The American Voice Institute of Public Policy Presents

Personal Health

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

 

 

 

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 Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.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

Personal Health for the Week of May 10-16

FRIDAY, MAY 16, 2003

  1. Molecule Battles Heart Disease
  2. Cancer Society Endorses Mammograms
  3. Older Hispanics' Eyesight Suffers More
  4. Home BP Monitoring OK, but Devices May Be Off
  5. School Screening for Asthma, Allergy in Works
  6. Hemophilia Drug May Have Wider Use
  7. Alcohol Doesn't Protect Against Parkinson's Disease
  8. Miscarriage More Likely with Older Father: Report
  9. Cranberry or Blueberry?
  10. Smoking Ups Hereditary Pancreatic Cancer: Study
  11. Rheumatoid Arthritis Tied to Birth Weight

    THURSDAY, MAY 15, 2003

  12. Study: Fish Fine for Pregnant Women
  13. New Medical Journal Refuses Drug Ads
  14. Epilepsy Drug Shows Promise in Alcoholism
  15. No Clear Link Between Alcohol, Parkinson's: Study
  16. Veteran Journalist Shines Light on Depression's Darkness
  17. Viral Protein Explains Why Some HIV+ Stay Healthy
  18. Understanding Prostate Cancer
  19. In Women, Low Bone Mass Linked to Alzheimer's
  20. How Hot is Hot?
  21. Cell Changes May Explain Diabetes Risk in Elderly
  22. Green Tea Gives Skin Healthy Glow
  23. Study Links Migraine, Major Depression
  24. Study: Radiation Starves Cancer While Killing It
  25. U.S. Moms Stop Breastfeeding Too Soon: Study
  26. Study Contends Secondhand Smoke Won't Kill You
  27. New York City Women Less Likely to Get Mammogram
  28. Aging May Shortcircuit Body's Ability to Ward Off Diabetes

    WEDNESDAY, MAY 14, 2003

  29. Remember This
  30. U.S. Changes Guidelines on Blood Pressure
  31. A Drink a Day Improves Overall Heart Health
  32. Too Much Booze Damages Key Hormones
  33. CDC: Fourth of Americans Get No Exercise
  34. A Hair-Raising Discovery
  35. Even Short Walk Reduces Deadly Clot Risk in Obese
  36. Broccoli Could Be Prostate Cancer Fighter
  37. Obesity Reported to Cost U.S. $93B a Year
  38. Acetaminophen Fights High-Altitude Headaches
  39. Nicotine-Blocking Drug May Curb Alcohol Cravings
  40. Drinking Gives Pause to Thinking
  41. Teens Exposed to Alcohol Ads, Study Says
  42. Italians Getting Healthier and Taller: Survey
  43. Sleep Well

    TUESDAY, MAY 13, 2003

  44. Personality Keeps Changing with Age, Study Finds
  45. Magazines Shower Teens With Alcohol Ads
  46. Starting Exercise May Help Older Women Live Longer
  47. Study Suggests War in Africa Spread an AIDS Virus
  48. Genentech Arthritis Drug Fails Key Test
  49. Mental Risk High in Children of Schizophrenic Mom
  50. Inactivity Blamed for Teens' Weight Gains
  51. African Milkbush Plant May Cause Childhood Cancer
  52. Genetics Play Part in Hardening of Arteries
  53. Some Rehab Patients Use Illicit Drugs to Ease Pain
  54. The Key to Vision?
  55. Big Eaters May Live Longer with Colorectal Cancer
  56. The Odds of Beating Prostate Cancer
  57. Protein Speeds Bone Healing in Animal Studies
  58. Painting an Unappetizing Picture
  59. Regular Drinking May Raise Rectal Cancer Risk
  60. Do More Calories Help Colon Cancer Patients?
  61. Compound May Ease Side Effects of Parkinson's Drug
  62. North Americans Better at Controlling High Blood Pressure
  63. New Malaria Drug Combo Said Promising
  64. Fewer People Get Health Info Online Than Thought

