The American Voice Institute of Public Policy Presents

Personal Health

Joel P. Rutkowski, Ph.D., Editor
June 24, 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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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 19-25

 

FRIDAY, APRIL 25, 2003

  1. Insulin Resistance a Double Whammy for Some Diabetics
  2. Tuberculosis Caught Later in Whites, Women
  3. Motor Problems Could Be Prelude to Alzheimer's Disease
  4. Rejected Burn Therapy Passes Acid Test
  5. Manual Therapy Best for Neck Pain
  6. Hip Replacement Safe for Oldest Patients
  7. Study Suggests DDT-Breast Cancer Link
  8. Attention: Tooth Decayers
  9. Flexibility Lowers Arthritis Risk in Older Women
  10. Good News for Diabetics
  11. Pain Undertreated in Toddlers: Report
  12. Day Care Won't Protect Kids if Mom Has Asthma
  13. Most 'Abnormal' Pap Smears Won't Lead to Cancer
  14. Rx for High Cost of Prescription Drugs

    THURSDAY, APRIL 24, 2003

  15. Stroke at Young Age Can Run in Family
  16. Clues to How Cancer Cells Grow Unchecked
  17. Babies Can Develop Dangerous Heart Condition –Study
  18. Improving Odds Against Esophageal Cancer
  19. WHO Defends Report on Sugar Consumption
  20. Emotional Odors
  21. U.S. Urges More Disease Prevention for Minorities
  22. Getting By on Little Sleep
  23. CDC: Some Bacteria Declining in Food, Others Not

    WEDNESDAY, APRIL 23, 2003

  24. Sleeping Pills that Aren't
  25. (Hospital Water Systems May Harbor Harmful Molds
  26. Vitamin D: New Weapon in Battle Against Breast Cancer?
  27. Obesity Behind 90,000 Cancer Deaths Each Year
  28. Study Gets Handle on Deadly Heart Condition in Kids
  29. Gene Found for Blind, Deaf Syndrome in Children
  30. Light Therapy May Boost Hormone Levels
  31. Antidepressant Use Not Linked to Birth Defects
  32. Implanted Device Prevents GERD
  33. Lifestyle Changes Alone May Lower Blood Pressure
  34. Don't Doctor Yourself for a Vaginal Infection
  35. Less Fat in Diet Linked to Injury Risk in Runners
  36. A Rundown on Shin Splints

    TUESDAY, APRIL 22, 2003

  37. Taking the Itch Out of Eczema
  38. Study May Explain Lung Condition's High Death Rate
  39. Coffee's Hidden Calories
  40. Five-Year Colon Cancer Screen May Be Too Frequent
  41. Simple Exercise Can Bring Seniors Back in Balance
  42. Age, Drinking Tied to Pedestrian Deaths in U.S.
  43. Sunscreen Screens Sun's Rays Better Than Beta Carotene
  44. Study Looks at Spinal Proteins, Alzheimer's
  45. Having a Baby is Good for Your Bones
  46. New Gene Linked to Breast Cancer
  47. Moderate Lifestyle Changes Control Hypertension
  48. Gene Activates Other Genes
  49. A Promising Blood Pressure Trial Cut Short

    MONDAY, APRIL 21, 2003

  50. Drink Tea to Stay Germ-Free: Report
  51. Statins May Cut Alzheimer's Risk
  52. Snoring Linked to Chronic Daily Headache: Study
  53. Melanoma Gene Discovered
  54. Highly Educated May Have Poorer Mental Health
  55. Another Genetic Link to ALS Found
  56. Study Supports Eight Glasses of Water a Day Advice
  57. Improving the Odds for Lung Transplant Patients
  58. Temporary Syndrome Found in Ironman Athletes

    SUNDAY, APRIL 20, 2003

  59. Blood Treatment Targets Heart Disease
  60. A Forecast for Pain?

    SATURDAY, APRIL 19, 2003

  61. Working Out to Stop Heart Failure
  62. It's Spring, and the Allergies Are A'Bloom


FRIDAY, APRIL 25, 2003

Insulin Resistance a Double Whammy for Some Diabetics

By Jennifer Thomas
HealthScoutNews Reporter
HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- Blood sugar control might have little influence over the development of heart disease in Type 1 diabetics (news - web sites), a new study says.

Instead, researchers say insulin resistance -- the hallmark of Type 2 diabetes -- is a better indicator of who's going to get heart disease among Type 1 diabetics.

"We suspect that insulin resistance occurs in those with Type 1 diabetes in the same way as it does those with Type 2, essentially giving these individuals 'double diabetes' and greatly increasing their risk of heart disease," says Dr. Trevor Orchard, acting chairman of the department of epidemiology at the University of Pittsburgh Graduate School of Public Health.

The study appears in the May issue of Diabetes Care.

For Type 1 diabetics, this may come as good news. It might mean that some Type 1 diabetics, at least those without insulin resistance, are at lower risk of heart disease than previously believed, Orchard says.

And while those with insulin resistance may be at higher risk, medications and lifestyle changes can boost the body's ability to use insulin.

Type 1 and type 2 diabetes are, in many ways, very different diseases, Orchard says.

Type 1, most often thought of as a disease that strikes in childhood, occurs when the body attacks and destroys its own insulin-producing beta cells. Insulin is responsible for helping tissues use glucose, the body's energy source.

Type 1 diabetes, the less common form of the illness, accounts for 5 percent to 10 percent of the 17 million people in the United States with diabetes, according to the American Diabetes Association. Type 1 diabetics need daily insulin injections to survive.

In Type 2 diabetes, the pancreas is usually still producing insulin, but the cells of the liver, muscles and fatty tissues develop a resistance to it. Type 2 can often be controlled with weight loss, diet and exercise.

Doctors have known for a long time that people with diabetes are at higher risk of heart disease, but most of the research has been done in Type 2 diabetics, says Dr. Nathaniel Clark, national vice president of clinical affairs for the American Diabetes Association.

"The question keeps coming up: 'What about Type 1 diabetics?'" Clark says. "There have been very few studies that have shown the risk factors for people with Type 1."

When trying to help diabetics control their risk of heart disease, doctors tend to focus on three risk factors: blood sugar, blood pressure and cholesterol. But it's unknown which is the most significant factor, or if, perhaps, one factor matters more or less in Type 1 or 2 diabetes, Clark says.

Orchard's study begins to get at that, he says.

"I think the most important finding is that these researchers looked at the traditional risk factors, and what they found was that blood sugar wasn't terribly helpful in predicting who gets heart disease," Clark says. "There were other factors that were much more important."

Namely, insulin resistance.

Orchard and his colleagues examined 658 Type 1 diabetics, aged 6 to 40, every two years for a 10-year-period. During that time, there were 108 cardiovascular events, including angina (news - web sites) and heart attacks.

Researchers then took a subset of 24 patients and measured their insulin resistance using a type of testing that's considered the gold standard. The problem with this test is that it's time-consuming -- patients have to stay overnight in the hospital -- and expensive.

So Orchard and his colleagues developed a surrogate test for insulin resistance using data about the patients' waist-to-hip ratio, blood pressure and long-term blood sugar levels.

They found that Type 1 diabetics with the highest levels of insulin resistance based on these calculations were the most likely to have a cardiovascular event.

Dr. Loren Wissner Greene, an endocrinologist at New York University Medical Center, is skeptical of the need for complicated calculations. In treating Type 1 diabetics, she says she occasionally sees people who gain a lot of weight and become insulin-resistant.

One easy way of telling if the patients are becoming insulin-resistant is if, over time, they require more and more insulin to maintain their blood sugar.

More information

The American Diabetes Association has information about Type 1 and Type 2 diabetes. You could also check out the National Institute of Diabetes and Digestive and Kidney Diseases.

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Tuberculosis Caught Later in Whites, Women

HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- White people and women are more likely to experience delays in being diagnosed with tuberculosis, says a study in this week's issue of the British Medical Journal.

British researchers analyzed surveillance data and a national survey to estimate delays in tuberculosis diagnosis for people in London from 1998 to 2000.

The study found a median delay of 49 days for all people. However, women and white people were more likely to experience a longer time between the onset of symptoms and a diagnosis of tuberculosis. The authors suggest this may be because tuberculosis may be suspected and investigated more aggressively among men, blacks or Asians.

The authors note that recent public health campaigns have tried to increase awareness of tuberculosis, particularly among ethnic minority groups. They say their findings indicate those campaigns also need to be targeted at white people, who account for one-third of tuberculosis cases.

More information

Here's where you can learn more about tuberculosis.

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Motor Problems Could Be Prelude to Alzheimer's Disease

By Robert Preidt
HealthScoutNews Reporter
HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- Symptoms that mimic Parkinson's disease (news - web sites) could actually be a prelude to Alzheimer's disease (news - web sites), new research suggests.

Muscle rigidity, difficulty walking and other motor problems are linked to the development of Alzheimer's disease, says a study in the April issue of the Archives of Neurology.

Researchers at Rush-Presbyterian-St. Luke's Medical Center in Chicago found older people who had a rapid progression of these symptoms were eight times more likely to develop Alzheimer's disease than those with no worsening of such symptoms.

Seniors with slow to moderate progression of the symptoms had a two to five times greater risk of developing Alzheimer's.

"So any progression of this at all was a bad prognostic sign and suggested somehow there are degenerative changes occurring in the brain that must be contributing to these (symptoms)," says study author Robert S. Wilson, a professor of neuropsychology at Rush-Presbyterian.

He and his colleagues studied 824 older Catholic clergy members from about a dozen states. Their average age at the start of the study was 75.4 years old. None of them had any clinical signs of Parkinson's or Alzheimer's at the start of the study.

The clergy members were followed for an average of 4.6 years. Some were studied for as long as eight years; 114 of them developed Alzheimer's during the study.

Once a year, subjects had clinical exams and completed a modified version of a test that measures signs of Parkinson's disease. They also had detailed cognitive testing and were checked for signs of Alzheimer's disease.

The researchers found that motor skill problems worsened in 79 percent of the subjects over the course of the study.

Among that group, those with the most rapid symptom progression had more than eight times greater risk of developing Alzheimer's disease than the people whose symptoms did not worsen. The risk of Alzheimer's more than doubled in those with slight symptom progression and more than tripled in those with moderate progression.

The study also found the rate at which the symptoms worsened was inversely associated with rates of decline on tests that measured cognitive function.

While these symptoms are similar to those seen in people with Parkinson's disease, Wilson says they're not actually caused by Parkinson's.

"We don't think that these people actually are going to go on to have Parkinson's disease. The cause of these motor abnormalities is not securely known, and we think that's going to be an important next step," Wilson says.

There are some theories about what causes the decline in motor ability.

"I think certainly stroke is one thing that's being looked at and we're very suspicious about. We're also looking at diabetes," Wilson says. "Both are things that can increase the risk of Alzheimer's disease as well."

All the people in this study agreed to donate their brains when they die to help further this research. Wilson and his team have collected nearly 250 of those brains so far for analysis.

While this study is interesting, its findings aren't all that surprising, says Bill Thies, vice president of medical and scientific affairs at the Alzheimer's Association.

"Alzheimer's disease is typically worse in people who have more dysfunction, and I think that's what this is sort of indicating here," he says.

Perhaps the most significant aspect of the study is the data showing that annual declines in motor ability are paralleled by reductions in cognitive function, Thies says. "There's a pretty decent relationship that would seem to indicate that the faster you're changing in the motor scores, the faster you're changing in cognition," he says.

While it isn't necessarily a new concept, this study provides actual evidence of a link between motor and mental skills.

"You hear lots of people talk about this relationship. I haven't seen a lot where they've actually measured it. It's been an observation more than anything else. So, from that standpoint, I think it's one of those studies that sort of confirms a commonly held belief," Thies says.

More information

Here's where you can learn more about Alzheimer's disease. And the Alzheimer's Association lists 10 warning signs of the disease.

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Rejected Burn Therapy Passes Acid Test

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- For skin burns caused by alkaline substances commonly found in household cleaning products, traditional first aid calls for rinsing the area with plenty of water.

Using weak acids such as vinegar to neutralize the area has always been considered dangerous.

Now, a new study challenges that age-old wisdom. Water followed by vinegar may neutralize these burns faster than water alone, reducing damage to the skin and tissue, the study authors say.

But the lead author of the study, published in the May issue of Plastic and Reconstructive Surgery, says he is not suggesting anyone with such a burn forgo rinsing with copious amounts of water.

"I would still say if you get an alkaline burn on you, you should still wash it under the tap or shower as a first-line measure," says Dr. Stephen Milner, director of the Regional Burn Center at Memorial Medical Center in Springfield, Ill. "I think it's important to wash it off for as long as you possibly can, about 20 minutes or longer. Adding vinegar [after the rinse with water] might be good."

In a rat study, Milner and his colleagues compared treating skin burns with water alone versus acetic acid, similar to household vinegar. Animals treated with the acetic acid had a shorter treatment period and their skin pH -- a measure how acidic or alkaline it was -- returned to normal more quickly. The vinegar-treated animals' wounds healed more quickly, although both groups had complete wound healing after 14 days.

"Most cleaning supplies [found around the home] contain alkali," Milner says. Alkaline skin burns are caused by household plumbing agents and general cleaners, plus industrial-grade solvents. Each year, alkaline agents are responsible for more than 15,000 skin burns in the United States, he says, citing several medical literature reports.

Another expert calls the study interesting. "It piques my interest and merits further investigation," says Dr. Peter Grossman, associate director of the Grossman Burn Center at Sherman Oaks Hospital in Sherman Oaks, Calif.

The concern about using a weak acid on a skin burn, he adds, has been that it might generate heat and make things worse. "In this study, it doesn't appear there was a significant problem with an exothermic [heat-producing] reaction."

However, he adds: "One study does not a rule make."

Milner cautions that his study looked only at skin burns, not burns to the eyes or internal organs, so he cannot say whether vinegar or other acetic acid might help those heal.

More information

For frequently asked questions about burns and other first aid, try the National Safety Council. Parents can get advice about burn first aid at Lucile Packard Children's Hospital at Stanford University.

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Manual Therapy Best for Neck Pain

HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- Manual therapy for neck pain is more effective and less costly than physiotherapy treatment or standard care by a doctor.

So says Dutch research that appears in this week's issue of the British Medical Journal.

The study included 183 people, aged 18 to 70, who had suffered neck pain for at least two weeks. Sixty of them received manual therapy (spinal mobilization), 59 received physiotherapy (mainly exercise), and 64 received standard care (medication, counseling and education) from a doctor.

After 26 weeks, the study found the people receiving manual therapy recovered more quickly from their neck pain than the people receiving physiotherapy or standard care from a doctor. However, the differences in recovery between the three groups were negligible by the end of 52 weeks.

The study also found the cost of manual therapy was about a third of the cost of the other two forms of treatment.

More information

Here's where you can learn more about neck injuries and disorders.

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Hip Replacement Safe for Oldest Patients

HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- Total hip replacement surgery can be done safely and effectively on people 90 years and older and provide them with years of improved quality of life.

So says a Mayo Clinic study in a recent issue of the Mayo Clinic Proceedings.

Researchers reviewed medical records of 65 people, 90 and older, who had total hip replacement surgery between 1970 and 1997.

The study found the patients experienced some medical and surgical complications, but those rarely compromised the successful outcome of the surgery.

People in this age group do often have medical conditions -- hypertension, anemia, cardiac disease -- that can make the surgery more challenging. That's why it's important they be monitored closely for medical complications during the early post-operative period.

As baby boomers age, there will be an increasing number of people in their 90s who require a first-time total hip replacement, as well as other people in their 90s who will need a second total hip replacement.

"Primary-care physicians and surgeons should be aware that both primary and revision total hip replacement can be done safely and effectively in patients 90 years old and older and can result in years of pain relief and functional improvement," study author Dr. Mark Pagnano says in a news release.

"In our study, the typical patient lived for more than five years after hip replacement and had substantial relief of pain and improvement of function during that period," he adds.

More information

Here's where you can learn more about hip replacement.

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Study Suggests DDT-Breast Cancer Link

Reuters Health
Friday, April 25, 2003

NEW YORK (Reuters Health) - Women with breast cancer (news - web sites) may be more likely to have pesticide residues in their blood, a new study from Belgium suggests.

In the study, women with breast cancer were more likely to have residues of the chemicals DDT and HCB in their blood than women who did not have cancer.

"These results add to the growing evidence that certain persistent pollutants may occur in higher concentrations in blood samples from breast cancer patients than controls," writes a team led by Dr. Charles Charlier of Sart Tilman Hospital in Liege, Belgium.

Nonetheless, the findings do not prove that exposure to the chemicals causes breast cancer.

In fact, a 2001 analysis of five studies involving more than 1,400 people with breast cancer and more than 1,600 people without cancer living in New York, Maryland and Connecticut found no association between DDT and chemicals called PCBs and breast cancer.

Charlier's team calls for more research on the topic, noting that the development of cancer "is a multifactorial event, and it is important to try to clarify the role of chemicals in cancer development."

These chemicals, which can build up in fatty tissue and blood, were used in the U.S. until the 1970s. DDT, a pesticide, was banned in 1972 after it was found to cause egg shell thinning in wild birds, and HCB was widely used as a pesticide to protect the seeds of agricultural plants against fungus until 1965. Currently, HCB is not used commercially in the United States.

Studies have shown that these and other environmental pollutants mimic the effects of estrogen by stimulating the growth of precancerous and cancerous breast cells in test tubes.

