45,941 samples of meat and poultry testing positive in 2001.

Elsa Murano, undersecretary of food safety, attributed the drop to the government's food safety program that has been in effect since 1998.

It requires plants to come up with plans to prevent salmonella and E. coli — bacteria that can cause food-poisoning — from infecting meat and poultry. Inspectors ensure compliance.

"This positive trend in regulatory samples will hopefully translate into fewer cases of salmonellosis due to meat and poultry," Murano said.

Salmonella can be found on raw meat, eggs, seafood, and dairy products, and sometimes on fruits and vegetables. It results in 1,000 deaths every year and sickens more than 40,000 people with salmonellosis, causing diarrhea, fever and abdominal cramps. Children, the elderly and people with weak immune systems are the most vulnerable to infection. Proper cooking can sterilize meat tainted with the bacteria.

The department's report says chicken products alone saw an increase in the prevalence of salmonella. Out of 429 samples taken from ground chicken last year, 29.1 percent tested positive. That is an increase from two years ago when inspectors found 19.5 percent of 262 samples had salmonella.

Broiler chickens had a slight drop in the incidence of salmonella over the past two years, with 11.5 percent of 9,183 samples testing positive last year, compared with 11.9 percent of 8,955 chicken samples in 2001.

Richard Lobb, a spokesman for the National Chicken Council, said he did not understand why the department is even measuring salmonella in ground chicken.

"There's very little ground chicken that's sold raw at the supermarket," he said. "Most of it would go into chicken franks, bologna, sausages that are cooked before they are sold."

Lobb noted that the incidence of salmonella in broiler chickens has remained steady. But packers now wash the birds after slaughter with chlorinated water to get rid of bacteria.

He added that consumers can protect themselves from illness by following cooking instructions printed on every package of poultry meat.

Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest, said the government is trying to present the numbers in a positive light. Regardless, she said, there was a definite upward trend in salmonella in chickens.

"I think the trend we're seeing for chickens is particularly worrisome," Smith DeWaal said. "It indicates that since the Bush administration took office that we're actually seeing food safety declining when it comes to salmonella in chickens."

The department's report also tracked samples from pork, ground beef, ground turkey, beef from cows and bulls, and beef from steers and heifers. All of those saw a slight decrease in samples testing positive for salmonella.

On the Net:

Agriculture Department's Food Safety and Inspection Service: http://www.fsis.usda.gov

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Experimental Drugs Block Hepatitis C Virus

By Maggie Fox
Reuters
Thursday, April 17, 2003

WASHINGTON (Reuters) - New experimental compounds may be able to help the body fight off hepatitis C -- an incurable virus that infects millions around the world and causes liver failure and cancer, researchers said on Thursday.

The research, done by separate teams in Canada and the United States, also led to new discoveries about how hepatitis infects the body -- and how the body fights off infection.

Hepatitis C, identified only in 1989, is spread mainly through blood transfusions and the reuse of needles -- including those used for drugs and tattoos.

It infects an estimated 175 million people around the world, many of whom do not know they are infected. About 8,000 die every year from hepatitis C in the United States alone.

Viruses such as influenza are eventually cleared by the immune system. But hepatitis C can stay in the body forever, eluding the various weapons of the immune system.

The U.S. Centers for Disease Control and Prevention (news - web sites) says 75 percent to 85 percent of those infected have chronic hepatitis C infection. Many will develop liver damage, sometimes leading to cirrhosis and liver cancer.

An antiviral drug called ribavirin, used along with an immune system booster called alpha interferon, can help some patients control hepatitis C infection, but does not cure it.

"Just a year ago, the hepatitis C virus field had no leads," said Michael Gale, a virologist at the University of Texas Southwestern Medical Center in Dallas who led one of the studies. "We were totally clueless."

Gale's team and a team led by John Hiscott at McGill University in Montreal, Canada, found out how the virus de-activates a cell's defenses, so that it can stay in the cell virtually forever.

Virus Blocks A Cell’s Defenses

Writing in the journal Science, both teams said they found the virus can block a cell's production of interferon regulatory factor 3, or IRF3 -- produced by cells to defend against infection and call in more immune system help. The McGill team found it also blocks a second compound called IRF-7.

"This really gives us the first evidence of how it is the virus can cause lifetime infection, as opposed to influenza which infects you for a week," Gale said in a telephone interview.

Gale's team also discovered that individual cells have their own immune responses, a finding his team has published in the April issue of the Journal of Virology.

"The whole thing works by IRF3 turning on genes in the human cell that fight off infection. We are going to find out what those genes are, what their products are," Gale said.

This in turn could lead to new ways to battle a number of different viruses, from the AIDS (news - web sites) virus to herpes.

In the meantime, two drug companies -- Schering-Plough and privately owned German company Boehringer Ingelheim -- have developed compounds they hope will work against hepatitis C.

Gale's team tested the Schering product, called by its experimental name SCH-6, and found it could protect the cell's defenses.

"We found that the new protease inhibitors could actually prevent the virus from blocking this immune response and basically restore the innate antiviral response in human cells," Gale said.

The work reported in Science was all done in the laboratory, and Gale said the drugs will be difficult to test because no animals are naturally infected with hepatitis C the way humans are.

But Boehringer has reported on Phase I clinical trials -- early research designed to test the safety of a drug in people -- that suggest its protease inhibitor is safe and may at least greatly reduce levels of the virus in the body.

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New Clue to Obesity

HealthScoutNews
Thursday, April 17, 2003

THURSDAY, April 17 (HealthScoutNews) -- A cellular receptor that controls obesity has been identified by researchers at the Salk Institute for Biological Studies in California.

This receptor, called PPARd, balances the accumulation and burning of fat in the body. It may prove to be a new target for anti-obesity and cholesterol-fighting drugs. The new research appears in the April 18 issue of Cell.

The researchers found that stimulating PPARd depleted fat deposits in mice. They also found that mice that were deficient in PPARd were prone to obesity.

Young mice with an activated PPARd gene weighed about 20 percent less than normal mice, even though they received the same amounts of the same kind of food. By the time they were a year old, the mice with the activated PPARd gene weighed 35 percent less than normal mice.

The researchers determined that PPARd regulates the rate by which fat is burned to produce heat or to maintain normal cell functions.

"We have long known that excess calories are warehoused in fat tissue for future use. We also know that fat is released and consumed in times when energy is needed, such as from exercise or shivering from cold exposure," researcher Ronald M. Evans says in a news release.

"This study shows us that PPARd is an important regulator of this function. By exploiting PPARd, we hope to design drugs that can control how much fat is stored in the body," Evans says.

More information

Here's where you can learn more about weight loss and control.

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Dad's Prostate Cancer Ups Son's Risk of the Disease

Reuters Health
Thursday, April 17, 2003

NEW YORK (Reuters Health) - A large research review confirms that having a father or brother with prostate cancer (news - web sites) is a major risk factor for the disease -- and lends support to regular and early screening for the cancer in men with a family history, according to researchers.

Their study found that men with an affected first-degree relative (a father or brother) had a 2.5 times greater risk of prostate cancer than those without a family history.

Having an affected brother conferred the greatest risk: These men had about a three-fold increase in cancer risk, while those with affected fathers had about twice the risk of men with no family history.

The findings emphasize that men with a first-degree relative with prostate cancer should be aware of their own increased risk, the study authors say.

These men "constitute an easily identifiable high-risk group that could benefit from PSA screening at an earlier age and at shorter intervals compared with the general male population," they write in the April 15th issue of Cancer

Prostate cancer is the second biggest cancer killer of men in the United States. The American Cancer Society (news - web sites) estimates that 220,000 new cases of prostate cancer will be diagnosed this year in the U.S., and nearly 30,000 men will die from it.

But the disease's mortality rate is relatively low because it is a slow-growing cancer, easily cured if caught early.

In the current study, Maurice P. A. Zeegers, of Maastricht University in The Netherlands, and colleagues evaluated 33 previously published studies on prostate cancer.

They found that the prostate cancer risk among men with an affected first-degree family member increased as the number of affected family members rose. Having just one first-degree family member with the disease more than doubled a man's risk, while men with two or more affected family members had a five times higher risk than men with no family history.

Having only a more distant relative affected appeared to raise a man's risk only slightly.

Currently, the American Cancer Society recommends annual PSA testing and a rectal exam beginning at age 50 -- and at age 45 for African Americans and men with a family history of the disease, who face a higher risk. Several other scientific and medical groups do not recommend routine prostate cancer screening.

PSA, or prostate specific antigen, is a protein produced by the prostate gland. PSA levels above four nanograms per milliliter (ng/mL) of blood can signal prostate cancer, but not always -- sometimes a rise in PSA is due to another cause, and sometimes cancer can occur without a rise in PSA. About 20 percent of aggressive prostate tumors are found in men with normal PSA levels.

Zeegers and his colleagues note that "ultimately, support for the argument in favor of (prostate cancer) screening will come from a decrease in ... death rates."

Source: Cancer 2003;97:1894-1903.

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Treating One Cancer May Beget Another

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Thursday, April 17, 2003

THURSDAY, April 17 (HealthScoutNews) -- The molecular action of a drug used to treat colon cancer might cause cancer in other tissues, researchers report.

That discovery calls for caution in the search for other anticancer drugs with the same action, but it is no cause for immediate concern, says Rudolf Jaenisch, a professor of biology at the Massachusetts Institute of Technology (news - web sites)'s Whitehead Institute for Biomedical Research. Jaenisch is the leader of the group reporting the finding in the April 18 issue of Science.

The drug is 5-azadeoxycytidine. It fights colon cancer by reducing the activity of a simple molecule, methyl, in the cancer cells. Intricate animal studies now show this process, hypomethylation, can cause leukemia, the journal paper says.

Methane consists of one atom of carbon and four atoms of hydrogen. It is found in a vast number of organic chemicals, such as methyl alcohol. Inside a living cell, methyl molecules attach themselves to DNA, the genetic molecule, turning genes off or on.

"It has been known for 30 years that cancer cells are hypomethylated, but it has not been known whether this is cause or effect," Jaenisch says. "We show that it is causal."

The discovery is important because several drug companies are searching for drugs that use the same mechanism as 5-azadeoxycytidine, which is very toxic, Jaenisch says. The new drawback could affect the use of such a drug, when and if it is found, he says.

The finding was years in the making. It started with a long effort by François Gaudet, a graduate student in the lab, to develop a strain of mice with abnormal hypomethylation. When that effort succeeded, it was found that 80 percent of those mice developed an aggressive form of leukemia, which originates in the thymus.

Amir Eden, a postdoctoral fellow, then showed that hypomethylation speeded the development of other forms of cancer in mice engineered to have those tumors.

"There seems to be a selective advantage for tumors to be hypomethylated, because their chromosomes are more unstable," Jaenisch says.

It's a fascinating discovery, says Dr. Stephen Baylin, a professor of medicine in the Johns Hopkins University Oncology Center, but no reason to lose one's head.

"This is not something we should ignore, something to think about, but I would caution against any suggestion that this would be a problem in treating cancer," Baylin says.

One important reason is the finding was made in very young mice that were altered as embryos, he says. "The study of tumors very early in the lifespan is very different from blocking tumors later in adult life," he says. "We can't extrapolate these results to what they would mean for treating cancers in adults, and probably in children."

Jaenisch plans to look at hypomethylation in other cancers, such as those of the pancreas, breast and liver. Studying metabolic differences in those tumors could lead to a better understanding of tumor formation, he says.

More information

You can learn more about colon cancer and its treatment from the National Cancer Institute, which also has a page on clinical trials for experimental drugs and therapies.

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After Menopause, Sugar Doesn't Taste as Sweet

Reuters Health
Thursday, April 17, 2003

LONDON (Reuters Health) - It's another bitter consequence of aging. Turkish researchers have found that some postmenopausal women lose their ability to taste sweet foods.

The scientists reported on Thursday that the hormonal changes during menopause seem to lower the ability of the palate to sense sugar, prompting some women to change their eating habits in favor of sweeter food.

Dr. Cagri Delilbasi, now at Osaka University, and colleagues conducted taste tests on 20 postmenopausal women at Ankara University and compared the results to 20 men of similar age.

They report in the British Dental Journal that the women had a significantly lower sensitivity to sucrose (sugar) on their palate. There was no difference between the groups for salt, sour or bitter tastes, and no changes in taste sensations on the tongue.

The researchers also asked the women if they'd noticed a change in their overall taste perception after menopause. Only 35 percent of the women reported that they had noticed a change, but 45 percent said their diets had changed, including a preference for sweeter food.

"The decline in sensitivity to sucrose is consistent with the altered diet reported by the female patients," the researchers write. "This finding is interesting as no previous report about failure of sucrose perception, and thus preference for sweeter food in menopausal women could be found."

What causes the change is hard to explain, the researchers write, and more research is needed.

"The crucial issue to be aware of is that the possible changes due to menopause can lead to more serious health problems, although these changes may not be uncomfortable to the patient."

Women who cannot taste sweet things might sweeten their foods, with potentially serious consequences for diseases like obesity, heart disease and diabetes they say.

Source: British Dental Journal 2003;194:447-449.

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Some Breast Cancer Drugs May Block Body's Defense Against Recurrence

By Colette Bouchez
HealthScoutNews Reporter
HealthScoutNews
Thursday, April 17, 2003

THURSDAY, April 17 (HealthScoutNews) -- The discovery of a new molecular pathway involved in the spread of breast cancer (news - web sites) may have far-reaching public health implications for women, possibly influencing the way breast cancer is treated.

That's the word from scientists at Emory University and The Winship Cancer Institute, where the latest research not only offers a new understanding of what makes certain breast cancers more aggressive, but also how some medications -- particularly those used to reduce cancer risks -- might ultimately contribute to its spread.

"We defined a pathway that regulates invasion [of cancer cells] and what we see is that some of the traditional anti-cancer drugs knock out this pathway," says Paul Wade, an assistant professor of pathology and laboratory medicine at Emory University School of Medicine.

Wade oversaw the research, which appears in the April 17 issue of Cell.

By examining laboratory cancer cell lines, the study focused on uncovering genetic differences between tumors that are "estrogen-sensitive" -- encouraged by estrogen to grow -- and those that are not. In the process, Wade and his group came upon a protein pathway known as MTA3, which, among other things, regulates a molecule identified as E-cadherin. This acts as a kind of biological "glue" that holds normal cells together, keeping them from rapidly dividing and forming tumors.

In tumors that are estrogen-sensitive, Wade says it's clear the MTA3 pathway is active -- along with the "glue" molecule holding cells together. This may be one reason why these tumors appear less aggressive and less likely to spread, he adds.

Conversely, they found that when a tumor was "estrogen receptor negative" -- meaning it did not require estrogen to grow -- the MT3A pathway was shut down and the E-cadherin protein didn't function at all.

This, says Wade, may be one reason why estrogen-negative tumors appear more virulent.