    MONDAY, MAY 12, 2003

  65. Pneumonia Vaccine May Hold Heart Benefits
  66. Hospital Water Can Carry Fungus Dangerous to Some
  67. Fen-Phen Gone, but Other Diet Drugs Still Popular
  68. Spread of HIV Strain Began in 1940, Spurred by War
  69. A Pitch for Kid-Friendly Baseball
  70. Americans Don't Understand Danger of Mini-Strokes
  71. Cutting Down on Medication Mistakes
  72. Study Looks at Chiropractic Treatment, Stroke Risk
  73. Coffee Highs
  74. Fewer Ear Infections for Babies Who Sleep on Backs
  75. The Facts on Endometriosis
  76. Less Patching for 'Lazy Eye' Still Effective: Study
  77. Scan Predicts Heart Trouble in the Healthy
  78. Tick Infections Often Go Undetected: Study
  79. Many Asthmatics Ignore Added Risk of Smoking
  80. Gender, Ethnicity Impede Info Giving to Doctors

    SUNDAY, MAY 11, 2003

  81. Stuffy Nose Can Mean Many Things

    SATURDAY, MAY 10, 2003

  82. Kids Who Lost Parent in 9/11 Attacks Still Suffer
  83. Sesame Oil Lowers Blood Pressure

FRIDAY, MAY 16, 2003

Molecule Battles Heart Disease

HealthScoutNews
Friday, May 16, 2003

FRIDAY, May 16 (HealthScoutNews) -- A molecule called beta3 integrin that scientists thought contributed to heart disease now appears to help fight it.

The surprise finding comes from researchers at Washington University School of Medicine in St. Louis.

The scientists fed a high-fat diet to mice that lacked the beta3 molecule and got unexpected results. The mice developed lung inflammation and clogged arteries, and about two-thirds of the mice died within six weeks.

That suggests that long-term suppression of this beta3 molecule may contribute to the development of heart disease, instead of preventing it, the study concludes. The information may help guide new strategies for developing drugs to combat heart disease.

The findings were published online this week in the Proceedings of the National Academy of Sciences.

Beta3 sits on the surface of cells and interacts with other molecules in the body, helping regulate functions such as blood clotting and inflammation. One of the proteins that beta3 interacts with is critical in causing blood platelets to form blood clots.

Because of that connection, people having heart attacks are often treated with drugs that block the action of beta3. By inhibiting beta3, these drugs prevent platelets from collecting in, and blocking, blood vessels. That helps preserve normal blood flow.

Many experts have suggested long-term use of these beta3 inhibitor drugs might prevent clogged arteries that result in heart attacks. But the results of this study seem to challenge that hypothesis.

More information

Here's where you can learn more about different forms of heart disease.

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Cancer Society Endorses Mammograms

By Daniel Yee
Associated Press Writer
The Associated Press
Friday, May 16, 2003

ATLANTA - Mammograms remain the most important tool in detecting breast cancer and women need not worry about performing breast self-exams, the American Cancer Society said Thursday.

The Atlanta-based society updated its breast cancer guidelines for the first time since 1997. More research has confirmed the society's 1997 recommendation for women to receive mammograms annually from age 40.

"A lot of women were reading a year or so ago that some people were not sure whether mammography had any benefit," said Debbie Saslow, the society's director of breast and gynecologic cancers.

"The level of confidence in the benefit is higher than ever. Mammograms find 80 percent to 85 percent of cancers we know they increase survival dramatically."

The largest change in the guidelines involves the breast self-exam, which previously was recommended once a month. But research has found the exams did not contribute to breast cancer survival rates.

Where mammograms typically find cancers that have grown for two years, self-exams typically detect cancer that has been growing for six years, Saslow said.

"We don't have evidence that doing it every month is having any survival benefit," she said. "For us it's not a huge change as a lot of people weren't doing breast self-exams anyway. To the public it probably is a big change."