But the effects of exposure to the chemicals in humans have remained unclear, with some studies finding an association among women with breast cancer, while others have not.

Charlier's group tested for the presence of DDT and HCB in blood samples from 159 women with breast cancer and 250 healthy women.

The study, reported in the journal Occupational and Environmental Medicine, found that women with breast cancer were more likely to show signs of pesticide exposure. Twenty-four percent of the healthy women had no detectable levels of the pesticides in their blood compared to only 2.5 percent of the women who had breast cancer.

Specifically, women with breast cancer had concentrations of DDT and HCB in their blood that were more than twice as high as those measured in healthy women.

Although some breast tumors are sensitive to the effects of estrogen and others are not, DDT and HCB levels were not related to estrogen sensitivity.

The authors conclude that more research is needed, including how women might be exposed to these chemicals.

Source: Occupational and Environmental Medicine 2003;60:348-351.

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Attention: Tooth Decayers

HealthScoutNews
Friday, April 25, 2003

(HealthScoutNews) -- You have to take care of your teeth because you know you don't get a second chance. Once they're gone, they're gone.

So, here's a Community Dental Health report on the major causes of dental wear among teens.

On the list of things you shouldn't do:

  • Grind your teeth
  • Eat most kinds of pickles
  • Drink soda

On the list of things that you can do without risking your teeth:

  • Have a stomach upset
  • Be overweight
  • Not brush after every meal
  • Eat ketchup
  • Eat pickled onions
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Flexibility Lowers Arthritis Risk in Older Women

By Stephanie Riesenman
Reuters Health
Friday, April 25, 2003

NEW YORK (Reuters Health) - Older women who are "double-jointed" -- or those who have super-flexible joints -- are less likely to have arthritic knees than their peers, according to a study of British women.

It's not clear from the study if women were born with extra-flexible joints or obtained them through a lifetime of exercise and stretching, according to Tim Spector, a professor of rheumatology at St. Thomas' Hospital in London.

However, the findings suggest the retaining flexibility in old age can ward off arthritis, he told Reuters Health.

"Our research suggests that both the innate or the exercise route (to flexibility) both seem to help prevent arthritis -- so exercise and stretching should be encouraged," said Spector.

"In our study we only tested the women once and can't really separate hypermobile women who remained flexible from normal women who exercised and stretched to become more flexible than their sedentary peers," said Spector.

People with hypermobile joints, as it's known medically, have an expanded range of motion. They can often pull their thumbs down to touch their wrists and have elbows that hyper-extend when they stretch out their arms. And the knees of double-jointed people may bow backwards when they stand up straight.

It's the looseness of the structures surrounding the joint that allow it to have more motion, similar to a hinge on a door that allows it to swing open and closed.

In some cases, hypermobility is a sign of inherited connective tissue or bone disease, and some studies had suggested it might actually increase the risk of osteoarthritis. Osteoarthritis occurs when the cartilage that cushions joints breaks down, often leading to pain, swelling and loss of mobility.

In a study of 716 women in England, 79 had some degree of joint hypermobility, a proportion consistent with the overall population. Most of these women showed increased flexibility in the spinal region and hip joints -- allowing them to easily bend at the waist and place their hands flat on the floor.

The women, ages 53 to 72, were part of the Chingford Study in London. In the ongoing study, predominantly middle-class white women have received regular x-rays and bone mineral density measurements since 1988.

Spector and his colleagues found that bone mineral density was three percent higher in the hips of the hypermobile group compared with other women. There was no difference in spine bone mineral density between the two groups of women, according to the study in the current issue of the Journal of Rheumatology.

The researchers also looked for osteoarthritis in the hands, knees, spine and hips of hypermobile women. Compared to their normal-jointed counterparts, hypermobile women showed a reduced risk for arthritis in the knees only.

People born with looser joints may be drawn to physical activity, which may also play a role in arthritis risk, according to Spector.

Women who were taller and more hypermobile in the study were also more physically active throughout their lifetimes. Spector says that may explain the differences in bone mineral density and arthritis between the hypermobile women and those with less flexible joints.

"We can't prove it -- as it's a chicken and egg situation -- but our data certainly strongly suggest an effect that may be related to fitness and flexibility, rather than exercise per se," he said.

This means that hypermobility in an aging population may be an advantage and a marker of fitness when it persists later in life.

Spector recommends that all postmenopausal women concentrate on flexibility, exercise regularly and keep their body mass index -- a ratio of weight to height -- below 25. He says all these can help prevent osteoarthritis.

The American Academy of Orthopedic Surgeons and the American Geriatrics Society recommend that adults engage in 30 minutes of moderate physical activity every day. In addition to the cardiovascular benefits, they say exercise strengthens bones and reduces joint and muscle pain.

Source: The Journal of Rheumatology 2003;30:799-803.

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Good News for Diabetics

HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- A non-invasive glucose sensor that can fit in the eye to measure sugar levels in body fluids has been developed by University of Pittsburgh researchers.

The new sensor could spare people with diabetes from having to prick their fingers several times a day to check their blood sugar levels. The research appears in a recent online issue of Analytical Chemistry.

The researchers created a thin plastic sensor that changes color based on the concentrations of glucose. They plan to embed the sensor material into contact lenses worn in the eyes. People wearing the sensors could check their glucose levels by looking into a specially designed mirror.

The mirror, similar to a woman's makeup compact mirror, would have a color chart. While looking in the mirror, the wearer could measure his or her glucose levels by comparing the color of the sensor in their eyes to the color chart on the mirror.

The sensor turns red when it detects dangerously low glucose concentrations and turns violet to indicate dangerously high glucose concentrations. Green is the color for normal glucose levels.

The researchers say it will be at least a year before the sensor is tested on humans.

More information

Here's where you can learn more about diabetes.

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Pain Undertreated in Toddlers: Report

Reuters Health
Friday, April 25, 2003

NEW YORK (Reuters Health) - Very young children may not be getting adequate treatment for pain, if the findings of a study conducted at one hospital are any indication.

"Children younger than 2 years of age receive disproportionately less analgesia than school age children, despite having obviously painful conditions," according to Drs. John Alexander of Maine Medical Center in Portland and Mariann Manno of the University of Massachusetts Medical School in Worcester.

In the current study, reported in the Annals of Emergency Medicine, Alexander and Manno sought to better understand how pain medication was doled out to infants and children treated for burns or fractures in a pediatric emergency department.

In a review of the medical charts of 180 children aged six months to 10 years, the investigators found that 65 percent of the youngsters younger than two years old went without pain medication compared to only 48 percent of older children.

And when the youngest children were given pain medication, they were usually given less potent drugs than older children.

"When analgesia was administered, very young children were more likely to receive over-the-counter medications and less likely to receive narcotic analgesic agents when compared with their older counterparts," the authors write.

Alexander and Manno speculate that the inability of very young children and infants to verbalize their feelings of pain may cause healthcare providers to overlook the pain relief needs of the very young.

What's more, the fear of sedating young children and infants too much may make physicians reluctant to use painkillers. Another reason for this reluctance, the authors suggest, is that some doctors may not be knowledgeable about guidelines for selecting the proper dose of pain medication for children.

The researchers did not identify any complications associated with the use of pain medication among any of the children, regardless of age. All drug prescribing followed established weight-based guidelines for all of the children, they report.

In 2001 the American Academy of Pediatrics and the American Pain Society called on pediatricians to do a better job of managing children's pain during medical treatments such as routine vaccinations.

For a variety of reasons, doctors have long tended to be less aggressive in treating the short-term pain children experience during illness or following an injury or medical procedure.

For instance, babies have long been believed to not experience pain the way adults do and to suffer no long-term consequences as a result of pain. However, studies in the 1980s produced the first physiological evidence that infants do indeed experience pain.

Another reason doctors have been reluctant to treat children's pain is concern about the effects of pain medication on children's bodies, and concern about whether the best dosages are known.

Source: Annals of Emergency Medicine 2003;41:617-622.

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Day Care Won't Protect Kids if Mom Has Asthma

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- Children who attend day care as infants gain protection against asthma as they grow, but not if their mother has a history of breathing trouble.

That's the conclusion of a new study by Boston researchers, who found that maternal, but not paternal, history of asthma undermines the benefits of day care on building up the immune system.

The findings appear in the May issue of the American Journal of Respiratory and Critical Care Medicine.

Roughly six in 10 children in this country attended some form of day care in 1995, according to the study. Thanks to the free trade in germs that occurs between kids, those who go to day care appear less vulnerable to allergies, asthma and other conditions that involve the immune system.

But not always.

In the new study, Dr. Juan Celedón, a lung specialist at Harvard Medical School (news - web sites), and his colleagues followed 453 boys and girls with at least one parent with a history of allergies, hay fever or asthma. Of those, 238, or about half, had attended day care during their first year of life. Most attended in-home outfits with a small number of other playmates. The researchers used questionnaires to track the children's allergy and asthma experience until they were 6.

For children whose mothers didn't have asthma, going to day care in the first year reduced their risk of later breathing problems by 70 percent. "But for children whose mother had asthma and who went to day care, they were not protected," says Celedôn.

What accounts for the difference isn't clear. It might be the result of something genetic or something that happened while the baby was in the womb. Or, Celedón adds, it could reflect an environmental exposure shared by mother and child after birth.

Whatever the case, Celedón says the results are similar to a previous finding that a mother's history of asthma dilutes the protective effect on her child's risk of breathing problems from having a cat around the house.

Dr. Jerry Shier, a lung expert and a member of the board of trustees of the Asthma and Allergy Foundation of America, says parents shouldn't be overly concerned about the latest work. "Even if they have a family history of asthma they can go to day care," Shier says.

However, Shier adds, children who do have severe asthma or wheezing that's triggered by airway infections should probably not be in day-care settings.

More information

For more on asthma and allergies, visit the American Academy of Allergy Asthma and Immunology or the Asthma and Allergy Foundation of America.

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Most 'Abnormal' Pap Smears Won't Lead to Cancer

By Stephen Pincock
Reuters Health
Friday, April 25, 2003

LONDON (Reuters Health) - At least 80 percent of women who have worrying evidence of cell abnormalities on a Pap smear will not go on to develop cervical cancer, a new analysis by British researchers suggests.

All of these women will be treated "just in case," meaning that many will undergo further tests and small operations. But cervical cancer treatments are relatively minor, and not too invasive, meaning Pap screening is still worth doing despite these problems, say Dr. Angela E. Raffle and colleagues.

"You can't escape the fact that to be effective in cancer screening you almost have to over-treat because the cell changes and tissue changes are so common," said Raffle, from Avon Health Authority in Bristol.

Her group analyzed screening records from 348,419 women in the Bristol area. They report their findings in Friday's British Medical Journal.

For every 10,000 women screened between 1976 and 1996, 1,564 had abnormal cervical cells detected in the Pap smear. Of those, 818 had further investigations, of whom 543 had evidence of abnormal cervical tissue. Within this group, 176 had abnormalities that persisted for 2 or more years.

Without screening, the researchers say, 80 of these women would be expected to develop cancer by 2011, of whom 25 would die. Screening would avoid 10 of these deaths.

"In the NHS cervical screening program, around 1,000 women need to be screened for 35 years to prevent one death," they write.

An important implication of their results is the need to help women understand what an abnormal Pap smear really means, the researchers say. While it is important for women to have tests and not to ignore the results, trauma caused by thinking it is something akin to a death sentence is not necessary.

"We really need to change people's perception of what's meant by an abnormal smear," Raffle said.

"Most of these abnormalities are no problem at all, but the treatment's simple and we really think that everyone with a high grade abnormality needs treatment because we know that for one in eighty it will make that big, life-saving difference."

Cervical cancer is ideal for screening, because doctors can get to the cervix without surgery, it can be treated locally, Raffle said. But the same cannot be said of all other cancers.

"I think the real implications for our findings are for prostate cancer (news - web sites), bowel cancer, ovarian cancer -- all these others that people say we must start screening for," the Bristol researcher said.

It is possible that a large proportion of abnormalities detected in those organs will never develop into cancer, but the treatment can be much more damaging than that for cervical cancer -- involving major surgery or radiation treatment.

"Our study points to the potential for harm. It's only minimal harm with the cervix because you're talking about worrying people, but if you're talking about an operation that could leave you dead, or impotent or incontinent, then it's a different equation really," Raffle said.

Source: British Medical Journal 2003;326:901-904.

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Rx for High Cost of Prescription Drugs

By Colette Bouchez
HealthScoutNews Reporter
HealthScoutNews
Friday, April 25, 2003

FRIDAY, April 25 (HealthScoutNews) -- You've seen their stories on the evening news: The elderly woman forced to eat cat food or the aging man who suffers without heat in the dead of winter.

Their problem: Trying to save enough money to pay for lifesaving prescription drugs.

While many Americans struggle with the high cost of health care, seniors often take the brunt of the beating.

"This is a significant problem. And the worst part is that many seniors are too embarrassed or ashamed to tell their families or even their doctor that they can't afford a medication they need to survive," says Eileen Zenker, assistant director of social work at New York University Medical Center.

According to a recent Wall Street Journal report, up to 80 percent of all retirees take a prescription drug every day. Yet, the Kaiser Foundation reports that four of every 10 Medicare beneficiaries have no drug coverage of any kind.

Another report by the Kaiser Foundation revealed that nearly one-quarter of all seniors don't even fill their much-needed prescriptions because they can't afford to -- or they try to save money by taking fewer pills.

"And most don't tell their doctor they are doing this, so they (doctors) can't get an accurate picture of the patient's health. They may assume, for example, that a drug is not working or that the patient's condition is worsening, when in reality it's simply that they are not taking their medication," Zenker says.

The good news is some help has arrived, courtesy of the National Council on the Aging (NCOA) and a program called BenefitsCheckupRX. It's a fast, easy-to-use online database devoted to helping low- and middle-income seniors find cost-saving programs for prescription drugs.

"The goal was to bring together all the various public and private discount drug programs for seniors and centralize the information in one place, plus make it fast and easy to find out if you are eligible, and ultimately, supply you with the information needed to contact the various programs," says Scott Parkin, spokesman for the NCOA.

Currently, the site supplies information on more than 240 public and private prescription savings programs, including state and federal initiatives along with those sponsored by individual drug companies. Included in the database is discount information on nearly 800 of the most commonly used prescription medications.

To see if they qualify, all seniors need to do is complete a safe, secure and brief online questionnaire. The computer program does the rest.

"In a matter of a few minutes, the service displays a personalized report that specifies which programs the person is eligible for, plus offers detailed instructions on how to enroll," Parkin says.

Once enrolled in a discount program, you receive all the necessary information to purchase your prescription at the discounted price at a local pharmacy. While not all pharmacies honor all prescription discount plans, most major chain drugstores and many smaller independent pharmacies do, Parkin says.

HealthScoutNews tried the program, looking for savings on two common blood pressure medications used together -- Norvasc and Atacand. The normal cost for a 30-day supply of each can range from $40 to $65 -- for a total of $80 to $130, depending on your purchase location.

Using two options suggested by BenefitsCheckupRX, the total cost for a 30-day supply of both drugs combined was just $25.

"Programs like these allow seniors to not only get their much-needed medication, but to keep their much-needed sense of pride and independence," Zenker says. This, she says, can go a long way toward improving both their mental and physical health.

Currently the program is available only in English, but a Spanish version is expected to be online this summer. For those who don't have a computer or are unfamiliar with navigating Web sites, NCOA suggests asking a close family friend or relative to log on and help out. And many senior centers, libraries and even doctors' offices and clinics offer online access and may be able to help, Zenker says.

In addition to NCOA, BenefitsCheckupRX is supported by The Commonwealth Fund, AARP, Pharmaceutical Research and Manufacturers of America, America Online, Lucent Technologies, The Merck Company Foundation, The Archstone Foundation, FJC Foundation, Pfizer, and Together-RX.

More information

To learn more about BenefitsCheckupRx, click here. For more on seniors and the high cost of prescription drugs, visit the Kaiser Foundation.

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THURSDAY, APRIL 24, 2003

Stroke at Young Age Can Run in Family

Reuters Health
Thursday, April 24, 2003

NEW YORK (Reuters Health) - People with a family history of stroke at a relatively young age may themselves face a higher risk of stroke -- particularly before age 65, UK researchers said Thursday.

Their study found that the risk of two common forms of stroke was twice as high among study participants with an immediate family member who had suffered a stroke at age 65 or younger.

And the link was even stronger among participants younger than 65, for whom such a family history meant a roughly three-fold greater stroke risk.

All stroke patients in the study had suffered an ischemic stroke, the most common form of stroke, caused by a blood clot. Family history was tied to the risks of two common subtypes of ischemic stroke -- "small-vessel" and "large-vessel."

The findings are published in the May issue of Stroke: Journal of the American Heart Association (news - web sites) (AHA).

"Traditional risk factors for stroke, such as high blood pressure, smoking, diabetes, and high cholesterol, only explain about half of all stroke risk," lead author Dr. Paula Jerrard-Dunne, from St. George's Hospital Medical School in London, said in an AHA statement. "There is growing interest in the role of genetic risk factors for stroke."

The new findings are based on a study of 1,000 ischemic stroke patients and 800 healthy people matched for age and sex. All were white.

Participants were interviewed on the history of stroke and heart attack among their close relatives. In the patient group, the strokes were classified as either large-vessel, small-vessel, cardioembolic, or ischemic stroke of unknown cause.

The researchers found that a family history of stroke before age 66 was associated with a roughly two-fold higher risk of both large- and small-vessel stroke. When they looked only at patients who had a stroke by age 65, the significance of family history was even stronger.