However, the inferences drawn from this study don't stop there. Wade believes the findings also have implications concerning popular anti-cancer drugs known as SERMs -- selective estrogen receptor modulators -- which include medications such as tamoxifen.

Frequently recommended following breast cancer treatment to reduce future risk of the disease, SERMs are thought to work by latching onto breast cells that would normally attract the tumor-promoting estrogen. When estrogen can't "log on," the thinking is the tumors won't grow.

What Wade now proposes is that part of the way in which drugs such as tamoxifen do their job is by disabling the MT3A pathway -- in a sense, turning a estrogen-positive tumor into one that is estrogen-negative.

In the process, SERMS may also disable the E-cadherin "glue-like" protein -- and that, in turn, may ultimately turn any future cancers more aggressive, Wade says.

One of the inevitable consequences of long-term SERM therapy is that cancer cells do develop a resistance to the drugs. Wade believes it is at this point that the less desirable effects demonstrated by the new research may kick in.

"We are not saying these are bad drugs -- it just means they can do more than one thing and one of the consequences of the therapy is a loss of the necessary pathway we defined," Wade says.

New York University breast cancer expert Dr. Julia Smith calls the research as important as it is fascinating.

"I think that these are, in fact, the kinds of molecular issues that, as we come to understand, will truly change our ability to treat not only breast cancer, but probably all cancers," Smith says.

However, she is less sure of Wade's conclusions regarding drugs such as tamoxifen.

"Their statement that there could be potentially negative results from compounds that affect cell architecture -- that tamoxifen could have deleterious effects -- right now, this is a leap of faith that is not yet proven in this research," Smith says.

She advises women who are taking tamoxifen not to worry, and not to stop the drug based on this one finding.

Wade agrees more research is in order. However, he believes it will only reinforce the idea that calls for more judicious use of SERM drugs -- not only in the treatment of breast cancer, but also in the treatment of other diseases. They include osteoporosis, for which certain SERM medications are currently prescribed.

"It's a new pathway, something that we think is important, and it's impacted by drugs that are used by an awful lot of women," says Wade. "So ultimately, it's going to be important for us to examine the consequences of treating women with these drugs in terms of what happens with the pathway that we've defined."

More information

To learn more about the various types of breast cancer, visit BreastCancer.org. For more information on tamoxifen, check with the National Cancer Institute.

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Noise Exposure May Delay Brain Development

By Alison McCook
Reuters Health
Thursday, April 17, 2003

NEW YORK (Reuters Health) - Exposing rats to continuous "white noise" during the first weeks of life appears to delay normal brain development in regions linked to sound processing, researchers said Thursday.

The findings suggest that living near an airfield or in a busy city, where outside noises can drown out parents' voices and other helpful sounds, may delay brain development and language learning in some infants, study author Edward F. Chang told Reuters Health.

Like rats, human infants also experience changes in brain regions involved in sound processing during the first year of life as they absorb and begin to understand the sounds of their native language.

In the case of babies growing up surrounded by loud noises, "you would expect there to be a delay, because they're not hearing (normal) speech sounds early in life," Chang said.

But he added that, based on the evidence, a delay in language learning would not be permanent and infants reared in a noisy environment would eventually catch up with their peers.

"These noise changes are not necessarily permanent," Chang said.

For many parents, leaving a noisy neighborhood to help their infant learn language is not an option, Chang said. In these instances, he recommended that parents try to provide their infants with as many normal sounds -- like words or music -- as possible, to counteract the effects of the environmental noise.

"The early life auditory experience is important," Chang said. Infants "need to be hearing salient speech and music and natural sounds."

Reporting in the journal Science, Chang and his co-author, Dr. Michael M. Merzenich, both of the University of California, San Francisco, obtained their findings by exposing rats to continuous white noise during the first weeks of life.

At this age, rat brains are typically undergoing dramatic changes in the regions that process sound, Chang explained.

The noise resembled the din heard in rooms in which multiple people are talking at once, he added.

Chang and Merzenich discovered that rats raised in a white noise environment did not experience the typical changes in brain development seen in rats raised in a quieter atmosphere.

When the animals were exposed to constant, moderate-level noise, "the achievement of these levels of maturation was far delayed," Chang said.

However, once the rats were removed from their noisy environment, their brains underwent normal development, and they soon resembled their peers, he noted.

Chang added that not all children raised in environments full of outside sounds will experience delays in their ability to learn language as a result.

A noisy atmosphere will likely have the strongest effect on the developing brains of infants who are particularly susceptible, he said, such as those with a genetic predisposition, or who were born prematurely.

Source: Science 2003;300:498-502.

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Can Folic Acid Prevent Down Syndrome?

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Thursday, April 17, 2003

THURSDAY, April 17 (HealthScoutNews) -- There seems to be a link between two disparate birth defects, Down syndrome and neural tube defects, and that link is folic acid, an international research group reports.

Studies of pregnancy outcomes in Israel and Ukraine find that families with a high incidence of neural tube defects also have an unexpectedly high incidence of Down syndrome, says a report in the April 19 issue of The Lancet. The research was done by a group led by Howard Cuckle, a professor of reproductive endocrinology at the University of Leeds in England.

Abnormal metabolism of folic acid appears to underlie both defects, the researchers say.

The link between folic acid and neural tube detects is well established; the U.S. Public Health Service recommends that women who are pregnant or might become pregnant take 400 micrograms of folic acid daily to prevent the defect, which affects the brain and spinal cord. But the new study is among the first to suggest a link with Down syndrome, which causes mental retardation.

The researchers are confident enough of their belief, Cuckle says, to have begun a trial in which pregnant women at high risk of having a baby with Down syndrome will be given massive doses of folic acid -- 5 milligrams a day, more than 10 times the recommended amount.

"We are enrolling about a thousand women in Israel, and within a couple of years we expect to have a handle on it," he says.

The criterion for entry in the study is simply age, since the incidence of Down syndrome is known to be higher in older women, Cuckle says, and he sees no reason why any pregnant woman should not take the supplement. "As far as we know, it does no harm," he says.

The report originated with an observation by doctors at the Interregional Medico-Genetics Center in Ukraine of a higher-than-expected incidence of neural tube defects in babies born to women referred to the center because of a history or diagnosis in the womb of Down syndrome.

Led by Cuckle, researchers then began examining the number of cases of Down syndrome in women seen at the Danek Gertner Institute of Human Genetics in Tel Aviv and other centers in the area because of a high risk of neural tube defects.

Overall, the two research centers reported 11 cases of Down syndrome in the 1,492 families at high risk of neural tube defects, about five times the expected incidence. And there were seven cases of neural tube defects in the 1,847 pregnancies at high risk of Down syndrome, compared to an expected incidence of 1.37.

Laboratory research points to a flaw in folic acid metabolism as a common, underlying mechanism for both conditions, Cuckle says.

Dr. Nancy Green, medical director of the March of Dimes Birth Defects Foundation, calls the new study "an interesting but very preliminary finding." The foundation's advice is that all women of childbearing age should take the daily 400-microgram folic acid supplements recommended by the Public Health Service.

But there are women who can benefit from much larger doses, she says. Four micrograms a day are recommended for women who have borne a child with a neural tube defect or have a neural tube defect themselves. Such large doses "may be helpful" for women who are obese or have diabetes, Green says.

And the 5-milligram dose being used in the Israeli study appears to do no harm "as far as we can tell, but it hasn't been studied," Green says. "I would add some caution to that."

More information

You can learn more about folic acid and pregnancy from the March of Dimes Birth Defects Foundation, which also has a page devoted to Down syndrome.

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Umbilical Cord Care

HealthScoutNews
Thursday, April 17, 2003

(HealthScoutNews) -- If you've just brought your newborn infant back from the hospital, your doctor has probably given you instructions on how to keep what's left of your baby's umbilical cord clean. Because the area may be an entryway for infection, it's important that you care for it properly.

Some doctors recommend using alcohol at each diaper change, while others suggest you use plain water.

You should also keep the cord dry by positioning it on the outside of your baby's diaper, advises Stanford University Medical Center.

Call your baby's doctor if there is:

  • Bleeding from the end of the cord or the area near the skin.
  • Pus.
  • Swelling or redness around the navel.
  • Signs that the navel area is painful to your baby.

The cord falls off by itself in about two to three weeks. Afterward, there may be a small amount of bleeding, but this should stop quickly.

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WEDNESDAY, APRIL 16, 2003

The Best of the Bunch

HealthScoutNews
Wednesday, April 16, 2003

(HealthScoutNews) -- The U.S. Department of Agriculture (news - web sites) recommends people eat three to five servings of vegetables a day. But not all vegetables pack the same nutritional punch.

Opt for dark green and orange vegetables because they're usually rich in vitamin A, iron and vitamin C, advises Rush-Presbyterian - St. Luke's Medical Center.

Here are some more suggestions:

  • Switch from iceberg to darker-green Romaine lettuce. It has twice the fiber and five times as much vitamins A and C.
  • Spoon green peas onto your plate instead of celery. They're far richer in fiber, vitamin A and vitamin C than celery.
  • Replace lettuce with broccoli or spinach.
  • Mushrooms have fiber and potassium and are low in calories, fat- and cholesterol-free, but they lack vitamin A. Rather, eat carrots -- which are rich in vitamin A and fiber.
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Low Lead Levels Delay Puberty in Girls, Decrease IQ

Reuters Health
Wednesday, April 16, 2003

NEW YORK (Reuters Health) - Children exposed to lead in their homes may suffer toxic effects even at levels once thought too low to cause harm, according to research released Wednesday.

Two studies published in The New England Journal of Medicine (news - web sites) show that even low blood levels of lead are associated with lower IQ scores in young children and delayed onset of puberty in girls.

Most lead poisoning occurs because children ingest chips or dust from lead-based paint. Though federal law now strictly limits lead levels in residential interior paint, millions of American homes are believed to still have surfaces painted with older, more dangerous paint.

Children are especially susceptible to the toxic effects of lead, experiencing neurological problems, including learning disabilities and a drop in IQ if lead levels climb above 10 micrograms per deciliter (mcg/dL) of blood.

In the first study, lead author Dr. Sherry Selevan of the US Environmental Protection Agency (news - web sites) and colleagues evaluated levels of lead in the blood and the onset of puberty among 2,186 girls between the ages of 8 and 18. Measurements of puberty included growth of pubic hair, breast development and age when menstruation began.

Among the entire group, blood lead concentrations were, on average, below 3 mcg/dL of blood, regardless of ethnicity. However, differences were seen between girls with blood lead levels of 1 mcg/dL compared to those with lead concentrations of 3 mcg/dL.

"Higher blood lead concentrations were associated with significant delays in all pubertal measures among African Americans and in breast development in Mexican Americans," even after the researchers took into account other "relevant physical, demographic, and socioeconomic factors," Selevan's team writes.

African American girls with blood lead levels of 3 mcg/dL started menstruating 3.6 months later than girls with lead levels of 1 mcg/dL, the authors report.

For white girls, a similar relationship between blood lead concentrations and delay in puberty development was seen but the findings were not statistically significant.

"Although our findings cannot prove a causal relation between mildly elevated lead concentrations and delayed puberty, they suggest that even a relatively low level of exposure to lead may influence growth and sexual development in girls," the authors conclude.

In the second study, Dr. Richard L. Canfield of Cornell University in Ithaca, New York, and colleagues periodically evaluated blood lead levels in 172 children starting when they were 6 months old and ending at the age of 5 years. IQ was checked at ages 3 and 5. They took into account a number of factors known to influence IQ, including birth weight, the mother's education level and smoking during pregnancy.

The average blood lead level in the 5-year-olds was 7.4 mcg/dL and their average IQ was 90 (the national average is 100).

Overall, children with the highest blood levels of lead had the lowest IQs, Canfield's team reports. From the data, the researchers were able to estimate a 4.6-point drop in IQ for each 10-mcg/dL increase in blood lead level. Among children with initially lower lead levels, the effect of rising lead was even more striking. There was a 7.4-point drop in IQ for children who started the study with the lowest lead levels (1 mcg/dL) but then had higher exposure (10 mcg/dL), the authors report.

"These findings suggest that more US children may be adversely affected by environmental lead than previously estimated," the authors conclude.

"The fact that associations seen at these low lead level concentrations is subtle is not reassuring; rather it implies that there is no safety margin at existing exposures," write Dr. Walter J. Rogan of the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina, and Dr. James H. Ware of Harvard School of Public Health in Boston, Massachusetts, in an accompanying editorial.

The two point out that eliminating elevated blood lead by the end of the decade is a priority for the federal government.

"The new reports underscore the importance of these goals and of the potential consequences of a delay in addressing this entirely preventable condition," Rogan and Ware conclude.

Source: The New England Journal of Medicine 2003;348: 1517 and 1526 and 1527-1536.

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Fireflies Shine Light on Cancer


HealthScoutNews
Wednesday, April 16, 2003

WEDNESDAY, April 16 (HealthScoutNews) -- Fireflies may shine a powerful new light on cancer treatment.

The unusual discovery comes in a British study in the April 15 issue of Cancer Research.

University College London and Ludwig Institute for Cancer Research scientists took the firefly gene that lets the insect create bioluminescent light and inserted it into modified cancer cells.

The firefly light source, called luciferin, made the cancer cells glow. When a photosensitizing agent was added to the cancer cells, they produced toxic substances that killed them.

"The cells produced enough light to trigger their own death," researcher Dr. Theodossis Theodossiou says in a news release.

This use of the firefly gene may offer another way to perform photodynamic therapy. That's a treatment that uses bursts of light to attack cancer near the skin's surface or on the lining of internal organs.

With photodynamic therapy, cancer cells are treated with a photosensitizer and then exposed to lasers or another external beam light source. That light activates production of active oxygen species that kill cancer cells.

However, external light sources are only able to pass through a thin amount of tissue. That makes it difficult to use photodynamic therapy to treat deeper cancers.

The use of the firefly gene means that the light source needed to destroy cancer cells can be imbedded in the cancer cells themselves.

"The light is generated within the tumor cell, so there's no need for outside penetration," study co-author John Hothersall says in a news release.

More information

Here's where you can learn more about photodynamic therapy.

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Air Pollution May Damage Brain, Heart

By Leonard Lee
HealthScoutNews Reporter
HealthScoutNews
Wednesday, April 16, 2003

WEDNESDAY, April 16 (HealthScoutNews) -- Air pollution may cause brain damage similar to Alzheimer's disease (news - web sites), as well as heart problems, two new studies suggest.

Dogs exposed to air pollution were found to develop damaged brain cell genes in as little as four weeks, according to research presented April 15 at the Experimental Biology 2003 conference in San Diego.

The animals were exposed to the highly polluted air in different parts of Mexico City, and compared against a control group of dogs kept in less-polluted rural parts of Mexico. Mexico City is considered one of the worst cities in the world for air pollution.