The recommendations say women in their 20s should be told about the benefits and limitations of the self-exam and that it is OK for women to choose to perform it occasionally or not to perform it at all.

"Unfortunately by the time you can feel something, it's big enough where it's either had a chance to spread and grow or it's pretty benign and finding it wouldn't hurt if you didn't find it," Saslow said.

The society also said women ages 20 to 39 should receive a clinical breast exam every three years and annually for women age 40 or older.

Older women who are healthy may find benefit in a mammogram but those with health problems need to consult their doctor to determine if the mammogram will be helpful, as "the survival benefit of a current mammogram may not be seen for several years," the society said.

Women at increased risk such as those with a family history of breast cancer may wish to have mammographies at age 30 as well as breast ultrasound or breast MRI.

But women who receive the breast MRI should receive it at a facility able to perform an MRI-guided biopsy in case something is detected that cannot be seen in a mammogram or by touch, Saslow said.

The society also warned that new, non-mammography screening technologies must equal or exceed the detection ability of mammography before they should be used as screening tools.

"There's over a dozen out there, some have not been approved," Saslow said. "None of them are far enough along or have enough effectiveness for screening instead of mammography."

Officials from the Susan G. Komen Breast Cancer Foundation said in a statement on their Web site they concurred with the society's updated guidelines and were "pleased to see updated recommendations specific to older women and women at increased risk."

On the Net:

American Cancer Society: www.cancer.org

Susan G. Komen Breast Cancer Foundation: www.komen.org

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Older Hispanics' Eyesight Suffers More

HealthScoutNews
Friday, May 16, 2003

FRIDAY, May 16 (HealthScoutNews) -- Older Hispanics suffer more visual impairments than their counterparts in other ethnic or racial groups.

So says the Los Angeles Latino Eye Study, the largest comprehensive study ever done to identify eye problems among Hispanics.

The five-year study included more than 6,200 Hispanic men and women over age 40 living in communities in and around the city of La Puente, Calif. Study volunteers were screened for eye disease, high blood pressure and diabetes.

They were also interviewed about their eye disease risk factors such as weight, health-care access, family history of eye disease and alcohol use.

The study found Hispanics have the following rates of vision impairment: ages 65-69, more than 2 percent; ages 70-74, nearly 4 percent; ages 75-79, nearly 7 percent; ages 80-84, nearly 12 percent; 85 and older, nearly 18 percent.

"Latinos are expected to make up about 26 percent of the U.S. population by 2025. It's important to get an estimate of disease in Latinos, and we found that vision-related problems in this community that need to be addressed," study leader Dr. Rohit Varma, an associate professor of ophthalmology at the Keck School of Medicine at the University of Southern California, says in a news release.

The study was presented recently at the annual meeting of the Association for Research in Vision and Ophthalmology in Fort Lauderdale, Fla.

More information

Here's where you can learn more about eye problems.

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Home BP Monitoring OK, but Devices May Be Off

Reuters Health
Friday, May 16, 2003

NEW YORK (Reuters Health) - Home blood pressure monitoring appears to help people lower their high blood pressure, the results of a new study suggest.

But a separate study also being reported this week indicates that the monitors patients use are often incorrectly calibrated and sized, which can result in inaccurate readings.

Dr. Margaret Scisney-Matlock and colleagues at the University of Michigan at Ann Arbor found benefits to home monitoring in a sample of 161 women with high blood pressure.

The women, aged 31 to 83, were randomly assigned to either daily home blood pressure monitoring -- morning and evening -- or monitoring plus reading patient education literature that urged them to take their blood pressure medication.

Systolic blood pressure (the top number in a blood pressure reading) fell by 9 millimeters per liter of mercury (mm Hg) in the monitoring-only group and by 6 mm Hg in those who monitored their blood pressures and read the literature.

The women in the second group may have had worse results because they happened to have higher blood pressures at the start of the study than the monitoring-only group, Scisney-Matlock said.