Previous studies have yielded conflicting results regarding the contribution of family history to stroke risk, Jerrard-Dunne noted. The failure of some research to establish a link may be because studies have "usually lumped all types of strokes together," she speculated.

Her team has begun to analyze DNA from patients with large- and small-vessel disease to identify genes that may increase stroke risk.

Any future gene therapies for stroke may yield better results if studies focus on patients for whom genetic factors are most important, Jerrard-Dunne noted.

Source: Stroke: Journal of the American Heart Association 2003;34.

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Clues to How Cancer Cells Grow Unchecked

HealthScoutNews
Thursday, April 24, 2003

THURSDAY, April 24 (HealthScoutNews) -- An explanation for how cancer cells can grow unchecked may be found in an enzyme that helps protect bacteria from attacks by the body's immune system, says a Wake Forest University Baptist Medical Center study.

This enzyme, called peroxiredoxin, is used by bacteria such as salmonella to deactivate hydrogen peroxide coming from the body's white blood cells. Hydrogen peroxide is released by white blood cells to kill invaders.

The study, published in the April 25 issue of Science, outlines how the peroxiredoxin enzyme works differently in mammals and bacteria.

The enzyme, which is a key to human cell survival and growth, acts as a biochemical switch to maintain low levels of hydrogen peroxide in the body. But the enzyme lets those levels increase when hydrogen peroxide is needed for signaling between cells. Those complex signaling pathways are present in mammals, but not in bacteria.

"Because the bacteria don't have the complex signaling pathways present in mammals, they don't need this ability to turn off peroxiredoxin," study author Leslie B. Poole says in a news release.

That means the enzyme is always available to the bacteria to eliminate hydrogen peroxide produced by white blood cells. That helps the bacteria to withstand attacks by a person's immune system.

That finding may provide new information about human diseases. For example, the researchers believe peroxiredoxin-regulated signaling may be related to cancer.

Normally, abnormal cells are programmed to die off. But in some cancer cells, this cell death process stops working and the cancer cells keep multiplying. The cancer cells may not get the signal to die because of the peroxiredoxin enzyme.

The researchers say they found a correlation between too much peroxiredoxin and the failure of cancer cells to receive the signal to die, suggesting the two could be related.

More information

Here's where you can learn more about cancer.

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Babies Can Develop Dangerous Heart Condition –Study

By Maggie Fox
Reuters
Thursday, April 24, 2003

WASHINGTON (Reuters) - Babies under a year old are especially prone to develop a deadly heart condition called cardiomyopathy, and the condition, while rare, may occur more often than doctors believed, researchers said on Wednesday.

They said pediatricians have been given the wrong advice for years -- that the heart condition was most likely to develop in late childhood.

But Dr. Steven Lipshultz of the University of Rochester, said he and colleagues found the opposite.

"A pediatrician who is concerned about a child potentially having a heart problem may consult some of today's most popular cardiology textbooks, and he or she will read that it is unusual for a young child to get cardiomyopathy," Lipshultz said in a statement.

"This study shows that children are about 10 times more likely to develop cardiomyopathy during their first year of life than ages two to 18 combined," he added. "This study shows that expert opinion from around the world is not a viable substitute for examining the data."

Cardiomyopathy can be caused by viruses, certain diseases, or by a birth defect. It is marked by damage to the ventricles, the lower chambers of the heart.

"Almost 40 percent of children with symptoms of cardiomyopathy ultimately die of the condition or require cardiac transplantation, and this percentage has remained unaltered by decades of medical research," Dr. Arnold Strauss of Vanderbilt University in Nashville and Dr. James Lock of Harvard Medical School (news - web sites) wrote in a commentary on the studies, published in the New England Journal of Medicine (news - web sites).

Lipshultz said symptoms are often vague, so a pediatrician who sees an infant who is unhappy, not feeding well, and is breathing hard may not suspect cardiomyopathy.

"A child like this could die of cardiomyopathy," Lipshultz said. "If pediatricians don't know to look for cardiomyopathy, they won't find out the child has it."

Lipshultz's team and a separate group in Australia both found the incidence of cardiomyopathy may have been underestimated by as much as 45 percent. Both found that about 1 in every 100,000 children develops the condition.

If doctors know to look for cardiomyopathy, there are treatments that can save a child's life. Lipshultz has found that a blood pressure drug called enalapril can help.

His team also found the incidence of cardiomyopathy was higher among boys than girls, while black and Hispanic children were more prone to develop the conditions than whites.

"This leads us to believe that genetics may be an important reason children develop cardiomyopathy," he added. "The regional differences are important because that suggests there may be environmental factors at play in those regions."

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Improving Odds Against Esophageal Cancer

HealthScoutNews
Thursday, April 24, 2003

THURSDAY, April 24 (HealthScoutNews) -- Using minimally invasive esophagectomy -- removal of the esophagus -- to treat esophageal cancer results in lower death rates and shorter hospital stays, compared to most open surgical procedures.

That's what University of Pittsburgh researchers found when they evaluated the effectiveness of minimally invasive esophagetomy (MIE) in 221 people from June 1996 through August 2002.

The results of MIE were compared to other methods, such as surgical opening of the chest wall and surgical opening of the abdomen.

The study found the mean hospital stay for people who had MIE was seven days, compared to more than 10 days for people who had open procedures. People having MIE had a death rate of 1.3 percent while the death rates for open procedures were 5 percent or more.

The findings were presented April 24 at the annual meeting of the American Surgical Association in Washington, D.C.

MIE is a video-assisted surgery that uses a tiny camera and surgical instruments that are introduced into the body through small incisions.

"Our study demonstrates that minimally invasive esophagectomy offers results as good as, if not better than, open esophageal procedures. These results are encouraging and demonstrate that MIE can improve patient outcomes without compromising accepted standards (news - web sites) of care," study author Dr. James D. Luketich says in a news release.

More information

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

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WHO Defends Report on Sugar Consumption

By Stacy Meichtry
Associated Press Writer
The Associated Press
Thursday, April 24, 2003

ROME - The U.N. health organization on Wednesday defended a report calling for people to eat less sugar to reduce obesity, calling criticism by the U.S. sugar lobby "misdirected."

The World Health Organization (news - web sites) report, made public Tuesday, said people should get no more than 10 percent of their daily calories from sugar and other high-calorie sweeteners.

In a letter to WHO chief Gro Harlem Brundtland, the Sugar Association said the study was not based on science and was "misguided." The body represents U.S. growers and refiners.

It pledged to "exercise every avenue available to expose the dubious nature" of the report, "including asking Congress to challenge future funding of the United States' $406 million contribution to the WHO."

Brundtland dismissed the criticism and stood by the report.

"I haven't seen such strong and misdirected language since I first came to the WHO," Brundtland told reporters after the WHO report was officially released in Rome.

Jacques Diouf, chief of the U.N. Food and Agriculture Organization (news - web sites), said the report's opponents had taken the recommendations on sugar consumption out of context.

Diouf stressed that the report was intended as a guideline for governments, not a list of rules to be regulated.

The report, written by 30 international experts and commissioned by both U.N. agencies, advises limiting sodium consumption to five grams a day, suggests a daily fruit and vegetable intake of at least 400 grams, and prescribes one hour of exercise a day for people with sedentary jobs.

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Emotional Odors

HealthScoutNews
Thursday, April 24, 2003

HealthScoutNews -- The human brain's most direct connection to the world outside the skull is through the nose.

Some 40 million nerves run from two small olfactory bulbs deep inside the brain to the roofs of the nasal cavity, protected from outside influences only by a thin layer of mucus, write Time-Life Books editors in The Mysteries of the Human Body .

One reason why smell, of all the five senses, is the most emotionally evocative may be that the olfactory centers are surrounded by the limbic region, the part of the brain that controls emotions and plays a key role in the formation of memories.

"This intimate association explains why odors and emotions are linked," says the book.

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U.S. Urges More Disease Prevention for Minorities

By Todd Zwillich
Reuters Health
Thursday, April 24, 2003

WASHINGTON (Reuters Health) - U.S. health officials on Thursday urged African-American men to increase their recommended daily intake of fruits and vegetables in a bid to lower their risk of diet-related disease.

They also renewed a call for minority adults to seek screening for preventable malignancies like prostate and colon cancer.

Officials said they are now urging black males between 34 and 59 years of age to consume nine servings of fruits and vegetables per day in order to lower body weight and improve nutrition. The recommendation is at the upper bound of U.S. dietary guidelines calling on adults to eat five to nine servings of fruit and vegetables daily.

Officials tied the recommendation to the dual problems of poor diet and obesity, both of which play an important role in cardiovascular disease, diabetes and certain cancers. All three disease categories are more common in minorities than in the general U.S. population.

"The burden of cancer is directly linked to the problem of obesity and weight gain," said Dr. Andrew von Eschenbach, director of the National Cancer Institute (news - web sites).

Thirteen percent of all African Americans have diabetes, double the rate for whites. African Americans are also twice as likely as whites to die from prostate cancer (news - web sites) or colorectal cancer, according to the Centers for Disease Control and Prevention (news - web sites) (CDC).

"They die too young. They leave their families without them," said Secretary of Health and Human Services (news - web sites) Tommy G. Thompson.

Federal figures suggest that approximately 61 percent of American adults are either overweight or obese, and rates are higher among African Americans.

Meanwhile, federal officials announced the launch of a campaign to encourage minorities to see their doctors for cancer screening.

Guidelines recommend periodic colorectal cancer screening for all adults older than 50, though only about half get it, said Dr. Nancy C. Lee, the CDC's director of cancer prevention and control.

"There is strong evidence that screening works" to lower death rates for prostate and colorectal cancer, Lee said.

Officials unveiled a series of radio and television spots urging minority men to improve their diets, exercise more and go for cancer screening.

Nationally syndicated radio host Tom Joyner told a crowd gathered at the Vermont Avenue Baptist Church in Washington, D.C., that he has upped his fruit and vegetable intake.

"I exercise so much, I married my trainer," he said.

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Getting By on Little Sleep

HealthScoutNews
Thursday, April 24, 2003

THURSDAY, April 24 (HealthScoutNews) -- While some of you can function on little sleep, others feel exhausted if they don't get a full night of slumber.

Currently, scientists don't have a full understanding of the biological differences between those two kinds of people. However, the U.S. Department of Defense (news - web sites) is supporting two University of California, San Diego (UCSD) School of Medicine studies to research the phenomenon.

The U.S. Navy (news - web sites) will fund a study using functional magnetic resonance imaging (fMRI) brain scans to examine healthy adults who function well with little sleep on a regular basis and other people who sleep more than average.

"The idea is to see if there are baseline differences in brain function due to habitual sleep times and to see if one group or the other is less vulnerable to the effects of sleep loss. We have seen some informal evidence of differential responses in people, but there hasn't been a formal study to evaluate these differences," Sean P.A. Drummond, UCSD assistant professor of psychiatry, says in a news release.

In the second study, funded by the U.S. Army, UCSD researchers will use fMRI to explore longer-term sleep deprivation -- as long as 62 hours without sleep -- and the effect it has on brain function in people who sleep normal amounts.

If these studies can pinpoint the biological factors that let some people function well even when they're sleep-deprived, that information may help identify people who are suitable candidates for jobs that require long periods of wakefulness.

That would include long-haul truckers, pilots and soldiers.

More information

Here's where you can learn more about sleep.

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CDC: Some Bacteria Declining in Food, Others Not

By Jesse J. Logan
Reuters Health
Thursday, April 24, 2003

NEW YORK (Reuters Health) - Foodborne illnesses caused by certain bacteria are on the decline in the U.S., but other bugs are still running rampant, according to a report released by the U.S. Centers for Disease Control and Prevention (news - web sites).

About 76 million people in the U.S. get sick each year from bacteria or other germs in food.

The researchers compared 16,580 laboratory-confirmed cases of food poisoning -- a tiny fraction of actual cases -- from 2002 with those documented since 1996. Overall, they found that infections caused by major types of bacteria such as campylobacter, listeria and yersinia have shown "substantial declines" over several years, according to the report.

However, the numbers of people getting sick from foods tainted with salmonella, shigella, cryptosporidium and E. coli O157 have not ebbed.

"The most important finding is that we've really made great progress in reducing the number of foodborne infections for some particular pathogens, or bacteria," said Dr. Matthew Moore, a medical epidemiologist at the CDC. "But there's still a lot we need to do. There's still a lot needed to reduce the risk of other foodborne infections."

Salmonella poisoning was the most common type of foodborne illness with 6,028 laboratory-confirmed cases in 2002, according to the study, published recently in the CDC's Morbidity and Mortality Weekly Report. Salmonella infections have increased since 2000, according to the report.

E. coli (Escherichia coli) O157 were found to be the cause of 673 of the laboratory-confirmed cases in 2002. The bacteria, related to those that normally inhabit the intestine, can be transmitted through food, water and direct contact with animals, Moore said. This strain emits a toxin that can cause dangerous, even life-threatening infections.

"I think what it means, this lack of a sustained decline in E. coli O157 indicates a real need for increased efforts to reduce the burden of these infections," Moore said.

Researchers said the results reveal that more efforts are needed to reduce the risk of illness. According to the report, "the majority of foodborne illnesses are neither laboratory-diagnosed nor reported to state health departments."

But there are steps people can take on their own to guard against infection, such as washing and cooking foods thoroughly and washing their hands.

"The simple things still are very important," Moore said.

The analysis was based on the CDC's FoodNet program, the Foodborne Diseases Active Surveillance Network, which tracked foodborne illnesses in nine regions.

A collaborative effort of the CDC, the Department of Agriculture, the Food and Drug Administration (news - web sites), and several state health departments, the FoodNet program currently monitors reports from a catchment area of over 37 million people, or about 13 percent of the US population.

The CDC calls for more "targeted efforts to reduce the rate of foodborne illnesses," including preventive controls on farms.

Source: Morbidity and Mortality Weekly Report 2003;52:340-343.

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WEDNESDAY, APRIL 23, 2003

Sleeping Pills that Aren't

(HealthScoutNews) -- Do your prescription bottles include little labels that warn, This medication may make you drowsy?

You'd better believe them, according to the Journal of the American Geriatric Society.

Researchers from the UCLA School of Medicine in Los Angeles studied how to predict fatigue in the elderly. They studied 199 people who had an average age of 88.

The researchers considered things like pain scores, number of disease conditions, gender and age. And they found that none of these factors was a good predictor of elderly fatigue.

When it comes to fatigue, the researchers found, it's not how many diseases you have, but how many drugs you're taking to treat them.

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Hospital Water Systems May Harbor Harmful Molds

Reuters Health
Wednesday, April 23, 2003

NEW YORK (Reuters Health) - Hospital water distribution systems may serve as an important reservoir of several varieties of disease-causing molds, researchers report.

Hospital-acquired mold infections can be an important cause of illness and death in patients with weakened immune systems, according to Dr. Elias J. Anaissie, from the University of Arkansas for Medical Sciences in Little Rock, and colleagues. Such infections are thought to arise from contaminated outdoor air that infiltrates hospital ventilation systems.

Despite the widespread use of special air filters, the incidence of mold infections continues to rise, suggesting that other sources for these pathogens must exist. Previous reports have shown that water systems can be colonized with such molds.

To investigate, Anaissie's group assessed mold levels in various environmental samples from a bone marrow transplantation unit outfitted with the best air precautions.

Molds were isolated from 70 percent of the 398 water samples that were obtained, the authors report in the April 1st issue of the journal Blood. Furthermore, 22 percent of 1,311 surface swabs and 83 percent of 264 indoor air samples harbored molds.

The authors note that several findings suggest that the airborne molds probably came from water sources.

Airborne levels were highest in rooms where water was typically used, such as bathrooms, they point out. Moreover, airborne molds corresponded closely to ones present in hospital water.

"Our findings suggest that, in hospitals with adequate air precautions, airborne molds originate from hospital water and not contaminated outside air," the investigators state.

"An effective and inexpensive approach to prevent patient exposure to waterborne molds in the hospital setting is to provide high-risk patients with sterile (boiled) water for drinking and sterile sponges for bathing," the authors note. Thorough cleaning of shower room floors may also help reduce airborne levels of disease-causing molds, they add.

Source: Blood 2003;101:2542-2546.

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Vitamin D: New Weapon in Battle Against Breast Cancer?

By Steven E. Reinberg
HealthScoutNews Reporter
HealthScoutNews
Wednesday, April 23, 2003

WEDNESDAY, April 23 (HealthScoutNews) -- The addition of a vitamin D analog to radiation therapy is more effective in killing breast cancer (news - web sites) cells than radiation alone, a new study suggests.

About 200,000 American women are diagnosed with breast cancer each year and about 40,000 die. Radiation therapy is often used before surgery to reduce the size of tumors and after surgery to reduce recurrence of tumors.

Other studies have shown vitamin D interferes with tumor growth in both cell cultures and animals, study co-author David A. Gewirtz says. This has been shown for both breast and prostate cancer (news - web sites), he notes.

Because high doses of vitamin D can be toxic, Gewirtz and his colleagues are experimenting with vitamin D analogs, modified forms of natural vitamin D that are less toxic. Their goal is to see if these analogs can enhance the response to radiation therapy.

In this study, Gewirtz, a professor of pharmacology and toxicology at Virginia Commonwealth University, and his colleagues found that when they treated breast cancer cells in a laboratory setting with normal doses of a vitamin D analog (ILX 23-7553) before radiation, the response to radiation was enhanced.