More than 200 dogs were involved in the study, which lasted for more than a year. The dogs in the highly polluted environment suffered lung and upper respiratory damage, which let particles enter the central nervous system, leading to gene and DNA damage in their brain cells. Even dogs less than 1 year old were found to have brain lesions similar to those of human Alzheimer's patients, the researchers say.

Lead researcher Dr. Lilian Calderon-Garciduenas, of the University of North Carolina, says exposure to air pollution causes inflammation in the respiratory tract, which lets tiny airborne particles and metals enter the central nervous system and brain. This, in turn, causes oxidative damage and DNA changes in brain cells.

Air pollution breaks down the vital blood-brain barrier that usually keeps toxic substances away from the brain, she says.

"This is extremely important," says Calderon-Garciduenas, "because once you break down the barriers, you have an entrance for pollutants directly to your brain."

The researchers also found signs of lung damage in children as young as 4 years old who were raised in Mexico City.

"The same breakdown in the respiratory system we're seeing in dogs is happening in children and adults in Mexico City," Calderon-Garciduenas contends, "and it probably also happens in cities like Los Angeles."

A separate study presented at the same symposium found a link between air pollution and heart problems in humans.

Exposure to air pollution raised levels of certain peptides in the bloodstream that can constrict blood vessels and decrease blood flow to the heart muscle, the researchers found.

The study was conducted at the Gage Institute of the University of Toronto, where healthy volunteers were exposed to air pollution in a laboratory setting. The volunteers were subjected to air pollution about two to three times the level normally found in Toronto, which is considered one of North America's less-polluted major cities.

The study focused on endothelin, a naturally occurring peptide that plays an important role in blood vessel health.

"If we expose healthy humans to airborne particulates, we can document a doubling of endothelin in the blood," says Renaud Vincent, one of the researchers and head of Health Canada's Inhalation Toxicology and Aerobiology Section.

"We now have at least one mechanism that could plausibly explain how someone with a heart condition exposed to a low level of air pollution could die or come down with severe symptoms, such as congestive heart failure," Vincent says.

Recent epidemiological studies have found higher rates of death and hospitalization in cities with high levels of air pollution. Vincent says the culprit appears to be airborne particulates.

When test subjects breathed polluted air for as little as two hours, the level of vasoconstrictive peptides in their blood rose sharply and stayed at abnormally high levels for as long as 24 hours, even without further exposure. The changes in peptide levels were proportionate to the concentration of particles to which the subjects were exposed.

"The picture is starting to come together of why we see these spikes in mortality associated with air pollution levels," says Fred Miller, a researcher with CIIT Centers for Health Research, an independent, non-profit research organization based in North Carolina's Research Triangle Park.

"The mortality may be coming about because you have this exposure, and how well can your system handle this added stressor?" he says.

Elevated levels of endothelin can reduce blood flow by as much as 50 percent, particularly in people with atherosclerosis, high blood pressure and diabetes, Vincent says.

Further study needs to be done on which specific particulates and their components produce the rise in vasoconstrictive peptide levels, he says.

More information

To learn more about the health risks posed by air pollution, visit the Centers for Disease Control and Prevention or the World Resources Institute.

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Genetic Link to Thyroid Cancer Found

HealthScoutNews
Wednesday, April 16, 2003

WEDNESDAY, April 16 (HealthScoutNews) -- A single genetic mistake is responsible for about two-thirds of papillary thyroid cancers.

That claim comes from a Johns Hopkins Kimmel Cancer Center study in the April 16 issue of the Journal of the National Cancer Institute (news - web sites).

The finding could help scientists develop new therapies to counteract this genetic aberration.

The Hopkins researchers found a mutation of the BRAF gene in 24 of 35 samples (68 percent) of papillary thyroid cancers. The genetic error involves a subtle change in the chemical bases -- or nucleotides -- that make up the gene's DNA.

The order in which these nucleotides occur determines the information that genes communicate to cells. In the case of this BRAF gene mutation, a single coding error among more than 2,000 nucleotides in the BRAF gene causes the gene to instruct thyroid cells to continuously grow and divide, ultimately leading to cancer.

Papillary thyroid cancer accounts for about 75 percent of all thyroid cancers and occurs mostly in women.

Thyroid cancer affects about 22,000 Americans each year and accounts for about half of all head and neck cancers. The thyroid gland regulates the body's metabolism, chemical balance and hormone production.

More information

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

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Cancer Drug Improves Stent Outcomes

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Wednesday, April 16, 2003

WEDNESDAY, April 16 (HealthScoutNews) -- Stents coated with the cancer drug Taxol keep arteries open longer than untreated devices, a new study suggests.

Stents are flexible metal scaffolds that prop open vessels after angioplasty to restore blood flow to the heart. Narrowing, or restenosis, of those vessels occurs in roughly 20 percent of patients, forcing doctors to repeat the costly procedure.

However, the new study found stents doped with Taxol are much less likely to fail because the drug retards the growth of cells in the lining of the blood vessels where the stents lie.

The U.S. Food and Drug Administration (news - web sites) is now considering the approval of a stent coated with the drug sirolimus, which has also been found to prevent restenosis.

Taxol, or paclitaxel, is commonly used to treat advanced breast and ovarian cancers, as well as certain lung tumors and a form of cancer associated with AIDS (news - web sites). The drug is a synthetic version of a molecule found in the bark of the Pacific yew tree, whose anti-cancer properties were discovered in the early 1960s.

Previous research has found stents that release the drug appear to reduce the rate of restenosis, which typically occurs within the first six months after the procedure. The latest research, reported in the April 17 issue of The New England Journal of Medicine (news - web sites), shows a high dose of the drug works best.

Scientists in the United States, Korea and Hong Kong compared the odds of restenosis in 176 men and women who'd undergone stenting of their coronary arteries. A third received stents carrying a large dose of Taxol and a third had stents with a smaller amount of the drug. The rest received uncoated stents. Patients also were given some form of blood-thinning therapy to reduce their risk of clotting.

After four to six months, those with the high dose of Taxol on their stents showed much less new narrowing than those with dry stents. Patients in the low-dose group also had less restenosis, but the effect wasn't as great.

The study was funded by Cook Inc., a stent maker in Bloomington, Ind. One of the authors also received speaking fees from Boston Scientific, another leading stent maker.

Coated stents cost more to implant, but if they reduce the rate of restenosis they could save money in the long run. Some 850,000 Americans receive stents every year. A recent study found that drug-coated stents cost about $2,000 more than conventional stents, but they managed to recoup much of that difference through eventual savings.

Dr. Lee Giorgi, an interventional cardiologist at the Mid America Heart Institute, part of Saint Luke's Health System in Kansas City, Missouri, says drug-coated stents are "hot stuff."

However, he says, while the data from clinical trials are impressive, it's likely their real-world performance will be somewhat weaker. Not only do trials typically include ideal patients, but the studies take place in heart centers with elite physicians, he says.

"You can almost predict that the results won't be as good" at an average clinic with more difficult patients, he adds.

However, Dr. Kenneth Kent, director of the cardiac catheterization program at Georgetown University Hospital, says heart specialists also had a "learning curve" with conventional stents when they first appeared. Eventually, Kent says, the devices will be as familiar as the old models.

"There's no question that these devices are an answer to a wish ever since we started doing" stenting nearly three decades ago, he adds. Recurrent narrowing of the vessels "has been the single most important deficiency" in the procedure.

More information

To learn more about angioplasty and stenting, visit the CardiologyChannel or the HeartCenterOnline.

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TUESDAY, APRIL 15, 2003

Filtering Blood Supply May Offer Some Benefits

By Alison McCook
Reuters Health
Tuesday, April 15, 2003

NEW YORK (Reuters Health) - Filtering white blood cells out of blood, a controversial practice that some experts believe increases transfusion safety, appears to indeed reduce the risk of certain health problems among patients who are significantly ill, researchers said Tuesday.

Although some evidence suggests that the white blood cells found in donated blood may increase the risk of infection and death in transplant recipients, research has provided a mixed picture as to whether removing those cells -- called leukoreduction -- poses any benefits to patients.

Given the mixed evidence in favor of leukoreduction and the costs involved with adding a new procedure to blood transfusions, different countries have adopted different policies toward the practice.

In Canada and parts of Europe, for example, all blood transfusions are required to undergo leukoreduction. In other countries, however, that is not the case. In the US, only a portion of the blood supply undergoes leukoreduction.

In the latest addition to the field, Dr. Paul C. Hebert and his colleagues discovered that leukoreduction may reduce the risk of death, fever and antibiotic use in people who are seriously ill, such as people in intensive care and those undergoing heart surgery.

The investigators also found that very low birth weight babies, who are at risk of a host of health problems, were less likely to experience a number of diseases linked to prematurity if their transfusions underwent leukoreduction than if the new blood contained the donors' white blood cells.

These findings suggest that in some patients, removing white blood cells does, indeed, provide certain health benefits, Hebert told Reuters Health.

"We found in two largely high risk populations that you cause no harm, and there's potential benefit," he said.

"Now, should you leukoreduce the entire blood supply?" Hebert asked. "We didn't find any reason not to. The issue is cost."

Leukoreduction adds $30 to the cost of each unit of blood, according to the American Red Cross (news - web sites)'s Web site. The agency, which recommends universal leukoreduction, collects and distributes half of the blood in the U.S. As of June 2002, 95 percent of the red blood cells distributed to hospitals by the Red Cross were leukoreduced, according to the agency.

Hebert and his colleagues' findings appear in Wednesday's issue of the Journal of the American Medical Association (news - web sites).

In the study, Hebert and his colleagues reviewed the health of 6,982 Canadian adults who received blood transfusions before the law requiring that all donated blood be leukoreduced and 7,804 people who received new blood after the law went into effect.

All study participants received transfusions as a result of heart surgery, surgery to repair a hip fracture, or during intensive care after surgery or serious trauma.

Hebert and his team discovered that patients who received leukoreduced blood were less likely to die while in the hospital and less likely to develop a fever or require antibiotics after receiving new blood than people who received transfusions before the law requiring leukoreduction went into effect.

However, recipients of leukoreduced blood developed just as many infections as others, suggesting that leukoreduction helps patients in ways other than reducing the risk of infection, as some have supposed, Hebert said in an interview.

"It would certainly suggest something else is going on," he said.

In the second report, the researchers investigated the effects of leukoreduction in 268 and 247 premature infants who received transfusions before and after the universal leukoreduction law in Canada, respectively.

All of the infants weighed less than 2.75 pounds.

Leukoreduced blood was linked to a host of health benefits, the authors report, including an almost 70 percent lower risk of illnesses associated with prematurity, including chronic lung disease, bleeding in the brain, and retinal damage.

However, removing white blood cells from donated blood did not appear to reduce the risk of death and bacteria in the blood.

Hebert explained that very low birth weight infants have a lot of hurdles to overcome in order to survive, and in the especially ill infants, leukoreduction of blood may not make much of a difference.

"But for those who survived, it dramatically changed the complication rates," he said.

In an accompanying editorial, Drs. Howard L. Corwin and James P. AuBuchon of the Dartmouth-Hitchcock Medical Center in New Hampshire note that it is important to remember that over time, improvements in treatment can affect how well patients fare after transfusion, regardless of leukoreduction.

For instance, in the adult study, aspirin and drugs to reduce blood pressure were given more often to patients who received leukoreduced blood than to patients whose transfusions took place before universal leukoreduction.

Although leukoreduction appears to help in some cases, "at this point, any benefits of leukoreduction must still remain categorized as potential," Corwin and AuBuchon write.

"The decision of whether the adoption of a universal leukoreduction policy warrants the enormous cost and redirection of attention still cannot be made on the basis of the data available," they add.

Source: Journal of the American Medical Association 2003;289:1941-1949,1950-1956,1993-1995.

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Caffeine and Ephedra Before Workout Tax Heart

HealthScoutNews
Tuesday, April 15, 2003

TUESDAY, April 15 (HealthScoutNews) -- People who consume ephedra and caffeine before they exercise alter their cardiovascular system, placing greater demands on their heart, says a South Dakota State University study.

The combination of ephedra and caffeine increases hypersensitive response before, during and after exercise, and increases systolic blood pressure before exercise. That higher rate pressure results in more work for the heart.

The findings were presented at the Experimental Biology meeting in San Diego, which runs April 11-15.

The study included five men and five women who were given either 150 milligrams of caffeine and 20 milligrams of ephedra or a placebo. They were then monitored while at rest, during exercise and after exercise.

The people who took the caffeine/ephedra had higher hypertensive response after 60 minutes of rest. That response remained higher at 30 and 60 minutes of exercise. The people who took the caffeine/ephedra also had higher systolic blood pressure while they were resting and had higher mean arterial pressure.

Ephedra is a controversial herb marketed as an energy booster and weight loss aid. It's been linked to almost 100 deaths, including high school, college and professional athletes who have collapsed during games or practice.

More information

Here's where you can learn more about ephedra.

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Estrogen Patch May Be Safer for Heart Than Pill

By Linda Carroll
Reuters Health
Tuesday, April 15, 2003

NEW YORK (Reuters Health) - Estrogen replacement therapy may be safer for the heart if it is delivered through a patch rather than a pill, a small study suggests.

Postmenopausal women who took hormone replacement therapy through a pill experienced an increase in an important marker of heart attack risk, while women who used a patch did not, according to a study published in the Journal of the American College of Cardiology.

Though long theorized to be helpful, several recent clinical trials have suggested that hormone replacement therapy might actually have a negative effect on the heart. In fact, the Women's Health Initiative, the largest study of its kind, was cut short in 2002 because researchers found that HRT -- a combination of estrogen and progestin -- increased the risk of heart attacks and other problems when taken in the long term.

The new research may be a hopeful signal to women with severe menopausal symptoms who worry that HRT might damage the heart, according to the study's lead author, Dr. Wanpen Vongpatanasin, an assistant professor of medicine in the division of hypertension and cardiology at the University of Texas Southwestern Medical Center in Dallas.

"Some women have severe hot flashes if they stop taking estrogen," Vongpatanasin said in an interview with Reuters Health. "So instead of telling them to tough it out, we wanted to figure out what went wrong in the clinical studies so that we might find an alternative form to help them with their problems."

For the new study, Vongpatanasin and her colleagues compared the effects of the estrogen patch to placebo and to oral estrogen in 21 postmenopausal women. The women were divided into three groups that were randomly assigned to receive the patch, the pill or a placebo. At the end of eight weeks, the groups were switched. They were again switched at the end of another eight weeks. Ultimately each group had experience with all three therapies.

Vongpatanasin and her colleagues decided to look at different modes of estrogen administration because oral medication has been shown to increase the levels of C-reactive protein, a marker for inflammation that is linked to heart attack and stroke risk.

"C-reactive protein is produced by the liver," Vongpatanasin said. "And when you give estrogen orally, you typically have to give higher doses than if you give it transdermally."

When researches looked at the levels of C-reactive protein, they found that it was unchanged when women took a placebo or used the estrogen patch, but rose when they took estrogen in the pill form.