The study included 60 African American women, whose blood pressure numbers improved slightly more than Caucasians during the study, with decreases of 11 mm Hg in the best-performing group.

"This is good (news) for African American women," Scisney-Matlock said.

Despite the encouraging news about home blood pressure monitoring, another study suggests that the devices are often inaccurate because they are poorly adjusted.

Melissa J. Goalen, a nurse practitioner at the Mayo Clinic in Jacksonville, Florida, tested more than 100 home-monitoring devices and found that about 20 percent yielded measurements that were inaccurate by at least 4 mm Hg.

"Five mm Hg, over or under, will affect treatment," Goalen noted.

The researchers found that the inaccurate devices were either improperly calibrated or had arm cuffs that were incorrectly sized. Cuffs that are too small will overestimate blood pressure, while those that are too large will underestimate it, she said.

To get accurate readings, the devices need to be calibrated by the patient's health care provider and the patient's arm should be measured, according to Goalen.

The studies will be presented on Friday and Saturday at the annual meeting of the American Society of Hypertension in New York.

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School Screening for Asthma, Allergy in Works

By Kathleen Doheny
HealthScoutNews Reporter
HealthScoutNews
Friday, May 16, 2003

FRIDAY, May 16 (HealthScoutNews) -- Vision and hearing tests are commonly given to students at school, but screening programs for allergies and asthma may soon become routine, too.

In a series of articles in the May issue of the Annals of Allergy, Asthma and Immunology, researchers report on four school-based pilot screening programs for allergy and asthma. In the programs, conducted in Chicago, Cleveland, Dallas, and Rochester, Minn., researchers polled both students and parents with various questionnaires, capturing information on more than 7,600 students.

Next, the researchers hope to develop a model questionnaire by pulling the good features from the four questionnaires used in the pilot studies.

One barrier to screening for asthma and allergy is that schools have not had such a validated questionnaire, says Dr. Robert Miles, past president of the American College of Allergy, Asthma and Immunology, who chaired a coordinating committee for the pilot projects. "We'll soon have validation," he adds.

The college funded the pilot projects with grants.

The hope is to phase the screening program into schools gradually and to have the program in all schools nationwide within a few years, Miles says. Screenings would probably occur annually.

The questionnaires used in the pilot programs varied, but in general students and parents were asked about any breathing problems, symptoms such as having a runny nose without a cold, having difficulty sleeping because of breathing problems, or having breathing problems after exercising or being out in the cold.

In 2001, 6.3 million Americans under 18 reported having asthma, according to the National Center for Health Statistics. While it is the most common chronic disease among children, the frequency with which it is recognized varies, Dr. Raoul L. Wolf, director of the Chicago pilot project, writes in his report.

"Studies show the sooner you recognize asthma and get it treated, the better the outcome," Miles says. Early diagnosis and treatment is also recommended for allergies.

"Earlier detection of children who might have asthma and allergies would lead to better and earlier management," agrees Wolf, a pediatric allergist at the University of Chicago and LaRabida Children's Hospital.

Children miss about 2 million school days annually due to asthma symptoms, according to the American Academy of Allergy, Asthma and Immunology.

In the past few years, Wolf says, people, including parents, have become more knowledgeable about the diseases. "The level of understanding has gone up," he says. The school screenings, he says, will help even more.

More information

For help in how to manage asthma at school, try the American Academy of Allergy, Asthma and Immunology, which also has a page devoted to helping your child take control of his allergies.

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Hemophilia Drug May Have Wider Use

By Steven Reinberg
HealthScoutNews Reporter
HealthScoutNews
Friday, May 16, 2003

FRIDAY, May 16 (HealthScoutNews) -- A drug developed to quickly control bleeding in hemophiliacs appears to have wider uses, especially in situations where swift bleeding control is essential but difficult, such as severe trauma and some surgeries.

The drawback is cost. At $6,000 a vial, use of the drug -- NovoSeven -- is not always practical.