Lower doses of radiation were needed and there was an increase in tumor cell death, Gewirtz says. In fact, vitamin D helped reduce the number of cancer cells by almost 30 percent more than radiation alone.

The study appears in the May issue of Cancer Chemotherapy and Pharmacology.

After treatment with the vitamin D analog and radiation, tumor cells continued to die for seven days, while cells treated with radiation alone did not. Treatment with the vitamin D analog was three times more effective in preventing new tumor growth, compared with radiation therapy alone, the study says.

"In addition, this combination was not toxic to normal cells," Gewirtz says.

He cautions these results were produced in cell cultures, and one should be careful before applying them to treating breast cancer in women. Currently, the vitamin D analog is not being tested in humans in the United States. However, it is being tested in humans in Europe, he says.

In a forthcoming paper, Gewirtz says he and his colleagues show the same effect is found when breast tumors are grown in mice.

"There is also evidence that using a vitamin D analog and radiation prevents cancer cells from growing back," Gewirtz says. Based on these findings, combined treatment with a vitamin D analog and radiation may contribute to preventing recurrence of cancer, he adds.

"We think that this treatment may also have implications for treating radiation-resistant brain tumors and prostate cancer," Gewirtz says. "That's the direction of our work."

Dr. Lamar McGinnis, a medical consultant for the American Cancer Society (news - web sites), says that although the effect was only seen in cultured cells, "it appears that this vitamin D compound is a radio sensitizer for cancer cells and results in a greater kill rate with a sustained effect."

With radiation therapy, there is always a balance in killing cancer cells and protecting normal cells, he adds. If these findings pan out in human trials, controlling cell growth within tumors could be enhanced, he notes.

"It is an interesting observation and I await the results of clinical trials, particularly since this compound seems to have no significant side effects," McGinnis says. "If it works out, it could offer a significant benefit to cancer patients."

More information

To learn more about breast cancer, visit the National Breast Cancer Coalition. For more on vitamin D, check with the National Institutes of Health.

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Obesity Behind 90,000 Cancer Deaths Each Year

By Alison McCook
Reuters Health
Wednesday, April 23, 2003

NEW YORK (Reuters Health) - A significant proportion of deaths from cancer may be due to excess body weight and obesity, according to an American Cancer Society (news - web sites) report.

Based on a study involving almost one million adults, the researchers conclude that 14 percent of deaths from cancer in men and 20 percent of cancer deaths in women may be due to being overweight and obese.

The study's authors estimate that more than 90,000 cancer deaths each year could be avoided if every American maintained a healthy weight.

"Obesity is related to most cancer sites, not just a select few," study author Dr. Eugenia E. Calle told Reuters Health.

Calle said she hopes these results help people understand the devastating impact being overweight or obese can have on health.

"I'm hoping that this study will increase the public awareness that this is yet another important health outcome that obesity puts you at higher risk for," Calle noted.

During the 16-year study, Calle and her colleagues followed more than 900,000 U.S. adults who were free of cancer in 1982, noting if any died of the disease. The researchers measured body weight using body mass index, which takes into account weight and height.

Compared to people of normal weight, those who were overweight and obese had a higher risk of death from a host of different cancers, according to a report in The New England Journal of Medicine (news - web sites).

Among both sexes, excess body weight upped the risk of death from cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas and kidney, as well as for non-Hodgkin's lymphoma and multiple myeloma.

In men, the heaviest individuals were more likely to die from cancer of the stomach and prostate. In women, excess deaths were seen for cancer of the breast, uterus, cervix and ovary.

And the higher the BMI, the more likely a person was to die from cancer, the researchers report.

A BMI of between 18.5 and 24.9 is considered normal, between 25.0 and 29.9 overweight, and 30.0 or more obese.

Among the heaviest people -- with BMIs of at least 40 -- the risk of death from cancer of any type was 52 percent higher in men and 62 percent higher in women than in people with normal BMIs.

"The more weight you have, the higher the risk," Calle said in an interview.

However, the fact that death risk appears to increase incrementally with body weight is somewhat encouraging, she added.

"Losing any kind of weight would help," Calle noted.

She explained that the current study measures risk of death from cancer, but not the risk of developing the disease. Previous research in breast cancer (news - web sites) has shown that carrying extra weight can increase the risk of both getting and dying from the disease, Calle said, but for other types of cancer, that may not be the case.

Although the exact reasons why obesity might increase cancer death risk are unclear, Calle said that people with relatively high BMIs also tend to have higher levels of hormones in their bodies, which can predispose them to cancer.

In addition, research suggests that carrying excess weight in the abdomen can disrupt the metabolism of insulin, resulting in a condition that can increase cancer risks, she explained.

People who are obese are also more likely to develop gallstones and reflux disease, which can lead to chronic inflammation in the body and, subsequently, certain types of cancer, Calle added.

In a related editorial, Drs. Hans-Olov Adami of the Karolinska Institute in Sweden and Dimitrios Trichopoulos of Harvard University in Boston write that this is not the first study to suggest that excess body weight increases cancer risk.

However, they write that programs aimed at preventing cancer through weight control have been stymied by a number of reasons, including the fact that other factors such as smoking play a larger role, and researchers remain uncertain why being overweight influences cancer risk.

It remains to be seen whether the latest findings "will provide the necessary additional motivation for controlling body weight in the United States and around the world," Adami and Trichopoulos write.

Trichopoulos has received fees from NutraSweet and Coca-Cola.

Source: The New England Journal of Medicine 2003;348:1625-1638.

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Study Gets Handle on Deadly Heart Condition in Kids

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Wednesday, April 23, 2003

WEDNESDAY, April 23 (HealthScoutNews) -- A first-ever report from a data registry on the often-fatal childhood condition called pediatric cardiomyopathy confounds some widely held medical views.

However, it also points the way toward better diagnosis and perhaps even treatment, says the man who started the registry.

The report finds the rare condition is likelier to strike boys than girls, and is more common among blacks and Hispanics than whites.

Cardiomyopathy consists of a family of conditions that affect the heart muscle. About 1,000 children are born in the United States each year with one form or another of cardiomyopathy.

While enormous strides have been made in treating conditions caused by problems with the heart's blood vessels, little progress has been made on heart muscle problems. A transplant is the only hope for many young cardiomyopathy patients and "the time to transplantation or death for children with cardiomyopathy has not improved during the last 35 years," says a report in the April 24 issue of The New England Journal of Medicine (news - web sites).

That report offers no miracle cure or treatment. Instead, it lays out precise numbers about pediatric cardiomyopathy -- when it is diagnosed, its incidence in different ethnic groups, the percentage of the different kinds of cardiomyopathy, and so on -- for two regions of the United States. They are New England and the central southwest region, which includes Texas, Oklahoma and Arkansas.

Those numbers alone represent a major advance, says study author Dr. Steven E. Lipshultz, who started the Pediatric Cardiomyopathy Registry when he was at Boston Children's Hospital. He is now a professor of pediatrics at the University of Rochester School of Medicine in New York.

For example, they show that many textbooks are flat wrong in a lot of the things they say about the condition, Lipshultz says. "If you look at some of the current textbooks in pediatric cardiology, you will find they state that hypertrophic cardiomyopathy [in which the heart muscle is abnormally thickened] is rare in adolescents. That is not true."

The registry says 42 percent of cases are hypertrophic, while 51 percent are dilated, in which the heart muscle expands abnormally, with scattered other causes accounting for the remainder.

And while pediatric cardiologists said in a survey the condition could be detected at almost any age, the registry shows most cases being diagnosed in the first year of life, Lipshultz says. "That suggests that many of the causes are genetic, while in adults many cases are related to health habit issues," he says.

Other indicators that genetics is important are striking differences in incidence between the sexes and ethnic groups.

The incidence is 1.32 per 1,000 in boys compared to 0.92 per 1,000 in girls, in large part because several genes for neuromuscular disease that can also cause cardiomyopathy are more common in boys.

The condition is more common in black children (1.4 cases per 1,000) and in Hispanics (1.41 per 1,000) than in whites (1.06 per 1,000). The incidence was about 50 percent higher in the Southwest than in New England, a finding that leaves the researchers puzzled.

The effect of genetics can be important in early detection, Lipshultz says. It is important to screen other family members when a case is diagnosed, he says, to pick up cardiomyopathy that may be causing few or no symptoms.

What he also finds striking is that an epidemiological study done in Australia, and reported in the same issue of the journal, produces very similar numbers. "These two studies, done without knowledge of each other, have come up with almost the same results," Lipshultz says.

That study, led by Dr. Robert G. Weintraub of the Royal Children's Hospital in Melbourne, covered all known cases diagnosed in children 10 and under between 1987 and 1996. It found about the same overall incidence, 1.24 per 1,000, the same concentration of diagnoses in the first year of life and the same higher incidence in a minority group, in this case Australian aborigines (2.47 per 1,000).

"It is remarkable" the studies have similar results, but also fortunate, Weintraub says. "We think that the two studies serve as external validation to each other."

Weintraub is director of the heart transplant program at Royal Children's Hospital, which serves all of Australia. He says the study was undertaken "to better gain an appreciation of how to plan heart transplantation for those children who require it." The study has helped to give "a better appreciation of how these cases present and behave, so we can make long-term predictions about which children will require transplants."

More information

You can get detailed information about cardiomyopathy from the National Heart, Lung, and Blood Institute. You can also read about children and heart disease from the American Heart Association.

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Gene Found for Blind, Deaf Syndrome in Children

By Keith Mulvihill
Reuters Health
Wednesday, April 23, 2003

NEW YORK (Reuters Health) - Scientists have identified a gene mutation associated with one form of Usher syndrome -- an inherited disorder in which children are born deaf and later lose their sight.

The discovery may present an opportunity for earlier identification of children with type I Usher syndrome, particularly children of Ashkenazi Jewish descent, according to a team led by Dr. Thomas B. Friedman of the National Institute on Deafness and Other Communication Disorders.

The newly identified mutation, called R245X, seems to cause a large proportion of cases of type I Usher syndrome in Ashkenazi Jews -- a branch of European Jews who historically settled in Central and Northern Europe. However, the disorder is not believed to be more common in Ashkenazi Jews than in the general population.

There are three types of Usher syndrome, and type I is the most severe. Children born with the type I syndrome are born deaf and, by around the age of ten, become blind due to retinitis pigmentosa -- a degenerative eye disease. Often, a diagnosis of type I Usher syndrome does not come until the onset of eye degeneration.

Currently, scientists have identified five out of a total of seven genes believed to be responsible for type I Usher syndrome, Friedman explained during an interview with Reuters Health.

The research group hopes that the findings will help doctors develop diagnostic tools to distinguish between people with the other, less severe forms of Usher syndrome in which children may not be completely deaf. This is important in helping patients know their prognosis.

"This disability is ascertained early in the child's life and appropriate rehabilitation for the disability is initiated soon after birth and continued throughout development," Friedman told Reuters Health.

"What is truly sad is that these same children will begin to experience vision loss around the age of 10 and eventually they will be both deaf and blind. This eventuality saddles them with a dual neurosensory deficit."

"If this dual neurosensory deficit could be correctly anticipated, then, potentially, such individuals could receive training and/or medical interventions that might help them to compensate for both of these daunting problems," said Friedman.

Conventional hearing aids (news - web sites) are typically inadequate for the profound levels of hearing loss in type I Usher syndrome, whereas electronic devices called cochlear implants appear to be highly effective in restoring useful hearing, he explained.

"Since the ability to see and read lips is an important part of oral speech and hearing rehabilitation after cochlear implant surgery, the results with a cochlear implant can be expected to be better if the implant is performed early and before the loss of sight occurs," Friedman said.

In the new study, published in Thursday's issue of The New England Journal of Medicine (news - web sites), Friedman's team identified the R245X gene mutation after analyzing the DNA of 18 affected persons from 12 unrelated families.

Genetic tests performed on a sample of Ashkenazi Jews in New York and Israel found that from 0.79 percent to 2.48 percent carried a copy of the defective gene. Carriers who have just one, not two, copies of the mutation do not develop the disorder, but they can pass on the mutation to their descendents.

Based on the findings, the researchers conclude that children of Ashkenazi descent who are born deaf should be tested for the R245X mutation and undergo eye testing.

Although the new gene mutation discovery appears to only be associated with Ashkenazi Jews, the actual incidence rate of type I Usher syndrome is thought to be the same among Ashkenazi Jews as the general population, explained Friedman.

Usher syndrome is estimated to affect about 1 in 16,000 to 1 in 50,000 people. It is the most frequent cause of combined deafness and blindness in adults.

Source: The New England Journal of Medicine 2003;348:1664-1670.

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Light Therapy May Boost Hormone Levels

By Randy Dotinga
HealthScoutNews Reporter
HealthScoutNews
Wednesday, April 23, 2003

WEDNESDAY, April 23 (HealthScoutNews) -- Researchers who have been exploring the effects of light therapy on mood are reporting that exposure to ultra-bright lamps appears to boost the body's ability to produce hormones.

The importance of the finding isn't yet clear. But it's possible that light therapy could one day be used to control ovulation in women or treat people who take antidepressants and find themselves with low sex drives, the researchers say.

"It's a very promising lead," says study co-author Dr. Daniel Kripke, a professor of psychiatry at the University of California at San Diego. Light therapy is natural and could be a safe and effective way to "accomplish some important health goals," he says.

Researchers have known for decades that exposure to light affects the way animals live. Changes in the light from the sun, for example, automatically set off hibernation in some mammals. Seasonal changes in light also control reproduction in rats and mice so they only mate during warmer months, Kripke says.

Researchers are still working to understand how exposure to light affects humans. Kripke and colleagues discovered two decades ago that light therapy -- shining powerful lamps at people's eyes -- affects mood. Light therapy has become a common treatment for seasonal affective disorder, a type of depression that strikes when days grow shorter.

In his new study, Kripke enlisted 11 healthy male volunteers, aged 19 to 30, to test whether light affects the body levels of luteinizing hormone, which is produced by the pituitary gland and assists in the production of other hormones, such as testosterone, in men. The men woke at 5 a.m. for five days and spent an hour in front of a light box giving off 1,000 lux, or much more brightness than typical indoor lighting. Later, they spent five days in front of a light box that only gave out 10 lux.

The findings of the study, supported by the National Institutes of Health (news - web sites), appear in the April 24 issue of the journal Neuroscience Letters.

Researchers found the body levels of luteinizing hormone grew by 69.5 percent in the men while they were exposed to the high levels of light.

The researchers didn't look at women because the rapidly cycling hormones in their bodies would make it difficult to study the effect of light, Kripke says. However, luteinizing hormone does affect ovulation, he adds, and "we think light is potentially a very promising treatment for women who have ovulatory problems or long and irregular menstrual cycles."

Light therapy could also boost testosterone in men, potentially increasing sexual potency and muscle mass, he says. Researchers, however, didn't monitor testosterone levels in the men.

The researchers hope to test light therapy on people with low sex drives and on postmenopausal women.

A hormone expert cautioned that plenty of research is still needed. The newly released study was relatively small, and it's not clear the changes in the level of the hormone are significant enough to actually cause changes in the body, says Dr. Ronald Swerdloff, chief of the division of endocrinology at Harbor UCLA Medical Center, part of the University of California at Los Angeles School of Medicine.

"I don't think it's clear where this is going to take us," he says.

More information

Learn more about light therapy from the Society for Light Treatment and Biological Rhythms or the University of Washington, which offers a fact sheet about its use to treat seasonal affective disorder and other conditions.

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Antidepressant Use Not Linked to Birth Defects

By Keith Mulvihill
Reuters Health
Wednesday, April 23, 2003

NEW YORK (Reuters Health) - Pregnant women who take selective serotonin reuptake inhibitors (SSRIs), the class of antidepressants that includes Prozac, Paxil and Zoloft, appear to be no more likely to have a baby with birth defects than other women, according to a study by California scientists.

"This study found no evidence that SSRI antidepressants used during pregnancy increase the risk of congenital malformations, low birth weight or preterm labor," said the study's lead author Dr. Victoria Hendrick of the University of California in Los Angeles.

"These findings extend previous studies that have similarly reported no association between prenatal use of SSRIs and congenital malformations or low birth weight," she told Reuters Health.

Further, although some research has suggested that SSRI antidepressants might increase the risk for early labor, "we did not find an elevated risk of preterm labor," Hendrick adds.

In their study, Hendrick's team evaluated the birth outcomes of 138 healthy non-smoking pregnant women between the ages of 24 and 44. All of the women began prenatal care early in their pregnancy, the authors report in the American Journal of Obstetrics and Gynecology (news - web sites).

Eighty-five women took an SSRI throughout their entire pregnancy, while the remaining women started the medication sometime during their pregnancy. SSRI medications taken by the women included Paxil (paroxetine), Prozac (fluoxetine) Zoloft (sertraline) and Luvox (fluvoxamine), the study indicates.

Overall, the rate of major birth defects was 1.4 percent, similar to that seen in the general population, according to the report.

The drugs were also not associated with an increased risk for low birth weight or preterm babies, but three women taking relatively high doses of Prozac -- 40 or 80 milligrams -- had low birthweight babies.

However, this may have been due to their depression and not necessarily the drug, according to the report. Depressed women may eat less during pregnancy and thus gain less weight, putting their baby at risk for low birth weight. However, the researchers did not find any difference in weight gain in those women taking high doses of Prozac and other study participants.

"Given the small number of low birth weight infants in this study, these findings should be considered preliminary," Hendrick's team write.