"I think our study suggests that the effects of estrogen on the body are very complex," Vongpatanasin said. "And the effects depend on the route of administration."

The study doesn't prove that estrogen from a patch is safe for the heart over the long term, Vongpatanasin allowed. For that, longer term studies need to be performed, she said.

It is still not clear if women who take estrogen alone are at increased risk for the heart problems seen in women taking estrogen and progestin. The arm of the Women's Health Initiative in which women -- usually those who have undergone a hysterectomy -- were taking estrogen only is ongoing to try to answer that question.

Grants from the National Institutes of Health (news - web sites) and the U.S. Public Health Service funded the study.

Source: Journal of the American College of Cardiology 2003;41:1358-1363.

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Ah Yes, I Remember It Well

By Janice Billingsley
HealthScoutNews Reporter
HealthScoutNews
Tuesday, April 15, 2003

TUESDAY, April 15 (HealthScoutNews) -- Young people who drink heavily and experience blackouts are more likely to have impaired memory skills than those who drink but don't have blackouts, a new study has found.

They also tend to reconstruct their fuzzy memories from their drinking bouts in positive way, so they have more positive expectations about future drinking than do drinkers who don't have blackouts.

When sober, the memory abilities of those drinkers who report blackouts and those who don't are the same. But when they drink, those who experience the blackouts have worse memory performance both during and immediately after they sober up than do their fellow drinkers who don't have blackouts, says Kim Fromme, an associate professor of psychology at the University of Texas at Austin.

"Alcohol clearly seems to impair these individuals' memory processes more than others," says Fromme, a corresponding author of the study, which appears in the April issue of Alcoholism: Clinical and Experimental Research.

Also of interest is that while it is known that heavy drinkers are likely to develop memory structures for alcohol effects that are biased toward positive incomes, this study suggests blackouts could accelerate this process, as those who had the blackouts reported strong positive expectations about future drinking.

"This is a really very interesting study," says William Fals-Stewart, a senior research scientist at State University of New York's Research Institute on Addictions in Buffalo.

"We often think about alcohol use as inducing memory problems, but this study suggests that memory problems facilitate alcohol use, which is a very different twist on how we think," he says.

In the study, Fromme and her colleagues recruited 55 men and 53 women whose average age was 22, and who reported that they indulged in binge drinking at least once a week, which meant five or more drinks on one occasion for men and four or more drinks for women. On average, the participants reported drinking 5.4 drinks per drinking occasion and drinking an average of nine times a month.

In addition, the study sample was broken down so half the participants had reported having blackouts in the past and half who did not.

For the study, the group was taken to a tavern-like setting for a half hour, where half of the group drank three vodka cocktails, and the other half drank three non-alcoholic drinks that had been doctored to simulate alcoholic drinks.

After a 15-minute absorption period, the young people were given Breathalyzer tests and then a series of tests to assess their memories. They then remained in a laboratory until those who had been drinking sobered up and then all were given additional memory tests.

Of the participants, those who drank alcohol and had reported prior blackouts when drinking had the worst responses to the memory assessments, which included tests such as seeing a list of 32 words and then, a half-hour later, having to match those remembered words to other words associated with the original words.

Although the study did not identify why some drinkers were more prone to blackouts than others, Fromme says those who did report the blackouts shared some traits not exhibited by those drinkers who did not have blackouts.

"Those who experienced fragmentary blackouts reported more frequent drinking, though not heavier drinking per occasion, and more positive beliefs about the effects of drinking alcohol," Fromme says.

Fromme says while this study can make no conclusions suggesting the blackouts could be markers for future alcohol problems, "they should not be ignored as possible indicators of alcohol-related problems."

"Health professionals should assess whether individual students experience fragmentary blackouts, and they should educate all students about the nature and potential negative consequences of fragmentary blackouts," Fromme says.

More information

The National Institute on Alcohol Abuse and Alcoholism offers some basic facts about alcoholism. A parent's guide to children's drinking can be found at the Nemours Foundation.

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Run, Don't Walk to Stave Off Heart Death: UK Study

Reuters Health
Tuesday, April 15, 2003

LONDON (Reuters Health) - A brisk half-hour walk five days a week might make you healthier, but may not be enough to avoid a premature death from heart disease, British researchers reported on Tuesday.

Current UK and U.S. heart guidelines recommend 30 minutes of moderately intense physical activity five days a week, but a study of nearly 2,000 middle-aged men suggests that only more-vigorous exercise protects against an untimely end from cardiovascular disease.

Dr. John Yarnell from Queen's University Belfast, Northern Ireland, and colleagues studied 1,975 Welsh men aged 45 to 59, none of whom had signs of heart disease at the beginning of the study.

They followed the men for 11 years and correlated their leisure-time physical activity with deaths from cardiovascular conditions.

The researchers graded exercise according to intensity. Light activities included walking, bowling or sailing; moderate activities included golf and dancing; and vigorous activities included climbing stairs, swimming and jogging.

During the study, 252 men died. More than 75 percent of these were attributable to heart disease and stroke, and the remainder to cancer.

Men with the lowest leisure-time exercise levels were more likely to die during the study, the researchers found.

The heaviest levels of physical activity were associated with the lowest rates of death from all causes and heart disease. But moderate and light levels of regular exercise had no consistent impact on death rates.

"Vigorous physical activity, such as climbing stairs, hiking, jogging, swimming, tennis, badminton, squash and heavy digging, may independently prevent premature death, principally from cardiovascular disease and coronary heart disease in middle aged men who have no evidence of pre-existing coronary heart disease," the researchers write in the journal Heart.

Closer analysis showed that it was the intensity of exercise, rather than the number of calories burned, that seemed to be the crucial factor.

The few men who regularly engaged in the highest levels of heavy exercise, expending more than 54 calories a day in this way, were 47 percent less likely to die early and 62 percent less likely to die of heart disease. Those 54 calories equate to just nine minutes of jogging or doubles tennis, or seven minutes of climbing stairs.

But men who engaged in the highest levels of light to moderate exercise, expending an average 343 calories a day -- which is equivalent to more than 90 minutes of walking or an hour of ballroom dancing -- were not protected from the risk of an early death.

Belinda Linden from the British Heart Foundation, which partly funded the study, said that current guidelines have been developed through a consensus of national and international research over time.

"Whilst this study adds to our understanding of how levels of physical activity affect an individual's risk of heart disease in the long term, it is just one study," she said in a statement.

"While we recognize that vigorous activity will provide maximum cardiac protection and promote physical fitness, there is evidence that 'five times 30 minutes' moderate-intensity activity still appears to provide health benefits."

"There is still not enough evidence to suggest that the current messages are not appropriate."

Source: Heart 2003;89:502-506.

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Sudden Heart Death Strikes Women, Too

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Tuesday, April 15, 2003

TUESDAY, April 15 (HealthScoutNews) -- Doctors should pay the same attention to preventing sudden cardiac death in women as they do for men, a new Harvard study urges.

Admittedly, the rate of sudden cardiac death is lower in women than in men -- only 30 percent of the 400,000 sudden deaths that happen in the United States each year occur in women, lead author Dr. Christine M. Albert says in a statement. But there seems to be an assumption that the conventional risk factors for heart disease -- such as smoking, high blood pressure, obesity and diabetes -- don't raise a warning flag for women as they do for men, she adds.

However, analysis of the Nurses' Health Study, which followed more than 121,000 women for 20 years, say otherwise. The research appears in the April 15 issue of Circulation.

"Our data suggest that coronary heart disease risk factors do indeed predict sudden coronary death in women, and therefore coronary heart disease risk factor intervention should impact risk of sudden cardiac death in women," the study says.

True, for 69 percent of the 244 women who suffered sudden deaths recorded in the study, death was the first sign of heart disease, Albert acknowledges. But almost every one of those women had a significant cardiac risk factor. For example, diabetes was associated with a 2.5-fold increased risk and obesity was linked with a 1.6-fold increase. Oddly, high blood cholesterol did not raise the risk significantly.

Smoking was the real killer. "The women who smoked 25 or more cigarettes a day had a fourfold increased risk of sudden cardiac death," Albert says.

"A genetic factor might be involved, particularly among women who die suddenly at a young age," Albert says. Family history was a risk factor if a woman had a parent who suffered sudden cardiac death before the age of 60.

The study does upset one belief about the difference between men and women. Many people assume sudden cardiac death is caused by a heart attack. In fact, a more common cause is ventricular fibrillation, a violent interruption of the rhythm of the blood-pumping chambers of the heart. It has been believed that sudden deaths in women were less likely to be caused by an arrhythmia. The report finds the cause of death was about the same for men and women: 88 percent in this study compared to 91 percent in a recent study of men.

However, there is one disturbing difference between the sexes. The incidence of sudden cardiac death in men appears to be declining, down 2.8 percent between 1989 and 1999 for men between the ages of 35 and 44. In women, meanwhile, it rose 21 percent in the same age group in that period.

The report means that more emphasis should be placed on detecting and treating risk factors in women, says Dr. Nieca Goldberg, a cardiologist at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association (news - web sites).

"It has been shortsighted in terms of the medical community ignoring symptoms for a lot of women detected in screening," Goldberg says. "Smoking, diabetes and hypertension [high blood pressure] needed to be screened for and aggressively treated."

More information

You can learn about sudden cardiac death and what can be done to prevent it from the American Heart Association. You can also try the National Heart, Lung, and Blood Institute's Women's Heart Health Education Initiative.

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Most Women Say Mammogram Pain Not That Bad: Study

By Alison McCook
Reuters Health
Tuesday, April 15, 2003

NEW YORK (Reuters Health) - Pain during mammograms is reported to be a significant reason why some women avoid screening. However, a new study released Monday suggests that the procedure's reputation for being painful might involve more fiction than fact.

According to the report, almost three-quarters of women who underwent a mammogram reported that the pain was relatively mild, falling at four or less on a scale of zero to 10, with 10 being the "worst pain you have ever felt."

This placed the pain from mammography below that of a mild headache or wearing shoes that are slightly too tight, according to the report in the April 14th issue of the Archives of Internal Medicine (news - web sites).

Furthermore, 94 percent of the study participants said they were "very likely" or "somewhat likely" to schedule another mammogram for the following year.

Not all of the women felt the pain was mild, though, noted study author Dr. Penny C. Sharp of Wake Forest University in Winston-Salem, North Carolina.

"There were a few women who said it was extremely painful," she told Reuters Health.

She also pointed out that the study surveyed women who had volunteered to undergo mammography -- a research technique that may miss those who feel the most pain from the procedure.

"It could be that years ago a woman had a mammogram and it was very painful, and she decided she was never coming back," she explained.

However, she said that the fact that for so many women, mammography pain is mild enough that they will seek yearly screening may be reassuring to a woman who fears the discomfort of the procedure.

"We're hopeful that the results of this study may encourage that woman to come back in," Sharp added.

During the study, Sharp and her colleagues interviewed 200 women at least 40 years old right after they underwent mammography.

The vast majority of women -- 96 percent -- said that the pain they felt during screening was "less than" or "about as expected."

Overall, the most painful portion of the procedure appeared to be during compression, the moment when the breast is compressed between two plates.

In an interview, Sharp noted that compression, while painful, typically lasts only two seconds, and occurs four times -- twice on each breast -- during the procedure.

"There is some pain," she said. "But it's short-term pain."

Sharp and her team also found no difference in the amount of pain reported by women with different breast sizes, despite the fact that some women believe that having smaller breasts makes the procedure more painful.

As for why many women avoid mammograms for fear of pain, Sharp noted that for some women, the procedure is indeed very painful. Those reports may stick in the minds of women better than stories of women who feel differently, she said.

And some women's feelings about mammography pain may be based on previous technology, which sometimes produced more pain than current techniques, Sharp added.

According to the women participating in the study, the most stressful part of undergoing mammography was waiting to get the results.

This finding suggests that health workers who want to improve the procedure for women should try to get them their results as soon as possible, Sharp and her colleagues write.

Source: Archives of Internal Medicine 2003;163:833-836.

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Screening Interval for Colorectal Cancer Questioned

By K.L. Capozza
HealthScoutNews Reporter
HealthScoutNews
Tuesday, April 15, 2003

TUESDAY, April 15 (HealthScoutNews) -- A new study questions the recommended guidelines for a common colorectal cancer screening procedure, and suggests the current five-year screening interval may be excessive.

The benefits of the procedure, called a sigmoidoscopy, can last as long as 10 or even 15 years, the study researchers say.

Almost 1 million cases of colorectal cancer are diagnosed worldwide each year. Several effective tests are available that can detect the disease in its earliest and most treatable stages, but little is known about how often patients over 50 should undergo these screenings.

Previous studies have shown that precancerous tissue, called polyps, can take up to 15 years to progress to cancer, suggesting that screening may not be necessary as often as every five years.

Researchers from the Fred Hutchinson Cancer Research Center in Seattle looked at the efficacy of sigmoidoscopy screening -- a procedure where a scope is used to examine the lower part of the large bowel -- in reducing the incidence of colorectal cancer. They also asked the question: How often should this test be used for the greatest risk-to-benefit ratio?

The study examined the screening history and colorectal risk factors of 1,668 patients between the ages of 20 and 75 living in Washington state. The researchers compared the rate of colorectal cancer in this group to 1,294 healthy individuals within the same age range.

The findings show those who had received a screening sigmoidoscopy had a fourfold reduction in the incidence of colorectal cancers compared with individuals who had never had the procedure. Moreover, this benefit appeared to be sustained for more than 15 years, indicating the recommended screening interval is too aggressive.

"If screening by sigmoidoscopy every 10 years was widely adopted by adults over age 50, the incidence and mortality of colorectal cancer could be substantially reduced," says Polly Newcomb, a researcher at the Fred Hutchinson Cancer Research Center in Seattle and lead author of the study, which appears in the April 16 issue of the Journal of the National Cancer Institute (news - web sites).

Patients don't like invasive screening procedures such as sigmoidoscopies and compliance is an ongoing problem for physicians. Moreover, if the screening was recommended once every 10 years, the reduction in usage would translate into significant savings for the health-care system, the researchers argue.

But Jack S. Mandel, chairman of epidemiology at Emory University's Rollins School of Public Health, says the structure of the study may undermine its findings.

"There's a tendency for these types of studies to overstate the benefits. We're trying to understand the precise magnitude of the benefit [of sigmoidoscopy screening] and in this study there's uncertainty in that benefit," he says.

The number of individuals involved in some of the study's analyses are so small that they could easily be distorted by a mistake or classification error. Moreover, says Mandel, the study looked at self-reported data that was not verified using patient records to ensure that the subjects had really undergone screening sigmoidoscopy.

That bias tends not to be a problem because sigmoidoscopy isn't a procedure that a patient is likely to forget, Newcomb says. People rarely confuse it with other screening tests because the experience is unique from the other available options, she says.