"NovoSeven, which is a Factor VII accelerant, is a very expensive, very effective way of treating bleeding in patients with Factor VIII inhibitor, but there is indication from other studies that it may have a much broader use," says Dr. Marcus E. Carr Jr.

Carr, from Virginia Commonwealth University Medical Center, notes one of the problems has been determining the right dose and showing that it is effective.

"This is important because the drug is so expensive, it is not appropriate for all patients," he adds.

Carr and his colleagues have developed a test that shows how NovoSeven works in normal blood and in blood taken from patients with different types of hemophilia, according to their paper in the May issue of Thrombosis and Heamostatis.

"We looked at clotting in whole blood, not in plasma alone, as is done in most other studies," Carr says. Platelets in whole blood are essential for clotting and this new test measures how strong the platelets are. NovoSeven improves the production of thrombin, which in turn strengthens the platelets faster than normal, he notes.

However, the optimal dose remains unclear. "The correct dose will probably vary from patient to patient and from condition to condition. In certain situations, a higher-than-recommended dose is called for, while in other situations a lower-than-recommended dose is better. This study shows that there are ways to determine how well the drug is working, so we should be able to tailor the dose to individual patients," Carr says.

The study was funded in part by Novo Nordisk, the makers of NovoSeven.

In another recently completed study, Carr's team found the test is useful in determining the dose not only of NovoSeven but other drugs used to treat bleeding disorders.

NovoSeven is being used in certain trauma situations and in surgery where there is extensive bleeding, although the U.S. Food and Drug Administration hasn't approved the drug for these purposes. In the future, NovoSeven will be more widely used for these applications, Carr predicts.

But Dr. Nigel S. Key, from the University of Minnesota, is skeptical. Key and his colleagues have developed a similar test based on activated clotting time, which they think is a better way of determining dosage.

"The truth is that neither Carr nor I know for sure if his test is accurate, because there is no clinical data to confirm what was found in the test tube," Key says.

Until clinical data are available, "it is not certain that what is found in the test tube will correlate with clinical outcomes," he adds.

Key believes NovoSeven works in some circumstances. However, he says it's still too early to determine whether it works in conditions other than hemophilia.

More information

To learn more about hemophilia, visit the National Hemophilia Foundation. To learn more about blood clotting, check with Indiana State University.

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Alcohol Doesn't Protect Against Parkinson's Disease

By Steven Reinberg
HealthScoutNews Reporter
HealthScoutNews
Friday, May 16, 2003

FRIDAY, May 16 (HealthScoutNews) -- Whether alcohol can protect you from developing Parkinson's disease is a hotly debated issue among researchers.

Now, a new study indicates alcohol has no effect on preventing onset of the disease.

"There is not a very strong association between alcohol consumption and the risk of Parkinson's disease," says study author Dr. Miguel A. Hernan.

Parkinson's is a chronic neurological condition with symptoms ranging from tremors on one side of the body to slowness of movement, stiffness of limbs and balance problems. It affects about 1.5 million Americans, with an additional 50,000 new cases diagnosed each year. While it can start at any age, Parkinson's is most common among adults over 50 years of age.

Hernan, who is from the Harvard School of Public Health, and his colleagues collected data from two large population-based studies -- the Nurses Health Study, which followed 121,700 female nurses for 25 years, and the Health Professionals Follow-up Study, which followed 51,529 male health-care professionals for 15 years.

Of the 88,722 women and 47,367 men for whom data on drinking were available, 167 of the women and 248 of the men developed Parkinson's, according to the findings, published in the May 15 issue of the Annals of Neurology.

There was no correlation between moderate to low alcohol consumption and the development of Parkinson's, Hernan says. There was no data available for heavy drinkers, he adds.

Some studies have shown cigarette smoking and coffee have a protective effect, Hernan says. Other studies have shown that alcohol helps reduce the risk of Parkinson's, he notes.