"We tell pregnant women that the available data are mostly reassuring but certain reports remain to be explored further -- such as reports describing an increase in perinatal complications in newborns like jitteriness and (rapid breathing) ... and reports of a possible increase in the risk of preterm birth," said Hendrick.

"Therefore we recommend that pregnant women try to minimize the use of antidepressants whenever possible, and that they maximize the use of nonpharmacologic options (such as) psychotherapy, couples counseling, or group support," concluded Hendrick. The study was funded by grants from the National Institute of Mental Health, the National Centers for Research Resources at the National Institutes of Health (news - web sites) and the National Institute of Child Health and Human Development.

Source: American Journal of Obstetrics and Gynecology 2003;188:812-815.

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Implanted Device Prevents GERD

HealthScoutNews
Wednesday, April 23, 2003

WEDNESDAY, April 23 (HealthScoutNews) -- A permanently implanted device to prevent the symptoms of gastroesophageal reflux disease (GERD) has been approved by the U.S. Food and Drug Administration (news - web sites).

GERD symptoms -- including heartburn and a burning sensation in the chest or back of the throat -- occur when stomach acid backs up into the esophagus. More than 60 million Americans have the disease and 25 million have daily symptoms. Chronic GERD often requires daily medication.

Enteryx, produced by the Boston Scientific subsidiary Enteric Medical Technologies, comprises a polymer device and a solvent. After implantation, the solvent separates away and the polymer solidifies into a spongy material that binds to the implantation site in the lower esophagus, preventing the fluid backup.

In a 12-month study of 85 people in the United States, Canada, and Europe, the device allowed 67 percent of all participants to stop all of their GERD medications. Another 9 percent said they could reduce their use of the GERD drugs by half.

Enteryx shouldn't be used in people who have dilated veins in the esophagus due to liver disease. Also, it can't be implanted in people who cannot tolerate a procedure involving use of endoscopic equipment in the lower throat.

The most common side effect of the device was pain beneath the breastbone, which usually subsided within two weeks. Others included temporary difficulty swallowing, fever, sore throat, and gas/bloating.

Here is the FDA Talk Paper announcing the approval. For more information about GERD, visit the National Institute of Diabetes and Digestive and Kidney Diseases.

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Lifestyle Changes Alone May Lower Blood Pressure

By Michael Conlon
Reuters
Wednesday, April 23, 2003

CHICAGO (Reuters) - A study said to be the first to test the impact of a combination of lifestyle changes on high blood pressure has found that mildly elevated blood pressure can be lowered without drugs, researchers say.

The beneficial changes in the study were 180 minutes of moderately intense exercise per week, a reduced-fat diet featuring more fruits and vegetables, weight loss of at least 15 pounds, reduced sodium intake and limiting alcoholic beverages to one per day for women, two for men.

"Our study shows that people can simultaneously make multiple lifestyle changes that lower their blood pressure and improve their health," Dr. Lawrence Appel, a professor of medicine at Johns Hopkins University who chaired the study, said Tuesday.

"The key issue now is helping people maintain these changes so they don't revert back to less healthy behaviors," he said, adding that "it may ... be a means to control blood pressure and a lot of heart disease and stroke without actually relying on medication."

The government-sponsored study involved more than 800 adults with an average age of 50 who were not on blood pressure drugs. In general, they were overweight and sedentary and all had "above-optimal" blood pressure readings, including some with mild, stage 1 hypertension.

Optimal blood pressure is a systolic blood pressure (the first number in a blood-pressure reading) of less than 120 mm Hg, and a diastolic pressure (the second number) of less than 80.

The report is published in the April 23rd issue of the Journal of the American Medical Association (news - web sites).

"Previous studies had established that each one (of the changes) lowered blood pressure, but no study had combined all," study co-author Dr. Laura Svetkey, of the Duke University Hypertension Center, said in an interview.

During the six-month study, some participants were given 30 minutes with a dietitian who offered general advice on lowering blood pressure; a second group received 18 counseling sessions on losing weight, reducing salt and increasing exercise; and a third group got the same 18 sessions plus information on a diet emphasizing fruits, vegetables and low-fat dairy products, but reduced in fats, red meat, sweets and sugared beverages.

While all three groups lowered their blood pressure, the third group did the best, with twice the success of the group that got only a half-hour of counseling.

At the end of the study only 27 people in all three groups required blood pressure drugs, the authors said.

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Don't Doctor Yourself for a Vaginal Infection

HealthScoutNews
Wednesday, April 23, 2003

TUESDAY, April 22 (HealthScoutNews) -- Women with vaginal itching and discharge shouldn't be too quick to self-diagnose a yeast infection.

That's the advice in a recent issue of Mayo Clinic Women's HealthSource.

Women who have what is a common problem should consult their doctor or another health professional. There are several other conditions, some serious, with symptoms similar to yeast infection.

Over-the-counter medications such as anti-fungal creams and vaginal suppositories generally work against yeast infections but aren't able to treat other vaginal problems.

Other conditions with symptoms similar to yeast infection include:

  • Bacterial vaginosis, which is caused by bacteria, not yeast. Antibiotics are the best treatment.
  • Trichomoniasis. It's caused by a tiny single-celled parasite and can be transmitted through intercourse. It can be treated with antibiotics.
  • Chlamydia. This is a common, primarily sexually transmitted infection of the cervix. It can lead to serious medical complications such as infertility. It requires antibiotic treatment.
  • Noninfectious vaginitis, which may be caused by an allergic reaction to vaginal sprays, douches or spermicidal products. Avoid these products if they cause irritation.

More information

To learn more, go to the American College of Obstetricians and Gynecologists.

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Less Fat in Diet Linked to Injury Risk in Runners

By Alison McCook
Reuters Health
Wednesday, April 23, 2003

NEW YORK (Reuters Health) - Female recreational runners who eat an average amount of fat in their diets may be less likely than those who opt for a slightly more restrictive cuisine to develop injuries, new study findings suggest.

These results contradict a "common attitude" among female runners that a low-fat and low-cal diet may reduce the risk of injury, study author Kristen E. Gerlach, a Ph.D. student at the University at Buffalo in New York told Reuters Health.

"The idea is, the lighter you are, the faster you'll run," she said. Moreover, Gerlach noted that some runners believe that a lighter body, which sustains less pounding on the joints, may also protect them from injury.

However, Gerlach and her colleagues found that women whose diet consisted of 30 percent of calories from fat -- a healthy amount, according to experts -- were less likely to be injured during a year of running than women whose diet consisted of only 27 percent of calories from fat.

"So it wasn't a huge difference, but the trend was definitely there for injured runners to be eating less fat," Gerlach said.

"Maybe runners in general, women runners, shouldn't be afraid of a moderate amount of fat intake," she added. "Eating a treat now and then might actually be beneficial to their running."

Gerlach and her colleagues obtained their findings after following 87 adult female recreational runners for one year, noting their diets and whether they developed injuries. The participants ran an average of 30 miles per week.

Fifty-five percent of the female runners developed an injury over the course of the year, the authors reported recently at the annual Experimental Biology meeting in San Diego, California.

Injured and non-injured runners tended to maintain the same amount of physical activity, but women who developed injuries tended to eat a diet that was lower in fat and calories than did women who remained injury-free.

On average, women runners who developed injuries ate 63 grams of fat per day in their diet, while those who escaped injury reported intakes of 80 grams of fat each day.

Gerlach noted that even runners who adopted a more restrictive diet still ate a quantity of fat that is considered normal for active women.

The researcher said that workouts can cause microscopic muscle damage. And women who ate relatively low levels of fat and calories may not have been taking in enough nutrients to repair that minor damage, she suggested, putting them at higher risk of injury during their next workout.

"These runners probably weren't taking in enough calories and nutrients to recover from a difficult workout," she noted.

Alternatively, Gerlach said that previous research has suggested that a very low-fat diet -- more restrictive than the one adopted by injured runners in this study -- can reduce endurance. Women who adopted even moderately low-fat diets may also have less endurance than others, she said, putting them at risk of a fatigue-related injury.

She said she is not sure whether the findings apply to men, as well, and suggested that the relationship between fat intake and risk of injury in men may not be as strong as it is in women.

Other factors that increased the risk of injury among women runners included a history of previous injury, difference in leg length, and poor flexibility, especially in the calves.

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A Rundown on Shin Splints

By Dennis Thompson Jr.
HealthScoutNews Reporter
HealthScoutNews
Wednesday, April 23, 2003

WEDNESDAY, April 23 (HealthScoutNews) -- Vows to exercise spring eternal this time of year, as many people set out to shed the extra pounds they gained during winter.

But if jogging is your workout of choice and you overdo it, your attempt to get fit could end in pain and frustration when you contract a nasty case of shin splints.

The enemy of marathon runners, fitness junkies, even weekend warriors, shin splints occur when people dive back into exercise and try to do too much too soon.

They occur most commonly when either tendons -- the tough bands of tissue that connect muscle to bone -- or the lining of the shin bone become inflamed after absorbing too much impact during strenuous exercise.

Exercise most likely to produce shin splints includes running on hard surfaces and those sports in which a lot of jumping is involved.

The best way to deal with shin splints is to avoid them altogether by gradually ramping up your exercise regimen to avoid overstress, says Dr. Henry Goitz, chief of sports medicine for the Medical College of Ohio in Toledo.

You also should stretch before any exercise and use weight training to ensure that the muscles are fit enough to absorb stress that could injure the tendons or bone, he says.

"The greater the demand you want to place on your body, the greater the preparation you want to employ," Goitz says. "You don't want to run a marathon day one. Listen to your body. Gradually increase the distance."

You also might want to consider varying your exercise routine to keep from falling into a repetitive pattern that could lead to shin splints.

"It's usually overuse that causes them," says Lori DeRosia, head fitness coach of the Courthouse Athletic Club in Salem, Ore. "When you're doing the same thing over and over, that's when you're more likely to get them."

DeRosia suffered from shin splints once herself. "They hurt like hell," she says. "It was just from overtraining, and I was teaching too many exercise classes." She found that ibuprofen and stretching were her personal keys to beating them back.

DeRosia says if she sees someone running six days a week, "I tell them to get on the bike or something. Get in the water. Try something different."

If you believe you have developed shin splints, the first thing you should do is see your doctor to make sure you don't actually have a stress fracture. These tiny, almost invisible breaks in the bone can heal with enough rest, but they must be detected or they could lead to a full-blown fracture.

Once you're sure that you are suffering from true shin splints, the worst thing you can do is take it easy, wait for the pain to go away and then start back up with your routine, Goitz says.

"You can't just take time off and expect everything to go away," he says. "When you pick up where you left off, so too will the shin splints."

Goitz recommends that you first attack the pain by taking anti-inflammation medications like aspirin or ibuprofen.

You then should enter into a low-impact regimen of stretching and weight training, to prepare your leg muscles to absorb more shock once you are ready to restart your exercise regime.

"While you're giving the bone a chance to rest, the muscle should be strengthened," Goitz says. "I can guarantee that if you don't do that, all those symptoms will come back."

Other tips for avoiding shin splints from the American Academy of Orthopaedic Surgeons include:

  • Purchasing running shoes that provide good shock absorption, stability and cushioning to the foot.
  • Replacing running shoes every nine to 12 months, particularly if you run up to 10 miles per week. Sixty percent of a shoe's shock absorption is lost after 250 to 500 miles of use.
  • Running on a clear, smooth, even and reasonably soft surface. Avoid running on hills, which will increase stress on the ankle and foot.

More information

To learn more about shin splints and treating them, visit Rice University or the American Academy of Orthopaedic Surgeons.

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TUESDAY, APRIL 22, 2003

Taking the Itch Out of Eczema

HealthScoutNews
Tuesday, April 22, 2003

TUESDAY, April 22 (HealthScoutNews) -- Long-term management that combines new and old kinds of therapy is the recommended approach for treating eczema.

That opinion comes from international dermatology experts in a report in the May issue of the British Journal of Dermatology.

Eczema is an itchy rash that affects many infants and children. It affects between 10 percent to 15 percent of children under age 5 in developed countries and the number of cases are increasing.

Previously, doctors focused on treating acute attacks of eczema with short courses of corticosteroid creams. Safety concerns have led to restrictions on the intensity and duration of topical corticosteroid use, especially in small children and in delicate areas of the body such as the face, neck and skin folds.

This new report says that new medications called calcineurin inhibitors should be used to relieve eczema symptoms over the long-term. These new medicated creams turn off specific inflammatory cells in the skin that cause eczema-related redness and broken skin.

Topical calcineurin inhibitors are not steroids and don't cause the skin atrophy, blood vessel growth, glaucoma or growth retardation associated with corticosteroids, the experts note.

The new treatment approach was adopted by experts from 10 countries who attended the 2nd International Consensus Conference on Atopic Dematitis. The conference was sponsored by a grant from Novartis Pharmaceuticals, which makes a calcineurin inhibitor medication.

More information

Here's where you can learn more about eczema.

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Study May Explain Lung Condition's High Death Rate

By Jacqueline Stenson
Reuters Health
Tuesday, April 22, 2003

NEW YORK (Reuters Health) - New study findings help explain why many critically ill patients with a serious lung condition known as acute respiratory distress syndrome (ARDS) die, researchers reported Wednesday.

ARDS, which can result from pneumonia, trauma, major infection or other factors, causes inflammation and fluid build-up in the lungs. But the most common reason that around one third of patients die is that organs other than the lungs begin to fail, in a condition called multiple organ dysfunction syndrome (MODS).

MODS proves fatal 60 percent or more of the time.

In the last several years, doctors have found that the method of mechanical ventilation used on ARDS patients to help them breathe can make a substantial difference in their survival.

A newer "lung-protective" ventilation strategy has been shown to help reduce MODS and deaths, although the reason has been unclear.

With this approach, the ventilator is set up to administer smaller breaths of air than the conventional method and to keep the lungs more inflated at the end of each breath, explained Dr. Arthur S. Slutsky, an author of the new study and a professor of medicine and surgery at the University of Toronto in Ontario, Canada.

In their report, published in the April 23rd/30th issue of the Journal of the American Medical Association (news - web sites), Slutsky and colleagues offer new insights on why the lung-protective strategy saves more lives than the conventional approach.

In the first of a series of experiments, the investigators used an animal model of ARDS to show that the conventional approach accelerated cell death in the kidneys and small intestines of rabbits, compared with the lung-protective strategy. The conventional approach also was associated with greater levels of biochemical markers indicating kidney dysfunction.

Then the researchers observed that rabbit kidney cells in a laboratory dish died off faster when exposed to blood taken from rabbits that had been subjected to the conventional approach. They also found that blocking a particular protein, called soluble Fas ligand, helped delay cell death. Past research has implicated this protein in promoting cell death.

Lastly, the investigators compared blood samples from 11 ARDS patients who had been ventilated with the conventional approach with those of another nine patients who'd had lung-protective ventilation.

Results showed that levels of soluble Fas ligand were higher in patients ventilated with the conventional tactic. And higher levels of the protein were linked to increases in the protein creatinine, a sign of kidney dysfunction.

As such, circulating levels of soluble Fas ligand may be involved in promoting MODS in patients on conventional ventilation, the researchers conclude.

The findings may help researchers develop new ways of combating MODS, which currently has no treatment, according to the authors.

Slutsky said the results confirm previous research showing that the newer ventilation strategy is optimal and should become standard at more hospitals.

"These finding offer more evidence for why doctors should be using it," he said.

The lung-protective strategy is not difficult to implement, according to Slutsky.

"This can be done with virtually any ventilator," he said. "It's pretty straightforward."

Source: Journal of the American Medical Association 2003;289:2104-2112.

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Coffee's Hidden Calories

HealthScoutNews
Tuesday, April 22, 2003

MONDAY, April 21 (HealthScoutNews) -- You're getting more than a dose of caffeine when you pick up your regular morning latte.

You might also be getting a mug full of calories, sugar and fat. For example, depending on the kind of milk and ingredients used, a large latte can be loaded with 250 to 570 calories, says a recent issue of the Mayo Clinic Women's HealthSource.

But there's no need to get all frothy over this information. You can still enjoy your java drink, as long as you follow these tips for a healthy coffee break:

  • Choose the smallest size cup -- either 8 or 12 ounces. That can save you 110 calories.
  • Get your coffee drink with fat-free milk instead of whole milk. That can save you about 80 calories and 8 grams of fat.
  • Replace sugar with sugar substitutes. Here's why. If you drink five cups of coffee a day with two teaspoons of sugar in each, you're taking in an extra 150 calories.
  • Do without the whipped cream, flavored syrup, or chocolate or candy toppings. They're loaded with calories.

More information

Here's information about coffee and your health.

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Five-Year Colon Cancer Screen May Be Too Frequent

Reuters Health
Tuesday, April 22, 2003

NEW YORK (Reuters Health) - Although guidelines recommend that adults older than 50 get sigmoidoscopy screening for colon cancer every five years, that may be unnecessarily frequent, a new study suggests.

However, one expert says the new findings alone are not enough to prompt changes to current screening recommendations.

Colorectal cancer screening methods include fecal occult blood testing, to identify blood in the stool; and colonoscopy and sigmoidoscopy, in which a physician inserts a flexible, lighted tube into the rectum and passes it through the colon to identify any polyps, or small growths, that can develop into cancer.

Colonoscopy examines the entire colon, while sigmoidoscopy looks only at the lower part.