Mandel argues a decision to lengthen the recommended five-year sigmoidoscopy screening interval should be postponed until more accurate data are available from a large randomized control trial -- several of which are currently under way.

Newcomb, however, cautions results from those studies are unlikely to be available for another 10 years. In the meantime, the results of studies like this one are the next best thing to a randomized control trial.

More information

Click on the U.S. Centers for Disease Control and Prevention for tips on preventing colorectal cancer. The American Cancer Society has a page explaining both sigmoidoscopy and colonoscopy. Also, try the Cancer Research and Prevention Foundation.

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U.S. Plan Targets Heart Disease, Stroke

By Todd Zwillich
Reuters Health
Tuesday, April 15, 2003

WASHINGTON (Reuters Health) - Federal health officials on Tuesday unveiled a national plan aimed at cutting Americans' risk of cardiovascular disease.

The plan seeks to emphasize heart disease and stroke as major preventable public health problems and to focus federal, state and local authorities on research and convincing the public to live healthier lifestyles.

Heart disease was blamed for 711,000 deaths in 2000, making it the nation's leading cause of death. Stroke is the third-leading cause of death, behind cancer, according to the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC).

Smoking, obesity and high blood pressure are all major risk factors for cardiovascular disease.

"These leading causes of death for men and women are largely preventable," said Health and Human Services (news - web sites) Secretary Tommy G. Thompson. "We must start emphasizing prevention of this epidemic."

The CDC estimated Tuesday that heart disease and stroke together will cost the nation $351 billion in medical and disability costs in 2003.

The plan calls for more-coordinated monitoring of cardiovascular disease in the population and for stepped-up research into how to reduce risk factors. It also calls on state and local health agencies to promote heart health and disease prevention, and urges government institutions to enact policies "that are favorable to health."

A report outlining the plan urges the use of prevention strategies in a wide range of settings, including schools and work places. It also directs officials to come up with ways of addressing prevention messages to different demographic and cultural groups.

"Only a comprehensive approach can most effectively control the progressive development of risk factors and disease outcomes," the report states.

Health departments should also work to harmonize criteria used in heart disease research, in an attempt to make study results more widely applicable, according to the report.

The American Heart Association (news - web sites) praised the plan, saying it would help make heart disease "a number-one priority" of health departments.

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Bullies More Dangerous Than You Think

HealthScoutNews
Tuesday, April 15, 2003

TUESDAY, April 15 (HealthScoutNews) -- Contrary to what many people believe, bullying is not a normal, if nasty, part of childhood.

Both bullies and their victims are at greater risk for committing violence and having other behavior problems, says a study by researchers at the U.S. National Institute of Child Health and Human Development.

The study of 15,686 students in grades 6 through 10 across the United States found bullies are more likely to engage in more serious violent behavior, such as carrying a weapon or frequent fighting. It also found children who are victims of bullies are also at greater risk for committing violent behaviors.

The findings appear in the April issue of the Archives of Pediatrics and Adolescent Medicine.

Among boys who said they had bullied other children at least once a week in school, 52.2 percent had carried a weapon in the past month, 43.1 percent carried a weapon in school, 38.7 percent were involved in frequent fighting, and 45.7 percent said they'd been injured in a fight.

Among boys who said they'd been bullied in school every week, 36.4 percent had carried a weapon, 28.7 percent carried a weapon in school, 22.6 percent were involved in frequent fighting and 31.8 percent said they'd been injured in a fight.

Those figures were much lower for boys who had never bullied others in school: 13.4 percent carried a weapon in the past month, 7.9 percent carried a weapon in school, 8.3 percent had frequent fights, and 16. 2 percent said they'd been injured in a fight.

Among boys who'd never been bullied in school, 18.7 percent carried a weapon in the last month, 12.2 percent carried a weapon in school, 12.4 percent got into frequent fights, and 18.3 percent were injured in a fight.

The study found that in all age groups boys were more likely to be involved in bullying and violent behavior than girls.

The study authors conclude that bullies may benefit from programs designed to prevent not just bullying, but other kinds of violent behavior as well.

More information

The American Medical Association has a list of resources on bullying.

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Fracture Risk Still High, Even with Hip Protectors

By Alison McCook
Reuters Health
Tuesday, April 15, 2003

NEW YORK (Reuters Health) - Providing elderly people with hip protectors appears to offer little protection against actually breaking a hip, most likely because few people wear them as recommended, researchers said Tuesday.

A group of Dutch investigators found that over a one and a half year period, elderly people at high risk of hip fracture were just as likely to have a hip fracture whether or not they were given an external protector -- worn underneath clothing -- to prevent the injury.

A small number of people experienced hip fractures while wearing the protector, the authors note in the Journal of the American Medical Association (news - web sites).

However, the device did appear to reduce the risk of fracture with every fall among the small number of people who seemed to wear the external protectors most consistently.

Study co-author Dr. Paul Lips of Vrije Universiteit Medical Center in Amsterdam told Reuters Health that part of the problem with hip protectors may lie not in the device itself, but in the fact that people don't wear it as often as they should.

During a surprise visit, only 37 percent of study participants provided with protectors were wearing them a year later, Lips and his colleagues report.

People who wear their hip protectors the most will likely receive the greatest protection against hip fracture, Lips noted.

However, given that most people don't use the protectors properly, Lips said that the best way to avoid a broken hip is to treat the bone-thinning disease osteoporosis and provide walking aids (news - web sites) -- and protectors if they will be worn -- to people at risk of falling.

In the future, a better, more comfortably designed hip protector may be easier for people to consistently wear, and therefore offer more protection against fractures, Lips added.

Study participants were given a hip protector that consisted of two shell-shaped plastic disks, which are sewn into special underpants. Lips noted that different hip protectors may work better than others.

The consequences of hip fracture can extend beyond a broken bone. Up to one-third of patients who experience hip fracture will die within a year, and many others develop severe disability.

A handful of studies have investigated whether external devices protect elderly people from hip fracture but they have yielded mixed results.

In the study, the reseachers distributed protective devices to roughly half of 561 people at least 70 years old.

All participants either had low bone density or were at high risk of falling, characteristics that placed them at high risk of breaking a hip.

Everyone also received written information about how to keep their bones healthy and avoid falls.

During the study, 18 people given hip protectors experienced hip fractures, and 20 such fractures were reported among the other participants.

Study co-author Dr. Paul Lips has received funding from the pharmaceutical companies Merck and Co, Eli Lilly, and Organon, all of which market drugs to treat osteoporosis.

Source: Journal of the American Medical Association 2003;289:1957-1962.

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Concord Grape Juice Stamps Out Hypertension

HealthScoutNews
Tuesday, April 15, 2003

TUESDAY, April 15 (HealthScoutNews) -- Concord grape juice may help men with hypertension reduce their blood pressure, says an American study.

The researchers found men with hypertension who drank Concord grape juice for 12 weeks had a significant reduction in both their systolic and diastolic blood pressure.

Researchers studied 80 healthy men, aged 45 to 70, for 12 weeks. Half the men drank an average of 12 ounces of grape juice a day and the other half drank the same amount of a placebo that looked and tasted like grape juice.

At the end of the 12 weeks, the 19 men who drank the grape juice had a drop from an average baseline systolic blood pressure of 142.7 mm Hg, to 137.0, and a drop in diastolic blood pressure from 87.9, to 82.1 mm Hg. The men who drank the placebo showed no change.

The study, by Radiant Research in Chicago, was funded by Welch Foods Inc. and presented at this week's Experimental Biology meeting in San Diego.

It's estimated that lowering systolic blood pressure by five points would result in a 14 percent reduction in deaths from stroke and a 9 percent reduction in deaths from heart disease, says the U.S. National High Blood Pressure Education Program.

Two previous clinical studies found Concord grape juice improved arterial wall flexibility, something that may help reduce blood pressure. Recent research also found that purple grape juice may inhibit the tendency of blood to clot and slow the oxidization of LDL (bad) cholesterol.

More information

Here's where you can learn more about high blood pressure.

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Simple Screening May ID Hearing-Impaired Adults

By Charnicia E. Huggins
Reuters Health
Tuesday, April 15, 2003

NEW YORK (Reuters Health) - Hearing impairment, a source of frustration and sometimes even depression among many older adults, can be easily detected with simple screening methods, according to a study released Tuesday.

Hearing loss is the most common chronic condition among older Americans, after high blood pressure and arthritis. Up to 40 percent of people age 65 and up are hearing impaired, and the prevalence of the condition increases with age.

Yet the majority of older people do not undergo routine assessments for hearing loss and consequently are not treated for their impairment, the authors of the new study point out. In fact, only one in four adults with "aidable hearing loss" get hearing aids (news - web sites), research shows.

"Patients and primary care providers ... should be aware of the increasing prevalence of hearing loss," study author Dr. Bevan Yueh of the Veterans Affairs Puget Sound Health Care System in Seattle told Reuters Health.

"Because there are effective treatments available -- hearing aids, surgery, etc. -- that restore quality of life for hearing-impaired elders, it is really important to make sure that the hearing loss is diagnosed and not overlooked," Yueh added.

Yueh and his colleagues reviewed nearly 1,600 articles from the medical literature on screening and management of hearing loss among older adults.

They found that various simple hearing tests, including the so-called Whispered Voice Test, have been used during routine physical examinations.

But because there is no way to ensure that, for example, one doctor whispers as softly as another, these tests cannot be standardized and are difficult to implement in systematic screening programs, the researchers report in the April 16th issue of the Journal of the American Medical Association (news - web sites).

An even simpler approach sometimes used is a self-administered questionnaire that measures the extent to which a person's hearing loss affects their social and emotional life.

Another is a self-administered physiologic test, in which people can use an audioscope -- a device that delivers tones at various frequencies, to determine the frequency at which a person can no longer hear a tone.

Both of these methods have "demonstrated excellent accuracy in detecting hearing loss and have gained widespread interest," Yueh and his colleagues report.

Once hearing loss has been identified, studies have shown that doctors can sometimes treat the underlying medical condition, and halt or reverse the hearing loss.

"A lot of older people feels it's just part of getting old and don't expect that anything can be done," Yueh said. "Unfortunately for these people, there is effective treatment available, and by accepting the disease, they are missing an opportunity for treatment."

For example, reports show that up to 30 percent of hearing-impaired older adults have impacted ear wax, which can be easily treated with gentle warm-water irrigation to loosen and remove the excess ear wax.

Other patients may need to be referred to hearing specialists such as audiologists, who can conduct extensive tests and afterwards counsel patients about telephone amplifiers and other assist devices. Otolaryngologists (head and neck doctors) can provide medical and surgical treatment.

Still, whether routine screening for hearing problems improves older adults' outcomes in the long term remains unclear.

To answer that question, the Veterans Health Administration is currently conducting the "Screening for Auditory Impairment -- Which Hearing Aid Test?" (SAI WHAT) trial. More than 1,800 people have been enrolled in the study so far, and preliminary results are expected in 2005, Yueh's team notes.

Until then, they write, "it seems reasonable" to screen older adults using either the questionnaire or audioscope methods.

The U.S. Preventive Service Task Force, the Canadian Task Force on Preventive Health Care and other groups also recommend periodic screening for hearing loss among older adults.

In a related study, also co-authored by Yueh and published in the same journal issue, researchers found that people can help increase their hearing-impaired relatives' and friends' comprehension by simply speaking slower -- rather than louder and with a raised pitch, as is commonly done.

Communicating in a quiet environment, whenever possible, and maintaining eye contact may also increase the odds that the hearing-impaired person will hear and understand the words, write Dr. Sidney T. Bogardus Jr., of Yale University in New Haven, Connecticut, and colleagues.

Source: Journal of the American Medical Association 2003;289:1976-1985,1986-1990.

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MONDAY, APRIL 14, 2003

Drinking in Pregnancy Tied to Child's Later Alcohol Problems

By Colette Bouchez
HealthScoutNews Reporter
HealthScoutNews
Monday, April 14, 2003

MONDAY, April 14 (HealthScoutNews) -- Women who drink during pregnancy may increase their child's risk of developing an alcohol addiction as a young adult -- and as little as one drinking binge could set the downward spiral in motion.

That's the finding of a new study in the April issue of the Archives of General Psychiatry. Researchers from the University of Washington offered first-time evidence that a mother's drinking habits during pregnancy might influence whether her child develops a problem with alcohol much later in their life.

"The goal of the study was to open new pathways of exploration into the causes of alcohol problems and possibly in understanding addiction to alcohol," says study author John Baer.

By examining the mother's drinking patterns, says Baer, the research appears to "predict, to some extent, the type and level of alcohol problems the child may experience later in life."

While he admits other factors certainly do figure into the equation -- most notably the environment in which the child is raised, as well as genetics -- he says that "we are reporting that the amount of alcohol consumed during pregnancy also plays a role."

The 22-year study was conducted from a unique perspective in that during the time of the initial interviews, drinking was not considered dangerous to pregnancy. As such, Baer says the women had "no reason not to be honest when documenting the amount of alcohol they consumed while pregnant."

In this way, says Baer, the study may offer what is perhaps a more accurate accounting of alcohol consumption than what researchers might get if the same questions were asked of women today.

For obstetrician Dr. Steve Goldstein, the study offers yet one more important reason why pregnancy and alcohol don't mix.

"It adds to the growing body of evidence that if you drink alcohol when you are pregnant, it can affect your child -- with problems that can last a lifetime," Goldstein says.

His only concern was the study did not have a control group by which the authors could compare and contrast results.

"I think the finding would be more powerful if drinking could be isolated as the cause of alcohol problems in children later in life. But even without that proof the message remains the same: Alcohol has no place in pregnancy," Goldstein says.

The study involved 433 families in which the mothers were first interviewed some 22 years earlier concerning drinking habits just before, and during, their pregnancy.

Of the group, 80 percent said they drank alcohol both before and during pregnancy, while 31 percent reported heavy episodic drinking (five drinks or more, on occasion). The women also answered questions about other lifestyle habits, including smoking, as well as providing information on family history of alcoholism.

Twenty-two years later, the same 433 families were interviewed again. This time, however, the children also answered questions about their behavior.

By the time they were 21 years old, 83 percent of the children including reported they were already drinkers, with 8 percent exhibiting at least mild symptoms of alcohol dependence.

Baer points out that between the ages of 18 and 24 many young adults typically drink, sometimes heavily, and most do not develop alcohol problems later in life. At the same time, he adds those who do end up with alcohol addiction problems typically began drinking as young adults -- a correlation he now believes has something to do with whether mom drank during pregnancy.

While that correlation seems clear, the questions remain as to why. Still, Baer hopes his study will "open yet one more avenue of thinking by showing at least some evidence of links between maternal alcohol consumption and the child's alcohol-related behaviors later in life."

More information

Learn about the effects of alcoholism by visiting the National Institute of Alcohol Abuse and Alcoholism. For more about the effects of alcohol during pregnancy, check out the March of Dimes.