But Hernan says, "Our findings show that alcohol drinking is not associated with a lower or higher risk of Parkinson's. It is possible that beer is associated with a slightly lower risk."

Hernan is quick to say that these findings and the findings of other studies should not encourage you to drink more beer or start smoking. The risk to your health from smoking or from excessive drinking far outweighs any possible benefit, he stresses.

Harvey Checkoway, a professor of environmental health at the University of Washington, adds that "the absence of any clear association with total alcohol consumption is not surprising in view of the mixed results from previous studies."

"The [Harvard] researchers' observation of a slightly reduced Parkinson's risk in beer drinkers is provocative, although somewhat unanticipated," Checkoway adds. "It is possible, as the authors mention, that components of beer other than alcohol may have a protective effect. Identifying what the specific protective factors are, and how they act in the brain, could be a valuable area for additional research."

More information

To learn more about Parkinson's disease, visit the Parkinson's Disease Foundation or the National Library of Medicine.

Miscarriage More Likely with Older Father: Report

By Alison McCook
Reuters Health
Friday, May 16, 2003

NEW YORK (Reuters Health) - Researchers have long known that older women are more likely to have a miscarriage, and now new research suggests that a man's age may also affect the risk, too.

European researchers discovered that 25-year-old women were more than twice as likely to have a miscarriage if their partners were at least 35 at the time of pregnancy than if their partners were younger than 35.

Study author Remy Slama told Reuters Health that some fetuses do not survive a pregnancy because they carry certain genetic abnormalities, which can come from either parent.

Previous research has suggested that older men have more genetic abnormalities in their sperm than do younger men, Slama noted, a trend that could explain why older fathers may increase the risk of miscarriage, also known as spontaneous abortion.

"This is, in brief, our biological hypothesis: the frequency of genetic and chromosomal anomalies in the (sperm) could increase with male age," Slama said. "Since these anomalies, if transmitted to the fetus, may cause a spontaneous abortion, male age could increase the risk of spontaneous abortion."

However, Slama cautioned that the current study did not measure the genetic health of the men whose partners had a miscarriage. The French researcher said that further research is needed to say for sure whether more abnormalities in older sperm increase the risk that the fetus will abort.

"I think that this is a plausible hypothesis but that there are too few studies on the subject to be positive about it," Slama, based at INSERM-INED in France, said.

During the current study, Slama and colleagues interviewed 1,151 women who had been pregnant between 1985 and 2000. The women reported a total of almost 2,500 pregnancies, 12 percent of which had ended in miscarriage, according to a report in the American Journal of Epidemiology.

Although the risk of miscarriage with older men was clearly seen when they partnered with young women, male age appeared to have no effect on miscarriage risk in 35-year-old women.

Slama said that this finding does not necessarily mean that a man's age does not influence miscarriage risk in older women, however -- only that this effect was not observed in the study.

The researcher explained that once women reach 35, their own age also starts to influence the health of the fetus, and this and other female factors may "blur" the influence male age has on pregnancy success.

"Indeed, it may be easier to detect an effect of male factors -- i.e., age -- in a group of couples in which women have ... rather good reproductive health," Slama said. "In this group, fewer female factors are likely to blur the effect of male factors."

Just how much of a role men play in the health of a fetus is a relatively new question, and one that will likely have a better answer as time goes on, the researcher said.

"There is still a lot to learn about the male influences on the ability to obtain a live birth," Slama said. "This is partly due to the fact that researchers have for a long time been almost exclusively interested in the female role. We are trying to take into account both partners, and there is still a lot of work on (the) way."

Source: American Journal of Epidemiology 2003;157:815-824.

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Cranberry or Blueberry?

HealthScoutNews
Friday, May 16, 2003

(HealthScoutNews) -- Which is better for you, blueberries or cranberries?

It's not even close, according to the European Journal of Clinical Nutrition, citing a study from the Technical University of Denmark.