Guidelines from the American Cancer Society (news - web sites) and others suggest that adults older than 50 receive sigmoidoscopy screening every five years, along with a yearly fecal occult blood test.

However, while sigmoidoscopy is known to slash colon cancer risk, it's unclear how long this benefit lasts after a screening, the authors of the new study note.

In fact, some have argued that once-in-a-lifetime sigmoidoscopy screening could be enough for average-risk people, Dr. Polly A. Newcomb and her colleagues write in the Journal of the National Cancer Institute (news - web sites).

They say that since it can take as long as 15 years for pre-cancerous growths called polyps to progress to cancer, sigmoidoscopy screening every five years may be "overly aggressive."

To investigate, the authors, from Fred Hutchinson Cancer Research Center in Seattle, studied nearly 1,700 people diagnosed with colon cancer and about 1,300 healthy adults.

They found that sigmoidoscopy screening appeared to cut the risk of cancer in the distal, or lower, colon by 74 percent.

Moreover, the researchers report, this reduced risk was "sustained for up to 16 years with little attenuation."

"Current recommendations regarding the frequency of sigmoidoscopy screening may be unnecessarily aggressive," Newcomb and her colleagues conclude.

However, in an accompanying editorial Dr. Jack S. Mandel stresses that this study -- called a case-control study -- is not the best type to determine cancer-screening policy and that altering the current recommendations is not the way to go.

"It would be premature to do so on the basis of results from this case-control study," writes Mandel, of Emory University in Atlanta.

He adds that "a more precise estimate of the benefit from sigmoidoscopy screening" should come from ongoing trials that are better designed to show the risks, benefits and cost-effectiveness of screening.

"Those results will provide a better basis on which to develop screening policy," Mandel writes.

The American Cancer Society predicts that 105,000 Americans will be diagnosed with colorectal cancer this year and 57,000 will die of it.

Source: Journal of the National Cancer Institute 2003;95:622-625.

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Simple Exercise Can Bring Seniors Back in Balance

HealthScoutNews
Tuesday, April 22, 2003

TUESDAY, April 22 (HealthScoutNews) -- A simple, inexpensive exercise program can help seniors achieve significant strength and balance improvements in just a few weeks and help protect them from falls.

These results come from a University of Arkansas-sponsored pilot outreach project.

The Project Urging Senior Health (PUSH) project was designed to demonstrate the ease of starting and maintaining senior exercise programs in the community. In a trial run, researchers implemented simple fitness programs at two senior centers in Arkansas.

The results were so impressive, the researchers suggest that similar programs across the country could greatly reduce the number of seniors who suffer falls and fall-related fractures.

The exercise program consisted of three 40-minute sessions per week. The seniors did stretching and strengthening exercises using therabands and exercise balls. At the end of 10 weeks, the 19 seniors being studied had statistically significant improvements in balance, strength and dynamic balance.

The researchers also found the exercise program improved the seniors' mental health and their levels of HDL ("good") cholesterol.

Their findings were presented at a recent meeting of the Association for Gerontology.

Falls present a serous health risk to seniors. One of three seniors who break a hip dies as a result of complications from the fracture.

More information

Here's where you can learn more about exercise for seniors.

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Age, Drinking Tied to Pedestrian Deaths in U.S.

Reuters Health
Tuesday, April 22, 2003

NEW YORK (Reuters Health) - One pedestrian is killed every 108 minutes in traffic accidents in the U.S., with young children, the elderly and those who've been drinking being the most vulnerable, federal officials reported Tuesday.

In 2001, there were 4,882 pedestrian fatalities from single-vehicle traffic accidents, according to the report by the National Highway Traffic Safety Administration (news - web sites) (NHTSA).

That was up slightly over the year before, and represents the first increase since 1995, according to the NHTSA.

Young children and the elderly were at particular risk, the report shows.

More than one-fifth of children between the ages of 5 and 9 killed in traffic accidents in 2001 were pedestrians. And older adults, ages 70 and up, accounted for nearly one-fifth of all pedestrian deaths and had the highest death rate of any age group.

In addition, alcohol use among pedestrians is a "major problem," according to the NHTSA. One-third of pedestrian victims -- as well as about 15 percent of drivers -- had blood alcohol levels that meet many states' criteria for intoxication.

"Clearly, some of the most vulnerable members of our society -- the young and the elderly -- are often the victims of serious pedestrian crashes," Dr. Jeffrey W. Runge, the NHTSA administrator, said in a statement.

"And the involvement of alcohol in many of these fatal crashes makes them especially senseless."

In other findings, roughly two-thirds of pedestrian deaths occurred at night (between 6 p.m. and 6 a.m.), and about the same percentage occurred in urban areas. More than 75 percent happened outside of intersections, and many occurred on roads without crosswalks.

Overall, men were more than twice as likely to be struck and killed as women. And a male driver, most often one in his 20s, was involved in almost two-thirds of the pedestrian deaths.

Among states, New Mexico, Arizona and Florida had the three highest pedestrian death rates. Five of the top 10 cities for pedestrian deaths were located in Florida.

North Dakota had the fewest fatalities, followed by Iowa and Nebraska.

In the report, the NHTSA recommends that states with the highest pedestrian fatality rates focus on developing special safety messages for pedestrians. These should highlight the increased risks tied to alcohol use, urban areas, roads without crosswalks and other factors.

The NHTSA also suggests that messages telling pedestrians to wear clothing that is more visible during evening hours, in addition to better lighting on darkened public roadways, might help reduce the number of pedestrian fatalities.

The report is available on the National Highway Traffic Safety Administration Web site at www.nhtsa.gov.

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Sunscreen Screens Sun's Rays Better Than Beta Carotene

By Jennifer Thomas
HealthScoutNews Reporter
HealthScoutNews
Tuesday, April 22, 2003

TUESDAY, April 22 (HealthScoutNews) -- It would be nice if you could just pop a pill to protect you from skin cancer.

But a new study shows the tried-but-true method of wearing sunscreen every day went a long way in warding off actinic keratoses, skin lesions caused by sun damage that signal a high risk of getting skin cancer later on.

Taking beta carotene supplements, meanwhile, did nothing to prevent the lesions.

"This study provides very rigorous documentation that daily use of an SPF 16 sunscreen will over a period of two years reduce the number of actinic keratoses," says Dr. Barbara Gilchrest, professor and chairwoman of dermatology at Boston University Medical Center. "These are a marker of sun damage and precursors to carcinomas."

The study appears in this week's Archives of Dermatology (news - web sites).

Researchers from the Queensland Institute of Medical Research in Australia divided 1,621 adults, aged 25 to 74, into two groups. One group applied sunscreen every morning to their head, neck, arms and hands. The other group used sunscreen at their own discretion.

Study participants were also assigned to take a 30-milligram tablet of beta carotene daily or a placebo.

Researchers found people who applied sunscreen daily had 24 percent fewer skin lesions than people who used sunscreen at their own discretion. This translates into one fewer skin lesion per person over the two-year study period.

No effect was seen among the people taking beta carotene compared to those taking a placebo tablet.

In an accompanying editorial, John L.M. Hawk of St. Thomas' Hospital in London praises the study.

"The study indicated yet again the great potential value of cutaneous sunscreen application, when undertaken conscientiously and carefully, against the now extremely well-documented ravages of sunlight," Hawk says.

Actinic keratoses, while they rarely develop into cancer, are strong predictors of future malignancies, Gilchrest says.

People who have a history of actinic keratoses have a three- to twelve-fold increased chance of developing basal cell carcinoma or squamous cell carcinomas, according to the study.

Beta carotene, an antioxidant found in many fruits and vegetables, had shown promise in preventing tumors in mice.

"Everybody would like to find an oral sunscreen because it's easier to pop a pill than put something on your skin," Gilchrest says. "But this is not the first to show beta carotene has no protective effect. We have excellent sunscreens and it's clear that they work. People should use those."

In the study, the people who used sunscreen daily were compared not to those who didn't use sunscreen, but to those who used sunscreen "at their discretion."

This is an important distinction, she says.

In Australia, there have been aggressive education campaigns about the dangers of sun exposure. As a result, Australians tend to use sunscreen relatively frequently, she says.

Gilchrest recommends everyone use sunscreen every day, not just at the beach or the pool. Most lifetime sun exposure comes from doing normal daily activities: walking to your car in a parking lot, sitting outside for lunch, gardening, to name a few.

"For most people, most of their lifetime sun exposure is in these little tiny bits," Gilchrest says. "It's not the weeks they go on vacation or go to the beach. If you really want to be careful about sun damage, you have to protect yourself every day."

More information

The Skin Cancer Foundation has more on the types of skin cancers, their detection and treatment. The American Cancer Society has details on beta carotene.

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Study Looks at Spinal Proteins, Alzheimer's

Reuters Health
Tuesday, April 22, 2003

NEW YORK (Reuters Health) - One of the largest studies to date suggests that two proteins found in spinal fluid may indeed help diagnose Alzheimer's disease (news - web sites), although the results are still preliminary, according to a report released Tuesday.

There is currently no good way to predict or diagnose Alzheimer's disease. Doctors usually diagnose the condition after ruling out other causes, and a suspected diagnosis can only be confirmed by looking at the brain after death.

In the new study, scientists found that the concentrations of the two proteins -- tau and a particular type of beta-amyloid -- were different in Alzheimer's disease patients compared with healthy "controls." Specifically, beta-amyloid levels were lower and tau protein levels were higher in patients with Alzheimer's disease.

While previous studies have suggested that this might be true, the study is the largest to date to see such a link, according to Dr. Trey Sunderland of the National Institute of Mental Health (NIMH) in Bethesda, Maryland and colleagues. These markers may one day be useful in diagnosing the disease, but the findings are still considered preliminary, according to the report published in Wednesday's issue of the Journal of the American Medical Association (news - web sites).

The researchers compared the cerebrospinal fluid of 131 people with Alzheimer's disease to 72 patients who were healthy. More study is needed to look at how the test would fare when used to compare patients with Alzheimer's disease to those with other types of dementia, they said.

Alzheimer's disease leads to low levels of beta-amyloid because this protein is used in the production of plaques in the patients' brains. Plaques are one of the hallmarks of Alzheimer's disease.

Tau protein levels tend to be high in Alzheimer's patients because this substance is released as neurons degenerate.

In the new study, patients with Alzheimer's had more than double the levels of tau than healthy people and levels of beta-amyloid were less than half the levels measured in healthy people, the authors report.

The findings were bolstered in a second part of the study in which Sunderland's team reviewed 17 previously published studies that examined beta amyloid and 34 studies that examined tau protein in Alzheimer's patients.

The data evaluated in this part of the investigation also show a clear difference in the two protein levels in people with and without Alzheimer's, according to the report.

"In addition, these differences appear to be found in patients with mild Alzheimer's disease as well as in patient's with moderate to severe Alzheimer's disease," they add.

The investigators conclude that "perhaps the most important future use" of this knowledge will be to use the two proteins as "biomarkers" in gauging a person's risk for developing Alzheimer's disease.

Source: Journal of the American Medical Association 2003;289:2094-2103.

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Having a Baby is Good for Your Bones

By Colette Bouchez
HealthScoutNews Reporter
HealthScoutNews
Tuesday, April 22, 2003

TUESDAY, April 22 (HealthScoutNews) -- Having a baby is good for your health -- or at least the health of your bones, says a new study of nearly 10,000 women.

The research, published in the May issue of the Journal of Bone and Mineral Research, found women who give birth to at least one child dramatically reduce their risk of hip fracture later in life, compared with women who remain childless.

What's more, the greater the number of babies you have, the greater your protection.

"We don't expect this finding to alter a woman's thinking about her childbearing options, but we do hope it will send an important message to women who do not plan to have children to take steps beginning in their childbearing years to protect their bones later in life," says Dr. Teresa Hillier, an endocrinologist and principal investigator for the study at the Kaiser Permanente Center for Health Research in Oregon.

The new study also found a bone mineral density test (BMD), an important measure of bone strength, did not predict the fracture risk in the childless group.

"A bone mineral density test is a very important indicator of bone health, but clearly, it does not tell the whole story, particularly in women who remain childless," Hillier says.

Although the researchers can't say for sure why pregnancy has this protective effect, Hillier theorizes it may slightly alter the shape of the bones, as well as strengthen some support muscles in the hip, ultimately reducing the risk of hip fracture.

Endocrinologist and osteoporosis specialist Dr. Loren Wissner-Greene calls the study intriguing, and sees several more possibilities for the findings.

"Even though the bone density is the same in both groups of women, it's possible that pregnancy may alter the micro architecture of the bone -- affecting the inner structure in a way that makes it stronger in certain areas of the body," says Wissner-Greene, a professor of endocrinology at New York University Medical Center.

In addition, she says, because weight-bearing exercises have been known to increase bone strength, it's possible the extra weight of pregnancy may help build stronger bones, particularly in the pelvic region.

The new research involved nearly 10,000 postmenopausal women aged 65 and older who were enrolled in the multi-center, U.S. government-funded Study of Osteoporotic Fractures -- the largest long-term observation study of its kind.

The women were divided into two groups -- those who had given birth to one or more child, and those who remained childless. The researchers measured bone density at the wrist, hip and spine, and questioned the women on a variety of health and lifestyle factors. These included their age at the time of their first and last menstrual periods, height and non-pregnant weight at age 25, change in weight since age 25, and calcium intake from ages 12 to 18 and ages 18 to 50.

In addition, the researchers also noted the women's level of physical activity before and after age 25, family history of fractures, whether or not they smoked, their personal exercise history, and the number of hours they spent each day sitting or lying down -- all factors that could influence bone health. The researchers also documented any personal history of hyperthyroidism, diabetes, hysterectomy or oophorectomy (ovary removal), as well as all regular use of medications, including hormone replacement therapy.

History of bone fracture before the start of the study was documented, while regular follow-ups during the study period provided continuing updates on fracture risks.

After adjustments were made for all lifestyle factors, the researchers found women who had one or more babies were 44 percent less likely to experience a hip fracture than women who remained childless. Interestingly, the risk of spine and wrist fractures remained the same in both groups of women, and all the women had similar levels of bone density.

To further tease out the effects of childbearing, the researchers then divided the group of mothers according to the number of children they had had. The result: The greater the number of children, the lower the risk of hip fracture.

"The important message in this finding is that women need to pay attention to bone health beginning in their childbearing years, and both women and their doctors need to take a woman's childbearing history into account when planning preventative care programs," Hillier says.

More information

To learn more about preventing bone fractures, visit The National Osteoporosis Foundation, or The National Institute on Aging.

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New Gene Linked to Breast Cancer

By Maggie Fox
Reuters
Tuesday, April 22, 2003

WASHINGTON (Reuters) - U.S. researchers said on Tuesday they had found a new gene linked with breast cancer (news - web sites) that could lead to new treatments and help explain why black women are more likely to die from breast cancer than whites.

The gene, called BP1, was found in 80 percent of the samples of tissue from breast cancer patients, the researchers report in the June issue of the journal Breast Cancer Research.

"We are hoping our results will be especially helpful for African-American women," Dr. Patricia Berg of the George Washington University Medical Center, who led the study, said in a telephone interview.

While just 57 percent of samples from white breast cancer patients tested positive for the gene, 89 percent from black women did, the researchers said.

"Because BP1 is expressed abnormally in breast tumors, it could provide a useful target for therapy," Berg's team writes.

Berg noted that her team tested only 46 samples, but she said the percentages were consistent. Of the nine normal breast samples she has tested, only one has shown "expression," or activation, of the BP1 gene.

She also only tested ductal cancer -- but ductal cancer makes up 80 percent of breast cancers.

Berg said that like some other genes linked with cancer, BP1 was activated early in the development of an embryo and turned off later.

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Moderate Lifestyle Changes Control Hypertension

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Tuesday, April 22, 2003

TUESDAY, April 22 (HealthScoutNews) -- A change of heart about your diet and exercise habits can help you keep a lid on your blood pressure -- but you have to be committed to the conversion.

New research shows people who cut down on salt and alcohol while losing weight and getting regular exercise do indeed control their blood pressure. Going a step further by adopting a low-fat diet high in fruits and vegetables works even better, but the added benefit isn't quite as great as many researchers may have suspected.

Even so, the scientists say, the results indicate people can pick and choose from a buffet of lifestyle changes to make a dent in their blood pressure. "You can combine all these things together, and that's pretty encouraging," says Victor J. Stevens, a psychologist at the Kaiser Permanente Center for Health Research in Portland, Ore., and a co-author of the study.

Nearly 50 million Americans, or about a quarter of the adult population, have high blood pressure -- defined as a reading of at least 140 millimeters of mercury (mmHg) for the systolic (the top number) and 90 mmHg for the diastolic (the bottom number). High blood pressure raises the risk of heart attacks and stroke and can seriously damage other organs, including the kidneys. The ideal blood pressure is 120/80.

"Reducing your blood pressure by even a few millimeters makes a difference," Stevens says. "The more pressure there is, the faster your circulatory system wears out."

The latest study, reported in the April 23/30 issue of the Journal of the American Medical Association (news - web sites), included 810 men and women with higher than optimal blood pressure, 38 percent of whom had clinical hypertension. Their average age was 50.

A third of the subjects received a single counseling session, typically with a registered dietitian, about the importance of diet in controlling their blood pressure. They were then left on their own to alter their behaviors.

The rest were assigned to two groups, both of which received much more intensive advice -- as many as 18 sessions over a six-month period -- about the link between lifestyle and hypertension. They were told to lose weight if they needed to, to get at least three hours a week of moderate exercise, and to cut down on their salt and alcohol intake.