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New Drug is Nitroglycerine Without Downside

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Monday, April 14, 2003

MONDAY, April 14 (HealthScoutNews) -- A new kind of drug that appears to have all the benefits of nitroglycerine in treating heart failure but none of its deficiencies looks good in animal tests, researchers report.

The discovery is a marvelous example of how scientific discovery works -- one brick on top of another, with some luck thrown in, says Dr. David A. Kass, a professor of medicine and biomedical engineering at Johns Hopkins Medical Institutions and lead author of a paper on the research in the April 14-18 issue of the Proceedings of the National Academy of Sciences (news - web sites).

It starts a little more than a decade ago with the discovery of how nitroglycerine, which has been used to treat heart failure for a century or more, actually works: by releasing a chemical called nitric oxide in the body. That discovery led to nitric oxide being named "molecule of the year" in 1990.

But nitroglycerine has its downside. While it helps a weakened heart get blood to the body by widening blood vessels, it also blunts the beta-adrenergic system that powers the heart's contractions. "It's like having your foot on the brake when you're driving," Kass explains. The new compound doesn't have that defect.

Two years ago, Kass talked with Dr. David Wink, a researcher at the National Cancer Institute (news - web sites), who had been doing some work with nitroxyl anion, a molecule of nitric oxide with one electron added. Wink's work indicated that nitroxyl anion might damage the heart, but Kass and Wink thought it looked interesting enough to warrant a closer look. "I handed it to one of my postdoctoral students, a little like a fishing expedition," Kass says.

They caught a big one. Nitroxyl anion not only widens blood vessels but strengthens the force of heart's contractions, lab work showed. Dr. Nazareno Paolocci, a scientist in Kass's group, took over, pushing the studies to see whether that effect could be put to medical use.

It looks very good, the journal report says. When a compound called Angelis' salt that produces nitroxyl anion in the body was given to dogs with congestive heart failure, not only did their blood vessels widen but the force of their hearts' contraction nearly doubled.

There is great promise in the research, says Martin Feelisch, a professor of physiology at the Louisiana State University Health Sciences Center who wrote an accompanying editorial. "What is new here is the appreciation that a very primitive molecule, nitric oxide with just one electron more, has completely different properties."

The compound used in the study "is not the breakthrough drug that will make it through to clinical trials," Feelisch says. "But the trial does show that with this principle, it is possible to come up with a new pharmacological way to improve the contractability of the heart."

Angelis' salt isn't the breakthrough compound, Kass agrees, and research has quickly moved beyond it. His laboratory has developed "a completely new nitroxyl anion donor that is almost 100 percent effective" and could eventually result in a simple pill for people with heart failure. He doesn't want to name the molecule, but steps have already been taken to patent it, and there have been "preliminary discussions" with one pharmaceutical company about the lengthy series of tests needed to bring a drug to market, he says.

Kass hopes to get more of a response from the pharmaceutical industry. "With this data published, we are interested in seeing what shakes out," he says.

More information

You can learn about heart failure and its treatment from the American Heart Association or the National Heart, Lung, and Blood Institute.

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Study: Only Vigorous Exercise Helps Heart

By Emma Ross
AP Medical Writer
The Associated Press
Monday, April 14, 2003

LONDON - A half-hour brisk walk every day may make you feel better, but it is not enough to ward off premature death from heart trouble, new research suggests.

A study published this week in Heart, a British medical journal, found that only vigorous exercise — such as jogging, hiking, climbing stairs, racket sports and swimming — seems to help lower the risk of early death from heart disease. Other research has shown moderate exercise helps.

Official government recommendations in the United States and elsewhere say 30 minutes of moderate activity every day, such as brisk walking, is sufficient for heart health. A major World Health Organization (news - web sites) consensus report published last month reached the same conclusion.

However, the latest study, conducted by scientists at Queen's University in Belfast, Northern Ireland, found that activities considered to provide mild exercise — such as walking, bowling and sailing — as well as pursuits of moderate intensity — such as golfing, dancing and brisk walking — did not lower the risk of early death among 2,000 British men followed for a decade.

"It's very compelling. It does kind of fly in the face of what we have been trying to tell people, and I think it will create a big stir," said Dr. Ron Sha, medical director of the Duke University Diet and Fitness Center in Durham, N.C.

Sha was not involved in the study.

Previous research has yielded conflicting results, dividing experts between a group that believes moderate exercise is enough and a smaller group convinced that vigorous exercise is needed before any heart benefit can occur.

"This is one report. It's important to have this information, but it's not sufficient for us to now scrap our recommendations, which rest on a huge amount of evidence," said Steven Blair, president of the Cooper Institute, a Dallas-based research organization that focuses on exercise.

Blair's own studies have concluded the heart benefits from moderate exercise.

The Belfast study involved 1,975 men who had no evidence of heart diseases and were between the ages of 49 and 64 when they entered the study. They each filled out an exercise questionnaire that estimated how many calories they burned each day through exercise in their spare time.

Types of exercise were classed as light, moderate or vigorous, according to how many calories the activity burned over a fixed period of time. About 30 percent of the men reported no vigorous exercise at all, and those who did exercise intensely did not do it very often.

After about 10 years, 252, or 13 percent, of the men had died, mostly from heart or blood vessel diseases.

One drawback of the study, the scientists acknowledged, is that the men only were questioned about their exercise habits one time at the start of the study, so there is no way to know whether the men changed their habits over the 10 years the study was conducted.

Only vigorous exercise was linked with a reduction in the risk of death from heart disease or any other cause within the 10 years of the study. The more heavy exercise the men did, the less their chances of dying during the study.

Those who did the most exercise were 40 percent less likely to die than those who did the least, the researchers found.

The results were adjusted for the exercise the men did at work, but that did not change its conclusions, the scientists said.

Studies that compare different intensities and patterns of exercise, but keep the number of calories burned equal, likely will provide stronger insight into the question of exactly what is required for heart health, Blair said.

He said the superiority of the vigorous exercise might simply come down to the fact that it burns more calories than moderate exercise.

On the Net:

The Cooper Institute: http://www.cooperinst.org/

Duke Diet and Fitness Center: http://www.dukedietcenter.org

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Aluminum in Drinking Water Tied to Alzheimer's

By Jacqueline Stenson
Reuters Health
Monday, April 14, 2003

SAN DIEGO (Reuters Health) - Adding support to a controversial theory linking aluminum with Alzheimer's disease (news - web sites), new research indicates the disease is more common in regions of northwest Italy where levels of aluminum in drinking water are highest.

And when the investigators studied the effects of one form of the metal on two types of human cells in the lab, they found it hastened cell death.

"We were absolutely surprised by these results," said study author Dr. Paolo Prolo, a researcher at the University of California at Los Angeles. "I did not expect any effect from aluminum."

In findings released here Monday at the annual Experimental Biology meeting, Prolo and colleagues focused on monomeric -- single molecule -- aluminum. This is the type that can be most easily absorbed by human cells, he said.

While there have been suggestions that aluminum cookware might pose a risk for Alzheimer's, the type of aluminum used in pots and pans consists of multiple molecules and does not appear to affect human cells, according to Prolo. "There is almost no evidence that the cookware is dangerous," he said.

When the researchers tested water in regions of northwest Italy in 1998, they found that total aluminum levels -- including monomeric and other types of aluminum -- ranged from 5 to 1,220 micrograms per liter, while monomeric aluminum levels alone ranged from 5 to 300 micrograms per liter.

Environmental officials generally recommended that total aluminum levels be below 200 micrograms per liter, Prolo noted.

After comparing this data to death rates from Alzheimer's in those regions, the researchers found that the disease was more common in areas with the highest levels of monomeric aluminum.

Back in the lab, Prolo and colleagues then tested the effects of monomeric aluminum on human immune-system cells and bone cancer cells. Ideally, human brain cells would be tested but these are not readily available because a biopsy of a patient's brain is necessary to acquire them, he said.

"We found that a very low quantity of aluminum added to our cell cultures was modifying cellular processes" like normal cell death, Prolo told Reuters Health.

When the aluminum was paired with beta-amyloid, a protein found in the brains of Alzheimer's patients, the combination killed off even more cells.

Because aluminum could kill both types of human cells, these findings raise the question of whether aluminum is potentially involved in other diseases, Prolo said.

But much more research is needed to understand how the metal does or does not affect people, he added.

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Super Slow Workouts Add Muscle

By Ira Dreyfuss
Associated Press Writer
The Associated Press
Monday, April 14, 2003

WASHINGTON - Dan Fitzgerald takes 10 seconds to lift a weight that other people lift in four. It takes him five seconds to ease it back down, even though others can do that in two.

Fitzgerald is not having trouble with his lifts. He wants them that way.

Supporters of super slow training regimens such as the one Fitzgerald uses at a YMCA in Quincy, Mass., say they can build more muscle. Fitzgerald said he's added a lot in the three years he's been doing super slow.

"I went from 165 to 180 (pounds) and I'm pretty solid," he said. "I'm 12 to 14 percent body fat. That's not too bad for a 50-year-old."

Researchers and exercisers say super slow workouts are an effective way to wear down muscle, triggering the body to respond by making the muscle fiber grow. But they warn that super slow can be very hard work.

In 1993 and 1999, exercise physiologist Wayne Westcott, who has done studies at the same Y that Fitzgerald uses, compared super slow and conventional workouts in people Fitzgerald's age. Fitzgerald was one of his experimental subjects.

The super slow group lifted up in 10 seconds, doing five repetitions. The conventional groups lifted up in two seconds, doing eight to 12 repetitions. All the trainers averaged four seconds in lowering the weights. Strength improvements in the super slow groups were about 50 percent greater than in the conventional groups, Westcott said.

Super slow workouts have special value on the downside, said Jeffrey Potteiger, an exercise physiologist at Virginia Commonwealth University. It's a new version of what veteran weight trainers know as doing negatives, he said. Negatives work on the part of the lift in which the weight is lowered. Positives are the part in which the weight is raised.

The body doesn't recruit as many muscle fibers on a negative movement, so a slow negative means "a tremendous amount of force is being applied to fewer fibers," Potteiger said. This extra work should build more muscle.

Compared with conventional workouts, super slow is super fast, said Frederick Hahn, a trainer and gym owner in New York City and author of one of the current spate of books on super slow workouts, "The Slow Burn Fitness Revolution."

Hahn's regimen requires only 30 minutes a week — 10 seconds up and 10 down per lift, with only three to six repetitions. And this set of lifts is done only once, while conventional regimens require each set to be done two or three times.

Super slow lifters also can drop aerobics. The combined demands of super slow and aerobics break down muscle faster than it can repair, Hahn said.

That happened to Fitzgerald, who described himself as a former 10K and half-marathon runner. "It was killing me," he said. "I cut it out because it was cutting into my recovery ability."

However, Potteiger thinks there's no proof that super slow can replace an aerobic workout. The idea that super slow workouts can improve cardiovascular fitness "is true if you are doing nothing now," he said.

Similarly, although super slow can burn calories, one new study found that conventional weight training burned more. Researchers at the University of Alabama at Birmingham looked at seven men with an average age of 25. The men did about 30 minutes of work in each session of each type of workout.

Conventional lifts used 45 percent more energy than did super slow, which had an energy demand equivalent to a walk, according to their report in the February issue of the National Strength and Conditioning Association's Journal of Strength and Conditioning Research.

Switching from conventional to super slow is not an easy change of pace, Fitzgerald said. Slowing down the movements to the creep of the super slow pace may require coaching, he said.

And super slow is a demanding workout, Westcott and Fitzgerald warned.

Super slow takes a lot of practice to learn, a lot of concentration in keeping the form right and the mental stamina to keep pushing weight while your muscles ache. "It's not for everybody," Fitzgerald said.

In Westcott's studies, 95 percent of the people who did super slow chose not to continue after the research ended. Their feeling was, "Even though it did work better, I'll just stay with the standard because it will get the same results but it takes longer," he said.

On the Net:

Frederick Hahn: http://www.seriousstrength.com/history.html

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Strong Thigh Muscle May Hasten Knee Arthritis

Reuters Health
Monday, April 14, 2003

NEW YORK (Reuters Health) - Strengthening the thigh muscle is generally thought to help arthritic knees, but a new study suggests that strong thigh muscles may hasten arthritis in those with certain joint or leg characteristics.

The results do not mean that exercise is harmful for those with arthritis, but does suggest more research is needed on whether or not special exercise programs need to be tailored for patients, according to the report, released Monday.

An estimated 12 percent of Americans aged 65 and older have osteoarthritis of the knee, and experts often recommend strengthening of the quadriceps muscle in the thigh as a treatment. Osteoarthritis occurs when the cartilage that cushions joints breaks down, often leading to pain, swelling and loss of mobility.

In an 18-month study, Dr. Leena Sharma of Northwestern University Medical School in Chicago, Illinois and colleagues, evaluated 171 men and women with an average age of 64 who had knee arthritis.

Patients with the strongest thighs at the beginning of the study who had leg bones that did not line up correctly or had a "loose" knee joint, were more likely to show signs of disease progression compared to those with weaker quadriceps.

The study did not specifically look at patients who performed exercises to strengthen their leg muscles. However, the findings could indicate that such exercises may not help everyone, according to the report.

"Our results raise questions about the use of quadriceps strengthening," the authors write in Tuesday's issue of the journal Annals of Internal Medicine.

The results are "interesting" and "hypothesis generating" but are not solid evidence that the standard leg-strengthening exercises are detrimental for some patients, according to an editorial by Dr. Kenneth D. Brandt of Indiana University School of Medicine, in Indianapolis.

Brandt adds that more research will be needed before a definite conclusion can be drawn.

The researchers only looked at the thinning of knee cartilage on an x-ray and did not ask patients about their pain or knee function, he notes. Patients with stronger thigh muscles may have less pain and better function, but more study is needed to determine this.

Of the 328 knees evaluated in the study, 78 were considered to be misaligned, meaning the two bones that meet in the knee joint were not perfectly in line according to x-rays. Overall, 110 of 328 knees were considered to be more lax or "loose" than other knee joints.

Source: Annals of Internal Medicine 2003;138:613-619,678-679.

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Lighting Up Lowers Vitamin B-6 Levels

HealthScoutNews
Monday, April 14, 2003

MONDAY, April 14 (HealthScoutNews) -- Too few people get enough vitamin B-6 and smokers are even more likely to have low levels of the vitamin, which is believed to offer protection against the DNA damage that can lead to cancers.

Washington State University researchers presented those findings April 14 at the Experimental Biology meeting in San Diego.

The study included six smokers and six nonsmokers. During the first 28 days, they were given carefully controlled diets that contained only marginal amounts of vitamin B-6. At the end of that time, all the study participants had lower levels of vitamin B-6 and higher numbers of DNA strand breaks.

During the second month, all the study participants ate a carefully controlled diet that included 1.4 milligrams of vitamin B-6. Some of that came from food and some from supplements. In the third month, the vitamin B-6 intake was increased to 2.2 milligrams a day.

For the final month, the study participants were allowed to eat whatever they wanted. However, they had to take 10.3 milligrams of vitamin B-6 supplement each day. That's more than seven times the recommended daily allowance.

The study found that as the amount of vitamin B-6 in the diet and bodies increased, the number of DNA strand breaks decreased. That pattern was seen as early as the first month of vitamin B-6 supplementation.

While the smokers' levels of vitamin B-6 did increase, they never matched the vitamin B-6 levels in the nonsmokers.

Foods high in vitamin B-6 include cereals, beef, chicken, fish, legumes, soy products and bananas.

More information

Here's where you can learn more about vitamin B-6.

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Mom-To-Be's Drinking May Up Child's Drinking Risk

Reuters Health
Monday, April 14, 2003

NEW YORK (Reuters Health) - Children heavily exposed to alcohol while still in the womb appear to be at higher risk for developing drinking problems in young adulthood, suggest new study findings announced Monday.

"It appears that exposure to alcohol during pregnancy can predict the amount of alcohol problems that a child will have in adulthood," said study author Dr. John S. Baer, research associate professor of psychology at the University of Washington and education coordinator at the Addiction Treatment Center at Veteran's Administration Puget Sound Medical Center, in a prepared statement.

The finding "takes us a step further in understanding why some people have alcohol problems," Baer added.

Scientists have long attributed alcoholism to a variety of factors including environment and heredity. This is one of the first studies to look for an association between maternal alcohol consumption during pregnancy and future alcohol problems in offspring.

The study began when Baer's team assessed the drinking habits of about 500 pregnant women in 1974 and 1975. The researchers than followed the offspring of these women for 21 years, at which time they were interviewed about their own alcohol consumption habits.

"We found that 14 percent of the young adults who were prenatally exposed to one or more episodes of five or more drinks had alcohol problems at age 21 compared to just 4.5 percent who were not heavily exposed to alcohol," said Baer.

This was true even after the researchers took into account a family history of alcohol problems, exposure to nicotine and other drugs, as well as other factors that can affect alcohol use.

Drinking problems among the 21-year-olds were identified through the use of a test known as the Alcohol Dependence Scale, which is used to measure the severity of drinking associated problems, like blackouts, and alcohol dependence symptoms.

"This is not a one-to-one relationship, but a mother's drinking elevates the risk of her offspring having alcohol problems," said Baer.

The US Surgeon General warns that alcohol use during pregnancy puts a fetus at risk of a wide range of medical problems, including premature birth, mental and physical retardation, and even death.

Source: Archives of General Psychiatry 2003;60:377-385.

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Calcium Helps Girls Keep the Weight Off

By Steven Reinberg
HealthScoutNews Reporter
HealthScoutNews
Monday, April 14, 2003

MONDAY, April 14 (HealthScoutNews) -- Whether calcium comes from dairy products or supplements, girls who consume the highest levels weigh less than girls who consume lower levels, a new study says.

"Dairy and calcium intake is associated with the level of fat and weight among adolescent girls," says lead author Rachel Novotny, a nutritionist at the University of Hawaii. Similar findings have been found in animals, adults and in very young children, but this is the first time it has been found in young girls, she adds. These findings support the idea that calcium, especially from dairy products, helps control weight and fat.

Novotny and her colleagues from the University of Hawaii at Manoa in Honolulu studied 323 girls, aged 9 to 14 years old. The researchers collected data on what the girls ate and their amount of physical exercise. They also measured the girls' weight and the amount of fat just above the hipbone near the bellybutton. This so-called "skin fold thickness" measures abdominal fat.

Naturally, the girls who consumed the most calories and did the least physical exercise weighed more and had more body fat. However, after Novotny's team looked at calcium intake, they found that despite differences in calorie intake and amount of exercise, girls who consumed more calcium weighed less than girls who consumed less calcium.

In fact, the investigators found that as little as a daily increase of one cup of milk or a small piece of cheese, about 300 milligrams of calcium, resulted in one-half inch less of abdominal fat and as much as two pounds less of body weight. "I have reason to believe that the same effect occurs in boys," Novotny says.

Novotny presented her findings on April 13 as part of the American Society for Nutritional Sciences program at the Experimental Biology meeting in San Diego.

Over the past several decades, the consumption of dairy foods in the United States has decreased, Novotny says. "This may be contributing to our high levels of obesity. These findings could have a measurable impact on levels of weight," she adds.

People should be encouraged to add more dairy to their diet, which will help them control weight throughout their lives, Novotny says.

"This study presents exciting results that adds to the previously published literature on the effects of higher calcium or dairy intake on body composition, particularly fat mass," says Dorothy Teegarden, a professor of nutrition at Purdue University.

She adds the result of this study provides further evidence that higher calcium intake may play an important role in reducing the growing problem of obesity in the United States, particularly in children.

However, Dr. Robert P. Heaney, a professor of medicine and bone expert from Creighton University, cautions that while high calcium intake can help, "nothing will help you if you eat too much."

More information

Learn about calcium intake from the American Dietetic Association and the American Academy of Pediatrics.

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Formula-Fed Babies May Metabolize Drugs Faster

By Jacqueline Stenson
Reuters Health
Monday, April 14, 2003

SAN DIEGO (Reuters Health) - Bottle-fed babies may need higher doses of certain medications than those who are breast-fed because formula causes their bodies to metabolize the drugs more quickly, Canadian researchers report.

Doctors have observed that formula-fed premature infants who are given oral caffeine to treat a condition known as neonatal apnea have consistently lower blood concentrations of the drug than breast-fed babies. Apnea causes the infants to stop breathing for short periods; caffeine, a stimulant, helps regulate respiration.

In search of an explanation for the difference, the researchers compared the effects of breast milk and two brands of canned liquid baby formula derived from cow's milk on human liver cells in the lab. The liver metabolizes medicines.

At the annual Experimental Biology meeting here Saturday, they reported that formula prompted the liver cells to pump out substantially higher levels of an enzyme known as cytochrome P450 1A (CYP1A), which helps metabolize caffeine and various other compounds.

"In human liver cell lines, breast milk has no effect in terms of this particular enzyme," said study author Dr. Shinya Ito, head of clinical pharmacology and toxicology at the Hospital for Sick Children in Toronto, Ontario. "But with formula, the enzyme levels increased about five- to six-fold."

As a result, he told Reuters Health, formula-fed babies may need higher doses of caffeine, fever-reducers and other drugs metabolized by this enzyme.

Ito and colleagues also found that formula activated a protein called the aryl hydrocarbon receptor on the surface of cells, which in turn triggers the release of CYP1A.

This receptor is known to be stimulated by a variety of environmental pollutants, including cigarette smoke, because the body wants to get rid of the contaminants as quickly as possible, Ito explained.

So the findings hint at the possibility that there may be some component of infant formula, perhaps some byproduct from when it is heated during processing to kill off bacteria, that the body is trying to rapidly remove, he suggested.

But much more research is needed to uncover precisely why formula has this effect. "We're trying to identify the compounds in formula that are doing this," Ito said.

Meanwhile, doctors should take note of the findings, he said. "Clinicians may need to think about the potential differences between formula-fed versus breast-fed infants in terms of capabilities of metabolizing drugs," he added.

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Spring Allergy Alert

HealthScoutNews
Monday, April 14, 2003

(HealthScoutNews) -- Spring flowers have barely sprung and already the pollen is making your eyes itch and your nose clog.

Fayette Community Hospital offers this advice:

  • Avoid staying outdoors for too long, especially in the morning between 5 a.m. and 10 a.m., when pollen counts are highest.
  • Use an air conditioner and a dehumidifier to keep air clean, cool and dry.
  • If it's your job to mow the lawn, wear a mask designed to filter pollen.
  • Keep your car and home windows closed.
  • Don't hang your sheets or clothes outdoors to dry.
  • After spending time outdoors, leave your shoes outside to avoid tracking pollen in.
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Obesity Surgery May Lead to Weakened Bones

By Jacqueline Stenson
Reuters Health
Monday, April 14, 2003

SAN DIEGO (Reuters Health) - People who have undergone gastric bypass surgery to lose large amounts of weight may also lose bone mass, even if they're taking recommended calcium supplements to help keep their bones strong, new findings suggest.

A study that followed patients for about 10 months after the surgery found they were losing more bone than they were replacing. Bone is a dynamic tissue that is constantly being created and destroyed by two types of cells, which will maintain bone strength if the cells are in balance.

It's not clear if the increase in bone turnover seen in obese patients is a lasting effect that could put patients at risk for significant bone loss leading to osteoporosis, but the results raise concerns, said study author Dr. Penelope Coates, an endocrinologist at the University of Pittsburgh in Pennsylvania.

The reason why it is occurring is also unclear, said Coates.

One potential explanation is that the surgery, which by design reduces the absorption of calories, also decreases calcium absorption. Another possibility, she said, is that the excess body weight that once put "increased mechanical force" on these patients' bones -- causing them to become stronger, just as weight-lifting helps build bone -- has decreased, so the bones are simply adjusting to the reduced weight burden.

Whatever the reason, patients should have their bone density measured every couple of years, Coates said here Sunday at the annual Experimental Biology meeting.

If bone loss is detected, patients may need more than the 1,000 milligrams of supplemental calcium that is currently recommended for them, she said.

The new study involved 27 male and female patients who had the popular Roux-en-Y gastric bypass surgery and another 29 people who were awaiting the procedure. During the surgery, doctors staple off a section at the top of the stomach to form a small pouch that can hold only a small amount of food. They also add a bypass that allows food to circumvent part of the small intestine, limiting the absorption of calories.

Ten months after surgery, patients had lost an average of 80 to 100 pounds. At the same time, urine and blood tests indicated that bone was breaking down faster than it was being rebuilt.

"The more weight people lost, the higher their rate of bone breakdown," Coates said.

By comparison, in patients awaiting surgery, bone was breaking down and rebuilding at similar rates, as it should.

"The major finding is that the rate of bone breakdown was higher -- about twice as high -- among those who had surgery as those who didn't," Coates said.

Nonetheless, bone scans did not reveal that surgical patients were showing clear evidence of bone loss, said Coates, possibly because it was too soon to see such an effect.

She and her colleagues plan to continue studying patients to see if the early signs of bone turnover actually translate into marked bone loss over time.

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Grape Seed Extract Blunts Hypertension

HealthScoutNews
Monday, April 14, 2003

MONDAY, April 14 (HealthScoutNews) -- Moderately high amounts of grape seed extract may blunt salt-sensitive hypertension as well as plant estrogens do, says a University of Alabama at Birmingham study.

The finding may be important for women entering middle age because hypertension rates jump after they reach menopause.

The researchers wanted to determine if the polyphenols in grape seed extract could provide the same benefits as plant estrogens. Previous research found that plant estrogens from soy can reduce salt-sensitive hypertension in young, estrogen-depleted spontaneously hypertensive rats (SHR).

This study concluded that grape seed extract does reduce the hypertensive effects of a high salt diet in the rats to about the same degree as plant estrogens. That means that grape seed extract may be a useful supplement to control hypertension in postmenopausal women.

The findings were presented at the Experimental Biology meeting in San Diego, which runs from April 11 to 15.

More information

Here's where you can learn more about hypertension.

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Bullying May Be Sign of Other Violent Behavior

By Charnicia E. Huggins
Reuters Health
Monday, April 14, 2003

NEW YORK (Reuters Health) - Bullying may be a part of many people's childhood experiences, but the practice is not normal and it is not harmless, according to a team of Bethesda, Maryland researchers.

In fact, being involved in bullying -- either as the bully or the target -- during the school years may be a sign that a child is more likely to carry a weapon or be involved in other more serious violent behaviors, study results released Monday show.

Although the Columbine school shootings and other similar incidents have raised questions about whether people who are bullied are more likely to engage in violent behavior, the researchers note, the present study suggests that violent behavior is likely to be more prevalent among the bullies themselves.

The researchers estimate that nearly three million students in the U.S. have been injured in a fight in the past year and 1.7 million students are frequent fighters. Further, an estimated 2.7 million students have carried a weapon during the past month, including nearly two million who carried the weapon to school.

"Bullying should not be considered 'normal' behavior among youth. It is socially abusive behavior, and is associated with involvement in other kinds of problem behavior," lead study author Dr. Tonja R. Nansel, of the National Institute of Child Health and Human Development told Reuters Health.

"Just as high blood pressure and high cholesterol serve as warning signs for heart disease, bullying others may indicate the presence of other problem behaviors," Nansel said.

The study's findings are based on a nationwide survey of nearly 16,000 public and private school students in grades 6 through 10. Students were identified as having been bullied if they reported that another student, or group of students, had done or said something unpleasant to them or if they were teased repeatedly.

Close to eight percent of boys and six percent of girls said they were sometimes bullied in school and five percent of boys and almost four percent of girls said they were sometimes bullied away from school. Nearly 12 percent of boys and seven percent of girls admitted to bullying others in school and seven percent of boys and about four percent of girls said they bullied others away from school.

Bullies were the most likely to report violence-related behaviors, such as participating in four or more fights during the past year, being treated by a doctor or nurse for fighting-related injuries during the past year and having carried a weapon during the past 30 days. Yet those who said they were the target of bullying were also more likely to report these violence-related behaviors than students who had never been bullied or acted as a bully.

"A child who is bullied is given the message that the world is not a safe place, and she or he cannot necessarily trust others," Nansel said. "This can lead to violence-related behaviors."

And the location of the bullying also seemed to influence whether students reported weapon carrying, the report indicates.

Students who said they were sometimes bullied in school were 50 percent more likely to report carrying a weapon and those who acted as bullies in school were nearly three times as likely as those who said they were never involved. Away from school, however, being bullied and bullying others was associated with a four- and six-fold increased risk of carrying weapons.

When the bullying occurs away from school grounds, "there is likely to be less adult supervision and protection for the child who is being bullied," Nansel said. "So the degree of threat to the child being bullied is higher, as is the possibility for escalation into violence."

Overall, up to 23 percent of boys and 11 percent of girls said they had carried a weapon in school, engaged in frequent physical fighting and had been injured in a physical fight, respectively, the report indicates.

Commenting on the study, Nancy Guerra, a professor of psychology at the University of California, Riverside said she's "most concerned about the weapon carrying," considering schools' zero tolerance policies toward the practice.

She was also "struck" by the high prevalence of fighting and bullying.

However, Guerra pointed out that the relationship between bullying and fighting is unclear, since bullying may indeed predict fighting -- as the study suggests -- but the opposite may also be true.

"It's hard to make a distinction between bullying and fighting when in fact people usually don't start fights (or) get into fights unless they have some reasonable chance of winning."

As for the other violence-related behaviors studied -- being injured in a physical fight and weapon carrying -- Guerra says, "of course if you get into more fights, you're more likely to be injured." Further, while people who are frequent targets of bullies may indeed be likely to start carrying weapons; on the other hand, "you're more likely to bully someone if you have some kind of weapon," she said, noting that it is again unclear which behavior predicts the other.