Subjects in one of these two groups also were advised to adopt the so-called DASH (Dietary Approaches to Stop Hypertension) diet, a low-fat meal plan that emphasizes fruits and vegetables and cuts back on red meat. It has been shown to help lower blood pressure.

People in all three groups saw their blood pressure drop, but those who received intensive counseling reaped far more benefits. Their blood pressure came down more on average, and fewer developed high blood pressure. They were also more likely to lose a significant amount of weight, and less likely to require drugs to control their hypertension.

The improvement was best for those who had the intensive counseling and the DASH diet, with blood pressure falling twice as much, on average, compared with the first group. Yet the addition of the DASH diet to aggressive lifestyle counseling only slightly reduced blood pressure compared with lifestyle changes alone. Losing weight had the greatest impact on reducing blood pressure and keeping it in a healthy range.

The relatively weak impact of the DASH diet in the latest study points up the challenge of implementing behavioral programs outside the confines of a clinical trial, says Dr. Thomas Pickering, a physician at Mount Sinai Medical Center in New York. "When you are giving people food that is already prepared [as previous studies with DASH did], you can be pretty sure they're getting what you want them to have," says Pickering, author of an editorial accompanying the journal article. But when they do it themselves they often dilute the benefits of the diet.

Dr. Laura Svetkey, director of the Duke Hypertension Center at Duke University and a study co-author, says it's not clear why adding DASH to the counseling regime didn't have a bigger effect. It may be that when it comes to blood pressure, "maybe there's a maximum bang for the buck that you can get" by altering behavior. Another factor, she says, is that people in the study may not have eaten precisely the DASH diet prescribed in earlier trials with the meal program.

But Svetkey says there are plenty of good reasons to make the DASH diet part of a routine to control or prevent hypertension. It is rich in calcium and thus good for the bones, the low-fat content is easy on the heart, and the high doses of fruits and vegetables can reduce the risk of certain cancers.

Although the intensive counseling is just that, Svetkey says "there's nothing magic" about the regimen. All it requires is motivation, support and the willingness to set small goals. "We simply asked people to eat a healthy diet, eat reasonable portions, increase their physical activity to a moderate level, and reduce their salt intake to recommended levels," she says.

More information

Learn about high blood pressure from Medline plus or the American Heart Association. Meanwhile, the National Heart, Lung, and Blood Institute has a primer on the DASH diet.

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Gene Activates Other Genes

Reuters Health
Tuesday, April 22, 2003

It is known as a transcription factor. "This type of gene makes a protein that is like a policeman directing traffic and turns on and turns off other genes," she said.

Her team will now try to find out what those other genes are.

In earlier work, Berg had found that BP1 is active in leukemia, particularly a form called acute myeloid leukemia, or AML. In AML patients it was very active in children.

A leukemia drug called all-trans-retinoic acid seemed to deactivate BP1 in lab dishes, Berg said -- showing there is potential for a drug targeting the gene.

"What we want to do is discover whether this gene will be useful for the early detection and treatment of breast cancer," Berg said.

"We found that the gene is active in all three grades of breast tumors, from the earliest to the most advanced. That means it is activated quite early in the process and potentially might be good for early detection." She said she is working with a colleague to try to develop such a test.

In a potential lucky piece of news, all the estrogen receptor-negative tumors tested positive for the BP1 gene, the researchers said.

Breast cancers fall into two categories -- those that respond to anti-estrogen therapy and those that do not. So-called ER-positive tumors are easier to treat and respond to such popular drugs as tamoxifen.

ER-negative tumors, which make up 40 percent of breast cancers, do not. BP1 might offer a new avenue for treating such tumors, Berg's team said.

Black women in the United States are more likely to have ER-negative tumors, researchers have found, and are also more likely to die of breast cancer even when they get similar treatment to white women.

More than 1.2 million women worldwide will develop breast cancer this year -- 200,000 in the United States. In the United States, 40,000 will die of breast cancer in 2003, according to the American Cancer Society (news - web sites).

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A Promising Blood Pressure Trial Cut Short

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Tuesday, April 22, 2003

TUESDAY, April 22 (HealthScoutNews) -- A study of a different drug treatment for high blood pressure was cut tantalizingly short after showing it might be better for some patients than existing treatments.

 

 

And the reason for halting the trial had nothing to do with medicine, the researchers say, but rather a merger involving the company that sponsored the study.

"The results were going in their favor," says Dr. Henry R. Black, chairman of the department of medicine at Rush-St. Luke's-Presbyterian Medical Center in Chicago and lead author of a report on the study in the April 23/30 issue of the Journal of the American Medical Association (news - web sites).

The study "was stopped short, as far as we know, for business reasons that had a lot to do with the merger," Black says. "There are new people in charge."

The idea of the study was to see if a slow-release form of verapamil, a calcium channel blocker drug that has been around for a long time, could do better than either a beta blocker or a diuretic -- the two other standard high blood pressure medications -- in preventing heart attacks and strokes. The study enrolled 16,602 people at 661 centers in 15 countries. It was supposed to run for at least five years but was ended after three years, in 2000.

The ongoing results of the study were known only to a monitoring board of specialists not connected with the research, a standard procedure in such trials to avoid physician bias.

"Had they known the results, they would not have stopped the trial," Black says of the sponsoring company. "We were within a few events of showing with statistical significance that the verapamil treatment was better."

Blood pressure reduction was just about the same in patients given the three different drugs. The incidence of heart attacks was reduced by 18 percent in patients getting verapamil. That decrease was offset by a 15 percent increase in strokes, but the benefit of the drug was approaching statistical significance, Black says.

The merger that stopped the study came in April 2000 when G.D. Searle, sponsor of the trial, was acquired by another pharmaceutical company, Pharmacia.

But Pharmacia no longer exists. It was acquired last week by Pfizer Inc. of New York City. Pfizer spokespeople did not respond to a request for comment.

Stopping the trial was "incredibly stupid as well as unethical," says Dr. Drummond Rennie, professor of medicine at the University of California, San Francisco, a deputy editor of the journal and co-author of an accompanying editorial.

"Running a trial like this is a major obligation, not only to physicians but also to patients," Rennie says. "If you take on an obligation like this, you can't just blow it off. Any company that buys another has to fulfill that obligation."

The most important consideration is that stopping the trial was unethical, Rennie says. "Then, ironically, it turned out to be stupid as well," he says, since it might have increased sales of the drug.

Physicians will think twice about signing up for such a demanding, long-term trial unless they have written assurance that the sponsoring company will not default on its obligation, Rennie says.

The net result is that high blood pressure treatment is pretty much where it had been, Black says.

In his practice, Black generally starts treatment with a diuretic, "always planning a second drug." The choice between a beta blocker and a calcium channel blocker can depend on other problems a patient may have.

"If they have asthma, I would not use a beta blocker," he says. "Or if they have constipation, I would not use verapamil."

The important thing is to have high blood pressure diagnosed and treatment started, Black says.

More information

To learn more about high blood pressure and its treatment, visit the National Institutes of Health or the American Heart Association.

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MONDAY, APRIL 21, 2003

Drink Tea to Stay Germ-Free: Report

By Alison McCook
Reuters Health
Monday, April 21, 2003

NEW YORK (Reuters Health) - Drinking tea appears to boost the immune system, perhaps helping people fight off or blunt the effect of infections, researchers said Monday.

Non-tea drinkers who downed five to six small cups of black tea per day for two weeks appeared to be better able to fight off bacterial infections, according to the report.

As an explanation for tea's benefits, experiments in the lab revealed that an ingredient found in black, green, oolong and pekoe teas boosted the ability of immune system cells to attack a bacterial invader.

The experiments used ethylamine, which is produced when the tea ingredient L-theanine is broken down in the liver.

Previous research suggests that ethylamine, which is also found in vegetables and wine, may target other pathogens as well, including parasites, viruses, and perhaps tumors.

Based on these findings, people looking to ward off diseases might want to add certain teas to their menu, study author Dr. Jack F. Bukowski of Brigham and Women's Hospital and Harvard Medical School (news - web sites) in Boston, Massachusetts, told Reuters Health.

"I think the elderly would benefit a lot from drinking tea," he said. "I think there's no downside to it."

However, he added that regular tea drinkers still get sick, so people should not throw out their medicine cabinet or tell off their doctors just yet.

"Drinking tea isn't a treatment or a cure for anything," Bukowski cautioned.

"Probably most (tea drinkers) will still get sick. But people who do get sick will probably get a milder case," he said.

The study findings appear in the online early edition of the Proceedings of the National Academy of Sciences (news - web sites).

During the study, Bukowski and his colleagues measured the activity of immune system cells called gamma delta T cells in people who normally did not drink tea.

Gamma delta T cells are an arm of the immune system charged with preventing and cushioning the blow of diseases. Previous experiments have shown that exposing these cells to ethylamine boosted the abilities of the cells to fight infections.

During the study, Bukowski and colleagues extracted gamma delta T cells from people and exposed them to ethylamine. After the cells were mixed with bacteria, the researchers saw that those that had not been exposed to ethylamine mounted no attack against the bacteria. However, cells that had been previously exposed to the tea component multiplied by 10-fold, and therefore produced larger amounts of a chemical that fights bacteria.

And in experiments with people, the researchers found that after drinking about 20 ounces of tea a day for two weeks, people's gamma delta T cells produced a wealth of anti-bacterial chemicals when exposed to bacteria. In contrast, people who drank coffee instead of tea during the study produced no disease-fighting proteins in response to bacteria.

Despite the supposed power of tea to fight infection, Bukowski urged people to maintain a healthy perspective on the findings.

"If people are sick, they shouldn't start drinking tea to get better," he said. "They should go to the doctor."

Source: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.1035603100.

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Statins May Cut Alzheimer's Risk

HealthScoutNews
Monday, April 21, 2003

MONDAY, April 21 (HealthScoutNews) -- Cholesterol-lowering drugs called statins decrease levels of an important precursor of Alzheimer's disease (news - web sites).

That's the conclusion of a study by researchers at the University of Texas Southwestern Medical Center at Dallas that appears in the April 21 issue of the journal Archives of Neurology.

The study of 44 people with Alzheimer's disease found that taking statins lowered their brain cholesterol levels by 21.4 percent. Brain cholesterol contributes to the formation of waxy buildups called amyloid plaques -- a hallmark of Alzheimer's disease -- that damage brain cells.

The people in the study were randomly assigned to receive either 40 milligrams a day of one of three different statins, or 1 gram per day of extended-release niacin, another kind of cholesterol-lowering drug, the researchers say. The study ran for six weeks.

The researchers found that the three statin drugs reduced brain cholesterol levels by at least 20 percent, while the extended-release niacin reduced brain cholesterol levels by 10 percent.

"This class of drugs [statins] may be potentially beneficial in the treatment of Alzheimer's disease," study lead author Dr. Gloria Vega says in a statement.

"If we limit cholesterol synthesis in the brain, we may be able to decrease the production of amyloid plaques. The findings from this research provide information about the safety and efficacy of a reasonable dose of a statin on the reduction of brain cholesterol," she says.

Alzheimer's disease affects about four million Americans. There is no cure.

More information

Check with the National Institutes of Health (news - web sites) to learn more about Alzheimer's disease.

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Snoring Linked to Chronic Daily Headache: Study

Reuters Health
Monday, April 21, 2003

NEW YORK (Reuters Health) - People who suffer from chronic daily headaches appear to be nearly three times as likely to be habitual snorers as those who only get headaches once in a while, a new study suggests.

About four percent of adults have chronic daily headaches, which is usually considered to be headaches on at least 15 days per month.

The findings suggest that this type of headache may be related to a sleep-related breathing problem, of which snoring is a common symptom. Sleep disordered breathing, or sleep apnea, is a condition in which the upper airway collapses and temporarily halts breathing, causing the sleeper to snort and gasp for breath.

Previous research has demonstrated a link between breathing problems during sleep and cluster headaches -- sudden, severe pain, often centered in one eye, which tends to be short in duration but runs in cycles.

However, little is known about the cause of chronic daily headaches, according to the study published in the journal Neurology.

To investigate, Dr. Ann. I. Scher of the National Institute on Aging in Bethesda, Maryland, and colleagues looked at the snoring habits of 206 people with chronic daily headaches and 507 healthy people who had occasional headaches.

All of the participants were asked how often they snored and chose one of the following responses: "never or rarely," "less than half the time," "more than half the time," "always" or "don't know."

About 24 percent of those with chronic daily headaches said they "always" snored, compared with just 14 percent of participants who only had the occasional headache.

Half of those with chronic daily headaches said they had 260 or more headache days per year, compared to 24 or more days per year for the healthy participants.

Overall, habitual snoring was three times more common in people with chronic daily headache than in those who did not have the condition, the authors report.

One potential weakness of the study, according to the authors, is the fact that the participants self-reported their snoring habits, and therefore may not have been completely accurate when it came to estimating their own snoring.

Nonetheless, Scher's team conclude that if the association between snoring and headache "proves causal, sleep-disordered breathing may provide a target for therapeutic interventions for chronic daily headache."

Source: Neurology 2003;60:1366-1368.

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Melanoma Gene Discovered

By Randy Dotinga
HealthScoutNews Reporter
HealthScoutNews
Monday, April 21, 2003

MONDAY, April 21 (HealthScoutNews) -- Researchers at Rutgers University think they've discovered a gene that contributes to melanoma, a form of skin cancer that kills some 7,600 Americans a year.

The finding won't immediately translate into a treatment, researchers say. However, it's possible doctors could eventually develop a test to determine which babies are at highest risk for the disease, giving them a chance to go into life with a special respect for the powers of the sun, says Dr. Martin A. Weinstock, a professor of dermatology at Brown University.

"We could take a lot of precautions and do lots of surveillance," Weinstock says. "You could protect them from ultraviolet [sun] exposure and screen them when they get to be adults."

While melanoma accounts for just 4 percent of skin cancer cases, it is by far the deadliest form of the disease. Melanoma, which often strikes moles on the skin, is easily cured if caught early. But the disease often kills if the cancerous moles aren't discovered until the tumors have spread to other parts of the body.

Suzie Chen, an associate professor of chemical biology at Rutgers University, stumbled upon a melanoma gene by accident as she studied how cells form and make themselves different from others. While working with genetically altered mice to understand how cells turn into fat cells, she noticed that one mouse developed a melanoma on its skin.

After more research, Chen found the cancer appeared to be directly tied to a gene that turns itself on only in the brain, where it releases a protein and contributes to learning and memory. Somehow, the gene -- which is in the DNA of every cell -- also turned itself on in the skin of the mouse, contributing to melanoma.

Chen's findings will appear April 21 in the online edition of Nature Genetics.

Chen and her colleagues later discovered the gene had turned on in one-third of tissue samples from people who had various types of melanoma. That suggests the gene contributes to the disease in humans and mice.

With more study, it could be possible to design chemotherapy to target melanoma cells by detecting a protein given off by the troublesome gene, Chen says.

Weinstock says genetic research by scientists like Chen is important to gaining a better understanding of melanoma. But the findings don't change the fact that the best way to prevent the disease is to limit sun exposure, he adds.

While melanoma can appear on parts of the body that never see the light, sunburns and exposure to ultraviolet light -- especially in childhood and adolescence -- are considered risk factors.

Weinstock calls on people to adopt a "slip, slop and slap" approach: "Slip on a shirt, slop on the sunscreen, and slap on a hat."

More information

Learn more about melanoma from the National Cancer Institute or the American Academy of Dermatology.

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Highly Educated May Have Poorer Mental Health

By Charnicia E. Huggins
Reuters Health
Monday, April 21, 2003

NEW YORK (Reuters Health) - Contrary to what they expected, a team of California researchers has found that highly educated workers may be more, not less, likely to have mental health problems in comparison to the general public.

"Highly educated employees may be at greater risk for mental health problems than common sense might suggest," lead study author Dr. Cheryl Koopman told Reuters Health.

"This was an unexpected finding," the Stanford University-based researcher said.

And its implications may extend beyond just the health of workers, Koopman suggested. It may also have an effect on their working ability.

"Mental health problems are particularly problematic for highly educated workers because they would tend to be employed in intellectually demanding occupations in which poor mental health could be expected to directly affect their job performance," Koopman said.

Approximately 33 million workers in the United States have a bachelors or higher degree. Previous research has shown that employees' impaired mental health status may lead to higher rates of absenteeism, accidents and injuries, job turnover, and higher employer costs for health and liability insurance. This study was unique in that it focused on highly educated workers, a growing sector of the U.S. workforce.

In the study, Koopman and her colleagues evaluated questionnaire responses from 460 employees at a large northern California worksite. More than half of the employees had a master's or doctoral degree -- a much higher percentage than in the general population. The respondents completed a five-item mental health assessment that asked questions such as "Have you felt so down in the dumps that nothing could cheer you up?" Possible scores ranged from 0 to 100, with higher scores indicating better mental health.

The respondents' average mental health score was 70, lower than what has previously been reported for the general U.S. population, the authors report in the American Journal of Health Promotion.

What's more, five percent of the workers had symptoms indicative of problem drinking. The study also showed that 10 percent of workers said they used antidepressants at least every week, or more frequently in some cases.

Mental health scores were lowest among those individuals who showed signs of problem drinking or who took antidepressants, as well as among younger respondents, those who reported higher levels of stress at home or work and those who used avoidance as a coping strategy, study findings indicate. Those who reported higher satisfaction with their jobs or their home life, on the other hand, were likely to also report better mental health.