Guerra said that the "really significant" finding is the fact that the behaviors are so prevalent.

"I'd be more concerned about that than 'bullying predicts serious violence,' because it's not a (long-term) study," she said.

The authors didn't distinguish between "serious" bullying and repeated teasing, which may have led to inflated rates of bullying, Guerra added, but our society's "high tolerance ... for just saying and doing nasty things" should be addressed."

"It's good that they bring attention to this because even if it doesn't cause serious school shootings, it is important to create a more civil society where people treat each other nicely."

Source : Archives of Pediatrics and Adolescent Medicine 2003;348-353.

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Studies Indicate Heart Can Repair Itself

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
Monday, April 14, 2003

MONDAY, April 14 (HealthScoutNews) -- The human heart may have more ability to repair itself after a heart attack than previously believed, says a New York cardiovascular researcher.

If that ability bears out, heart attack treatment could change drastically, says Dr. Bernardo Nadal-Ginard of the New York Medical College, who will present his findings April 15 at the Experimental Biology 2003 meeting in San Diego.

Working with an animal model, Nadal-Ginard and his team successfully repaired hearts damaged by heart attacks. They did so by stimulating the stem cells -- the body's "master" cells that can turn into specialized cells -- to multiply and differentiate to repair the damaged heart muscle. The team has accomplished the repair without removing the stem cells, stimulating them in place by injecting a protein that helps communication between cells.

"We believe this might work in humans," Nadal-Ginard says. "But we must study it more in animals to see if there are any long-term [adverse] effects."

If the treatment works, it has the potential to change the current approach to the treatment of heart attacks, suffered by more than 1 million Americans each year. Currently, the emphasis is on increasing blood supply to the heart to preserve the surviving heart cells, using such approaches as clot-busting drugs or balloons to open up clogged vessels.

But that approach is based on the belief, challenged in recent years, that the heart has no ability to regenerate -- that once cells die during a heart attack, the heart can't make new ones.

Two years ago, Nadal-Ginard and his colleagues published a report in The New England Journal of Medicine (news - web sites), reporting evidence that cardiac myocytes, or heart muscle cells, regenerate after a heart attack.

And other researchers have taken stem cells from the bone marrow of animals and transplanted them into the damaged animals' hearts, succeeding in producing replacement cardiac muscle cells.

Now, Nadal-Ginard will report on his team's success in repairing animal hearts and on other observations in human hearts.

In the animal studies, they retrieved heart stem cells, grew them in the lab, cloned them and injected them back into the heart after a heart attack had been induced. The cells differentiated into myocytes, smooth muscle, and endothelial cells, he says, "and made a new myocardial wall."

"Then we showed you don't need to take the cells out," Nadal-Ginard says. "You can stimulate the cells in place with cytokines [proteins that help cells communicate] and the cells proliferate and differentiate and make a new [cardiac] wall."

In human studies, Nadal-Ginard's team took myocardial tissue out of patients who had died of an acute heart attack and examined it. "At the time they died, they were regenerating myocardium," he says.

Nadal-Ginard's team also examined, in the laboratory, myocardial tissue that was removed from more than 20 patients during a valve replacement operation. "These patients were making new heart cells from cells that looked like stem cells," Nadal-Ginard says. The studies support the fact that cells with stem cell characteristics do exist in the human heart. However, he was not prepared to call them full-blown stem cells.

"Until now, researchers have transplanted bone marrow stem cells to the heart [in animal studies]," says Dr. Valentin Fuster, director of the Cardiovascular Institute and Health Center at the Mount Sinai School of Medicine in New York City. But Nadal-Ginard's approach may be simpler and more effective, he says. What he has done is not to transplant cells, but stimulate cells already present in the heart to proliferate and differentiate, Fuster says.

Someday, Fuster adds, it may be possible to "inject a drug that may repair the heart by stimulating the cells that are there."

More information

For more information on stem cells, go to the National Institutes of Health. For information on heart attack treatments, try the American Heart Association.

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Autistic Kids Grasp Changes in Music, Not Words

By Alison McCook
Reuters Health
Monday, April 14, 2003

NEW YORK (Reuters Health) - Children with autism often have difficulty understanding spoken language, and new research released Monday may help explain why.

Patterns of brain activity in autistic children as they listen to sounds reveal that they indeed hear and listen to language, but fail to pay attention to the sounds the words make.

In contrast, brain scans showed that children with autism appeared to both hear and pay attention to musical tones of a similar complexity to language.

These results contradict previous theories that suggested that children with autism do not learn language because they are unable to take in and process complex sounds.

All of the children included in the study were between the ages of 6 and 12 were considered to be high functioning, meaning they had an IQ above 70 and could speak some words.

But without attention to the sounds words make, learning to fully speak and understand language is impossible, study author Dr. Rita Ceponiene of the University of California at San Diego told Reuters Health.

"Attending to something is a necessary prerequisite for learning," she said.

Ceponiene said that the findings may also one day help researchers identify infants with autism earlier, and children who are diagnosed earlier with the condition often fare better.

However, she cautioned that much more work is needed before researchers can provide parents with new tools to help their children with autism learn language.

"This is a step. It's quite an informative step. But, unfortunately, it's still far from giving something that's applicable on the everyday basis to these parents," Ceponiene said.

During the study, Ceponiene and her colleagues measured brain activity linked to hearing and processing sound in nine children with autism and 10 children without the condition.

The children listened to a series of simple and complex tones and vowels. At one point, the investigators changed the pitch of the tone or vowel played for the children, and recorded how their brains responded to the deviating sounds.

The results appear in the early online edition of the Proceedings of the National Academy of Sciences (news - web sites).

The investigators discovered that autistic children were able to hear and process the sound of both vowels and musical tones equally well.

However, while autistic children appeared to attend to changes in the pitch of simple and complex musical tones, they did not heed any changes in the sound of vowels.

"They did not move their attention to changes in speech sounds," Ceponiene noted.

A lack of attention to the sounds of language may be one reason why children with autism have trouble learning language, she noted.

As an alternative, Ceponiene noted that children with autism may have been able to pay attention to language when younger, but lacked the ability to extract meaning from what they heard. This inability may have led them to eventually stop paying attention to what they heard.

If language never made sense to autistic children, "with time, they might learn to ignore it," the researcher explained.

The current study findings also appear to corroborate previous research that found that people with autism can outperform their peers in certain tasks related to musical abilities.

To parents of autistic children, Ceponiene offered one bit of advice: Keep talking.

Even if children are unable to understand what the words mean, perhaps a little more exposure and practice will cause something to click in their minds, she said.

"So maybe they should not give up speaking to them," Ceponiene noted.

Continuing to expose autistic children to language may help "provide more opportunities to exercise the skill that is weak in them," she added.

Source: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.0835631100.

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One More Key to Mystery of Alzheimer's

HealthScoutNews
Monday, April 14, 2003

MONDAY, April 14 (HealthScoutNews) -- A protein long associated with Alzheimer's disease (news - web sites) causes serious damage by sealing off mitochondria in affected neurons, leading to an "energy crisis" and a buildup of toxins that causes the neurons to die.

The discovery of that pathway by University of Pennsylvania scientists, which appears in the April 14 issue of the Journal of Cell Biology, offers the first specific biochemical explanation for how the brain is damaged by Alzheimer's disease.

The finding could help lead to development of medicines to counter the protein's action.

The normal function of this protein, called amyloid precursor protein (APP), remains unknown. However, in studies with mice, University of Pennsylvania scientists determined that a stretch of 50 amino acids in APP causes damage by starving mitochondria and the cells they nourish. The mitochondria are the main energy source of the cell.

"APP has an acidic, negatively charged region that causes it to jam irreversibly while traversing protein transport channels in the mitochondrial membrane. This hampers, and eventually completely blocks, mitochondria's ability to import other proteins and produce cellular energy," senior author Narayan G. Avadhani says in a news release.

More information

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

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SUNDAY, APRIL 13, 2003

Nicotine May Have Link to SIDS

HealthScoutNews
Sunday, April 13, 2003

SUNDAY, April 13 (HealthScoutNews) -- Newborn rats exposed to nicotine in the womb have an increased risk of apnea, a condition where breathing simply stops.

That's the claim of a study presented April 12 at the Experimental Biology meeting in San Diego.

University of Arizona researchers exposed developing rat fetuses to nicotine and found that it led to enhanced function of GABAa receptors, an important component of brain cells that control breathing rhythm.

This increased function of GABAa receptors in the baby rats made them more likely to suffer apnea.

The amount of nicotine given to the pregnant mother rats was calculated to produce nicotine blood levels equal to those found in a person who smokes two packs of cigarettes per day. The mother rats were given the nicotine from the fifth day of pregnancy through to the 21st day, when they delivered their pups.

The researchers suggest their findings offer important evidence that exposure to nicotine in the womb increases the functional capacity or density of GABAa receptors on neurons that control breathing.

This evidence in newborn rats may indicate that prenatal nicotine exposure could be a factor in causing human babies to suffer frequent, longer-lasting and possibly fatal apnea episodes.

Sudden Infant Death Syndrome (SIDS) cases occur most often in human babies between the ages of two to four months, while they are sleeping. These deaths are often attributed to apnea or breathing cessation and the failure of the baby to resume breathing.

Previous research has found that babies of mothers who smoke during pregnancy have a five times greater risk of SIDS.

More information

Here's where you can learn more about SIDS.

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Straight Talk About Vaccines and Kids

By Jennifer Thomas
HealthScoutNews Reporter
HealthScoutNews
Sunday, April 13, 2003

SUNDAY, April 13 (HealthScoutNews) -- Nobody likes to see their baby shriek when the doctor jabs the infant with a needle.

But making sure your child is up-to-date on vaccinations is one of the most important steps you can take to keep your baby healthy, experts say.

Vaccinations provide protection from 11 or more serious and even deadly infectious diseases, from chicken pox to polio (news - web sites) to diptheria to measles.

National Infants Immunization Week is April 13 to 19, and public health experts are using the week to underscore the importance of vaccines and clear up any confusion about what children need and when.

While almost all parents say they understand the need for immunizations, a recent survey found vaccines confuse and even frighten many parents.

About 80 percent of 1,000 new parents surveyed didn't know which shots their children needed or what the vaccines protected against. About 55 percent said they became anxious when they saw their children poked, according to the survey by three nurses' groups.

"It may hurt the parents more than the kids," says Diane Peterson, associate director for immunization projects at the Immunization Action Coalition in St Paul, Minn.

The rule of thumb is that vaccinations should begin before the baby leaves the hospital after birth and be completed by about age 2, Peterson says. After that, children periodically get booster shots.

Here's a partial rundown of the latest childhood vaccine schedule from the U.S. Centers for Disease Control and Prevention (news - web sites). For the full list, click here:

Birth:

  • The first hepatitis B vaccine is usually given in the newborn nursery.

Two months:

  • The first diptheria, tetanus, pertussis (DTaP) vaccine, which is usually combined into one shot.
  • Haemophilus influenzae type B (Hib).
  • The first inactivated polio shot.

One year to 18 months:

  • The first measles, mumps, rubella (MMR) vaccine, which is usually combined into one shot.
  • Varicella to prevent chicken pox.

Major health organizations, including the U.S. Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics, also encourage children between the ages of 6 and 24 months to get vaccinated against the flu.

"I believe you'll see stronger recommendations as the years go by to prevent flu in children," says Dr. Natalie Smith, deputy director of the CDC's National Immunization Program in Atlanta. "Very young children and the elderly traditionally do worse."

Hepatitis A is also a recommended vaccination in some areas of the United States where the disease is prevalent, Smith says. Check with your doctor on this.

Vaccination rates have been relatively steady in the United States. About 82 percent of children received the diptheria, tetanus, pertussis (DTaP) vaccine in 2001, according to the CDC.

About 90 percent received the polio vaccine; 91 percent received measles, mumps, rubella; 93 percent received Hib; 89 percent received hepatitis B; and 76 percent received the varicella vaccine.

While the compliance rates are high, public health experts say it's as important as ever to get message out about the value of vaccines.

Many of the diseases for which there are vaccines have seemingly disappeared in the United States, Smith says. When a disease falls out of the public eye, people mistakenly believe it's no longer a risk.

"In the late 80s, measles went way down and people got complacent and we had a horrible epidemic," Smith says. "In California alone, there were 70 deaths of children from measles."

There's also a segment of parents who are afraid of the vaccines. Recently, some have speculated that the measles, mumps, rubella (MMR) vaccine could be linked to autism. However, major medical studies have found no such connection, Smith says.

Still, no vaccine is 100 percent safe or effective. The vaccines can cause, on very rare occasions, serious side effects. And occasionally, a child is vaccinated and is still not protected from the disease.

"Vaccines are remarkably safe and very effective, and it's important to keep using them," Smith says.

More information

Visit the U.S. Centers for Disease Control and Prevention (CDC) to read six common misconceptions about vaccinations. Or read this overview of vaccine safety from the CDC.

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SATURDAY, APRIL 12, 2003

Supersized Meals Shortchange Your Health

HealthScoutNews
Saturday, April 12, 2003

SATURDAY, April 12 (HealthScoutNews) -- Supersized meals are no bargain when it comes to your health, say two Penn State University studies.

The first study found bigger restaurant portions result in people consuming more calories.

Another study found that when portion sizes of all foods served over a two-day period were increased, people kept eating more at each main meal. That means they didn't compensate for overeating the first day by reducing the amount they ate the second day.

"The bigger portions that restaurants are providing make consumers vulnerable to overeating, since most individuals eat all or most of what is served. The excess food in megaportions is not going home in doggie bags. It is, instead, fueling the obesity epidemic," Dr. Barbara Rolls, lead author of both studies, says in a news release.

Both studies were presented April 12 at the Experimental Biology conference in San Diego.

In the first study, the size of the baked ziti meal served at a cafeteria-style restaurant was varied between a standard portion and a larger serving, with 50 percent more food. The price for both meals was the same.

Customers were asked to rate their satisfaction and the appropriateness of the portion size. The customers' food intake was gauged by weighing each meal in the kitchen before and after the meal.

The study found that when people were served 50 percent more food, they ate nearly all of it -- an average of 172 more calories. People rated both the normal and larger potion sizes as equally appropriate.

In the second study, 32 men and women ate breakfast, lunch and dinner. They were given take-out snacks and water for between meals. This was done for two consecutive days a week for three weeks.

Each week, the same daily menus were served but the portion sizes varied. When portion sizes were larger, women ate 335 more calories per day and men ate 513 more calories per day. When the portion sizes were doubled, women ate 530 more calories per day and men ate 803 more calories per day.

The study found it didn't matter how much the men and women ate the previous day. If they were given larger portions, they ate more food. They didn't eat less on the second day to compensate for overeating the previous day.

More information

Here's where you can learn more about the dangers of obesity.

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