The workers were, as a whole, a highly educated group, and higher educational levels were associated with poorer mental health, but only in men. Among women, advanced degrees were associated with higher mental health scores. The reason for this unexpected finding is unknown, according to the report.

The researchers did not investigate why the study participants' mental health was worse than that found among the general population.

"Perhaps the demands of (their) occupations ... put undue stress on their personal lives," Koopman speculated. Or perhaps these workers were under pressure to "make decisions in the face of high levels of uncertainty and (had) a great deal of responsibility at work," but perceived their job resources as inadequate, she said.

Since the study was conducted at only one worksite, however, the findings may not apply to other worksites with highly educated employees, the researchers note.

Still, Koopman said, "we need to better understand how the work force environment and programs can best support mental health in the highly educated workforce."

"Research and program development are needed to determine whether work-based interventions can improve employees' mental health by helping them cope more effectively with work and home stress, derive greater life satisfaction from work and home and avoid harmful or hazardous drinking," she added.

A grant from the Center for Substance Abuse Prevention funded the study.

Source: American Journal of Health Promotion 2003;17.

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Another Genetic Link to ALS Found

HealthScoutNews
Monday, April 21, 2003

MONDAY, April 21 (HealthScoutNews) -- Genetic abnormalities have been discovered in the chromosomes of several people with sporadic, or non-hereditary, amyotrophic lateral sclerosis (ALS).

So says a study in the April 22 issue of Neurology.

The German study examined the chromosomes of 85 people with sporadic ALS and found five of them (5.9 percent) had chromosomal abnormalities. The normal rate for such abnormalities in healthy people is about .05 per cent.

The finding suggests these chromosomal abnormalities are a previously unknown risk factor for sporadic ALS. The researchers don't know how these abnormalities contribute to ALS, but suggest they may cause a disruption or alteration of certain genes.

It's also possible that an unknown underlying mechanism of ALS could cause the chromosomal abnormalities.

ALS, also known as Lou Gehrig's disease (news - web sites), is a progressive, degenerative disease of the nervous system. About 5 percent to 10 percent of ALS cases are hereditary. Scientists have identified several genes linked to hereditary ALS.

Researchers have identified several genetic risk factors for sporadic, or non-hereditary, ALS, but much more needs to be learned about the role genetics plays in sporadic ALS.

More information

Here's where you can learn more about ALS.

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Study Supports Eight Glasses of Water a Day Advice

Reuters Health
Monday, April 21, 2003

NEW YORK (Reuters Health) - Drinking only half of the recommended eight glasses of water a day may result in mild dehydration, a small study of college students has found.

The preliminary study may add credence to the notion that most people would do well to gulp down at least eight 8-ounce glasses of water each day, lead researcher Dr. Wayne Askew of the University of Utah in Salt Lake City told Reuters Health.

"For people who aren't exercising a lot or living in a very warm climate, eight glasses of water a day may be a good rule of thumb," said Askew.

Those who are exercising and sweating more than normal need to replenish the essential liquid to avoid dehydration, according to the Utah researcher.

The findings were presented last week at the annual Experimental Biology meeting in San Diego, California.

In the 12-week experiment, Askew's team monitored the hydration status and well being of 10 college students. Over the course of the study period each student drank four, eight or 12 eight-ounce glasses of water per day in four-day test cycles. Between tests the students stuck to their normal water consumption and during one other week, they did the same, Askew explained.

At the end of each water consumption cycle, all of the students underwent a battery of tests that assessed their body's hydration status. They also answered questions about their general well being.

When students consumed only four glasses of water, their blood plasma volume -- a measure of hydration -- was five percent below those who drank eight glasses of water, who had normal blood plasma volume, explained Askew.

In addition, drinking only four glasses of water was associated with more highly concentrated urine.

"The levels of dehydration associated with four glasses of water were mild -- what we refer to as a suboptimal hydration level," said Askew.

Although the health effects of drinking less water were mild, the researchers did notice a difference in student's well being. When students drank the least amount of water, they reported feeling less energetic and less focused than when they drank more water.

Drinking 12 glasses of water caused blood plasma volumes to be 10 percent above levels measured when the students drank eight glasses of water. Attitudes of well being did not differ between those who drank eight glasses of water compared to those who drank 12 glasses of water, according to Askew.

Water makes up more than 70 percent of solid body tissue and helps regulate body temperature, carries nutrients and oxygen to cells, removes waste, cushions joints and protects organs and tissues. Lack of adequate water intake leads to headaches, grogginess and dry, itchy skin. Severe dehydration affects blood pressure, circulation, digestion, kidney function and nearly all body processes.

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Improving the Odds for Lung Transplant Patients

HealthScoutNews
Monday, April 21, 2003

MONDAY, April 21 (HealthScoutNews) -- A "cocktail" of immunosuppressants sharply cuts rejection rates in lung transplant patients, says a Loyola University Health System study.

The researchers found that adding two new immunosuppressive drugs -- daclizumab and mycophenolate mofetil -- to a base regimen of tacrolimus resulted in a three-year downward trend in rates of chronic rejection. That's the most common cause of death for lung transplant patients.

It's the first time this combination of anti-rejection drugs has been tested on lung transplant patients. It indicates this combination may be more effective than any of the drugs used alone.

The study was presented recently at the International Society for Heart & Lung Transplantation meeting in Vienna, Austria.

The researchers found that 11 percent of the lung transplant patients who received the combination of anti-rejection drugs suffered acute rejection. That's where the body's white blood cells begin attacking transplanted tissue.

In comparison, lung transplant patients who received the traditional base therapy of the anti-rejection drug tacrolimus and steroids had a 41 percent rate of acute rejection.

People given the three-drug combination had no second or third acute rejections, compared to 22 percent of the patients on the traditional therapy.

A significant reduction in chronic rejection rates could greatly increase life expectancy for lung transplant patients, the study says.

More information

Here's where you can learn more about lung transplantation.

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Temporary Syndrome Found in Ironman Athletes

By Natalie Engler
Reuters Health
Monday, April 21, 2003

BOSTON (Reuters Health) - Triathletes have to be the fittest of the fit, but a small, unpublished study of athletes who competed in an Ironman triathlon suggests that the arduous, all-terrain event can take its toll, creating a "constellation of symptoms" defined as post extreme endurance syndrome (PEES).

More than a third of the athletes who sought medical attention suffered from the condition, which is characterized by decreased body temperature, nausea, vomiting, diarrhea, dizziness, headache, cramping and the inability to drink fluids, said Dr. Hilary Ann Petersen of the University of Arkansas Medical Center.

She presented her findings here at the 32nd annual sports medicine symposium of the American Medical Athletic Association.

Professional athletes appeared to be particularly susceptible to the condition, encountering it 1.5 times as often as amateurs. This may be because the professionals "are motivated to win," Petersen told Reuters Health in an interview. "They can't afford to wait and race another day."

However, waiting would be a good idea, she noted. While little is known about PEES, it appears to be related to dehydration and over-hydration, both of which can put people at risk for more serious problems.

Dehydration, in extreme cases, increases the risk for potentially fatal heat stroke, while drinking too much fluid can lead to a rare condition known as hyponatremia, in which a person's blood sodium drops to dangerously low levels, putting them at risk for seizure, coma and death.

Athletes need to "know when to stop," said Petersen, a two-time Ironman finisher who required post-race medical intervention herself. "Your body tells you when you've had enough. Listen to it."

Previous research has suggested that extreme endurance activities, such as marathons, triathlons and long-distance cycling may cause temporary heart damage.

In the new study, Petersen and her colleagues studied 1,818 amateur and professional athletes who participated in the 2001 Ironman triathlon in Panama City, Fla., and interviewed 200 medical volunteers and 1,800 logistic volunteers.

The participants swam a 3.9 km (2.4 miles) ocean swim, biked 180.2 km (112 miles) and ran a full 42.2 km (26.2 mile) marathon. Temperatures on the November day of the race ranged from 50 degrees to 70 degrees Fahrenheit, and participants finished the endurance test in anywhere from 8 hours and 21 minutes to 17 hours.

Volunteers at the medical tents asked participants whether they felt dehydrated, too hot or cold, nauseous, breathless or dizzy, whether they were experiencing cramps in their abdomen, hands or feet and whether they had any abrasions or blisters.

While researchers expected to see a large number of knee injuries, wrist fractures and blisters, only relatively few of the 312 competitors who sought medical attention complained of these types of injuries. Just 24 blisters and scrapes and 16 orthopedic injuries were reported. By contrast, 119 participants suffered from PEES.

Though the researchers have not identified what causes the condition, they say athletes may be able to protect themselves by taking a more scientific approach to nutrition and hydration. Fortunately, most people fully recover from PEES and go on to race again, Petersen said.

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SUNDAY, APRIL 20, 2003

Blood Treatment Targets Heart Disease

By Gary Gately
HealthScoutNews Reporter
HealthScoutNews
Sunday, April 20, 2003

SUNDAY, April 20 (HealthScoutNews) -- Can a vial of a heart-failure patient's blood -- zapped with heat, radiation and ozone gas, then injected back into the body -- reduce the risk of death?

The developer of an experimental treatment thinks so, and now the theory's about to be put to its first large-scale test.

It's called "immune-modulation therapy," an unconventional approach to fighting heart failure by tricking the immune system into reducing inflammation.

The therapy yielded impressive results in a pilot trial of 73 patients with advanced heart failure. During the six-month review, about half the patients received the immune-modulation therapy; the other half, placebos. All the patients also received their normal medications.

Only one patient receiving the therapy died during the course of the study, compared with seven deaths among the patients who were given placebos. And 21 patients who received placebos had to be hospitalized, compared with 12 of those who got the therapy.

Dr. James B. Young, head of the heart failure and cardiac transplant medicine section at the Cleveland Clinic, participated in the pilot and is to serve as principal investigator in a yearlong, 2,000-person study beginning this spring.

Noting that a few previous attempts to treat heart failure with anti-inflammation drugs have failed, Young says, "I entered the original pilot study pretty skeptical."

The results of the initial trial, however, convinced him immune-modulation therapy -- developed by Toronto-based Vasogen Inc. -- merited a large-scale test.

"What we saw was a highly statistically significant reduction in death rates as well as a statistically significant reduction in hospitalizations," Young says.

Nearly 5 million Americans suffer from congestive heart failure, which weakens the heart so it doesn't pump blood efficiently. About half of these patients die within five years of diagnosis.

Effective new drug treatments have been elusive in recent years, and if the coming study proves fruitful, it could represent a treatment breakthrough, Young says.

"If you look at where we are with new medications, I think we are at our limit with new drugs," Young says. "I just don't think we're going to have a lot of hits as far as new drugs are concerned. What this has led a lot of us to do is focus on alternative measures that can be combined with traditional therapies."

In immune-modulation therapy, about 10 cubic centimeters of blood are drawn from the heart-failure patient, then exposed to 108-degree heat, radiation from ultra-violet light and ozone gas. The computer-controlled process stresses the cells, causing cell death. When the blood is injected back into the body, it alters the immune system and, through a variety of signaling processes among cells, reduces inflammation, which is associated with heart failure.

In the trial beginning this spring, patients will receive immune-modulation therapy for a year -- twice weekly at first, then weekly, then monthly. As with the pilot, the therapy will be in addition to the patients' regular medications.

"The immune system is an unbelievably powerful ally if we learn to harness it and appropriately activate it when necessary and suppress it when we need to," Young says.

Still, he acknowledges the small sample size in the pilot study, and says judging success would have to await results of the larger test. /p>

Dr. Clyde Yancy, an associate professor of medicine at the University of Texas Southwestern Medical Center, says immune-modulation therapy appears to be based on "sound science" and the preliminary test yielded encouraging results.

That said, he cautions against concluding the therapy works based on the small pilot study. "We have many times before seen pilot trials not pan out in a larger study," says Yancy, a spokesman for the American Heart Association (news - web sites).

Yancy says inflammation, which the therapy targets, is associated with heart failure, but experts remain uncertain whether it causes the disease or is a symptom.

"We are still looking for that initial problem that occurs that sets up this whole cascade of events that is known as heart failure," Yancy says. "We need to find that single focus that identifies how this whole thing gets started."

The experimental therapy, he says, may help determine whether inflammation is the root cause of the disease.

Yancy stresses that highly effective medications already exist for all but the most severely ill heart patients. But he says many patients who could benefit from medications, including angiotensin-converting enzyme (ACE) inhibitors and beta blockers, do not take them.

More information

For more on heart failure, visit the American Heart Association or the Heart Failure Society of America.

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A Forecast for Pain?

HealthScoutNews
Sunday, April 20, 2003

SUNDAY, April 20 (HealthScoutNews) -- Decreases in barometric pressure typically signal an approaching storm, but for many such changes can also be a forecast for physical pain.

From headaches to bone pain, various discomforts have long been associated with the types of weather changes that can be particularly drastic during spring and fall. Yet, just as many people fail to fully comprehend how barometric pressure works, doctors are still largely in the dark as to how it causes some to suffer pain.

One of the most common types of problems linked to barometric pressure is arthritic pain. While there's no solid evidence showing precisely how arthritic pain is aggravated by weather changes, people have complained for centuries that their pain worsens with barometric pressure changes, as well as with increases in humidity.

Experts have theorized that external pressure changes could somehow impact the pressure against joints inside the body, but the relationship remains a mystery.

Migraine headaches are another malady associated with pressure changes. According to the National Headache Foundation (news - web sites), barometric changes can cause the blood vessels in the head to swell to compensate for changes in oxygen levels, hence leading to the headache.

And even some asthma sufferers report that barometric pressure changes can trigger asthma symptoms. According to the National Lung Association, reports of such reactions are common. Doctors speculate the rapid temperature fluctuations that can accompany barometric pressure changes may bring on the asthma symptoms.

People with migraines and arthritis problems typically report that pain related to barometric pressure, though noticeable, is mild enough to respond to over-the-counter pain relievers. If pain of any type persists beyond normal levels of discomfort, consult your doctor.

More information

You can learn more about precisely how barometric pressure works from the National Oceanic and Atmospheric Administration.

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SATURDAY, APRIL 19, 2003

Working Out to Stop Heart Failure

HealthScoutNews
Saturday, April 19, 2003

SATURDAY, April 19 (HealthScoutNews) -- A $37 million study to determine if a tailored exercise program can help heart failure patients live longer is being led by Duke University Medical Center cardiologists.

The 5-year, 3,000-patient randomized trial will be conducted at more than 50 American and Canadian hospitals. It's the first large-scale prospective trial meant to find out whether exercise can stave off death for people with heart failure and other diseases.

The study will also examine whether exercise has any effect on reducing hospital stays for that group of people.

"Smaller studies over the past 10 years have shown that exercise can do good things for heart failure patients, such as reduce levels of harmful hormones and improve physical activity. However, these studies weren't designed to uncover an effect on mortality and morbidity," Dr. Christopher O'Connor, principal investigator for the new trial, says in a news release.

Heart failure is a condition where the heart muscles aren't able to pump enough oxygen and nutrients in the blood to the body's tissues. It can be caused by infections of the heart, coronary artery disease, high blood pressure, valve problems and previous heart attack.

About 4.7 million Americans have heart failure and about 400,000 new cases are reported each year. About 50 percent of people diagnosed with heart failure die within five years. There is no cure but drugs can improve heartbeat strength, relax blood vessels or remove excess fluid buildup in the lungs.

After providing a medical history and being given a medical examination, people taking part in this study will be assigned to receive either intensive exercise training or usual care.

The people in the exercise program will be given a personalized workout regimen. For the first three months, they'll exercise three times a week on a treadmill or stationary bicycle at the institution taking part in the study.

After that, they'll continue their exercise program at home for up to three years. The exercise equipment will be provided to them. Researchers will have frequent phone contact with the study subjects to monitor their health and to make sure they're continuing to exercise.

Anyone interested in taking part in the study can get more details at the trial's Web site.

More information

Here's where you can learn more about heart failure.

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It's Spring, and the Allergies Are A'Bloom

HealthScoutNews
Saturday, April 19, 2003

SATURDAY, April 19 (HealthScoutNews) -- Millions of Americans suffer from allergies in the spring, when airborne pollens are most plentiful.

While these allergies mirror the symptoms of a simple cold -- including sneezing, runny nose and watery eyes -- they also cause itchy eyes, which colds don't. Conversely, a fever can accompany a cold but not an allergic reaction.

Allergic rhinitis, also known as hay fever, is the most common type of springtime allergy, affecting about 35 million Americans. According to Inova Health System, a not-for-profit health-care system based in Northern Virginia, allergic rhinitis is an immune disorder that causes the body to react to airborne allergens such as pollen, dust mites, mold and animal dander. Those who suffer only during the spring months are probably allergic to tree or grass pollen.

Inova recommends checking with a physician to make sure your symptoms are an allergic reaction and not a cold or some other problem. The physician may run some tests to see which allergen is causing the trouble and then advise the patient to steer clear of the source as much as possible. This is difficult with tree pollen, however, because of the sheer volume of it in the spring air.

Springtime asthma is another common seasonal allergy. As the weather warms and people spend more time outdoors, exposure to outdoor asthma triggers such as pollens, molds and animals dander are increased. Inhaling these seasonal allergens can cause the airways of the asthmatic to become inflamed, produce mucus and constrict.

For both allergic and non-allergic asthma, experts recommend environmental control and avoidance of triggers, plus the use of anti-inflammatory medications.

More information

The allergy prevention center has more on springtime allergies.

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