Blueberries are rich in phenolic compounds, which are antioxidants, so researchers thought blueberry juice might be a useful antioxidant drink. They compared the benefits of a pint of cranberry juice cocktail with a pint of blueberry juice.

Cranberry juice, which is rich in vitamin C -- a powerful antioxidant -- showed real benefits. But the phenolic compounds in blueberry juice proved no more effective than sugar water.

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Smoking Ups Hereditary Pancreatic Cancer: Study

Reuters Health
Friday, May 16, 2003

NEW YORK (Reuters Health) - People with two or more family members with pancreatic cancer should be encouraged to kick the habit as smoking may nearly quadruple their odds of developing the disease, researchers report.

Among people with a family history of pancreatic cancer, smoking appears to increase the risk of the disease even more in men and in people younger than age 50, according to the results of a new study.

Pancreatic cancer is the fourth leading cause of cancer deaths in the U.S. An estimated 30,000 people will be diagnosed with the disease in 2003. Most people with pancreatic cancer do not have a family history of the illness, but about 10 percent of pancreatic cancer cases are hereditary, according to a report published in the journal Gastroenterology.

Little is known about what factors might play a role in tumor formation in familial, or hereditary, pancreatic cancer, according to a team led by Dr. Stephen J. Rulyak of the University of Washington in Seattle.

Previously, researchers identified a number of environmental factors, including smoking, that may increase the risk for non-familial pancreatic cancer, but such effects have not been evaluated for pancreatic cancer that runs in families, the authors report.

To investigate, Rulyak's team evaluated risk factors for pancreatic cancer among 251 individuals from 28 families. All families had at least two members with pancreatic cancer.

Smoking was an independent risk factor for familial pancreatic cancer, with smokers being almost four times more likely to develop the disease than nonsmokers, the authors report.

The risk was increased about five times in male smokers and more than seven times in smokers younger than 50.

In addition, the researchers found that smokers developed cancer almost a decade earlier than nonsmokers -- at an average age of 59.6 years versus 69.1 years.

The researchers also found that the risk of cancer increased with the number of close relatives -- mother, father, sister or brother -- who had the disease. For each first-degree relative with pancreatic cancer, the risk rose by 40 percent.

Although the pancreas produces the sugar-processing hormone insulin, diabetes was not a risk factor for pancreatic cancer, according to the report.

"Overall, our results further highlight the dangers of cigarette smoking and emphasize the need for additional research focusing on gene-environment interactions in the genesis of pancreatic cancer," the authors conclude.

The study received financial support from the National Institutes of Health, the C.D. Smithers Foundation, Solvay Pharmaceuticals, Inc. and the Italian Association for Cancer Research.

Source: Gastroenterology 2003;124:1292-1299.

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Rheumatoid Arthritis Tied to Birth Weight

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Friday, May 16, 2003

FRIDAY, May 16 (HealthScoutNews) -- A Swedish study finds a relationship between high birth weight and development of rheumatoid arthritis later in life.

It's a puzzlement, as are the other relationships found in the study, says Dr. Lennart Jacobsson, who reports the finding in the May 17 issue of the British Medical Journal. But then, a lot about rheumatoid arthritis is puzzling.

This is not the wear-and-tear arthritis, formally called osteoarthritis, that many people experience as they grow older. Instead, it is an autoimmune disorder, in which the body's immune system attacks joints and surrounding tissue for unknown reasons.

"We know that genetics can explain about 50 percent of cases," says Jacobsson, an associate professor in the Malmö University Hospital department of rheumatology. "We have not yet identified a major environmental factor that is involved."

He and his colleagues tried to identify such a factor by digging up the birth records of 77 people with rheumatoid arthritis who were born in the Malmö area between 1940 and 1960 and comparing them with the records of 308 area residents who don't have arthritis.

They looked at just about everything in the perinatal period, the time around birth, that could be looked at: mother's age, father's occupation, whether the baby was breast-fed, the baby's weight at birth, whether the mother had a previous miscarriage, and so on. And a few associations emerged.

One of them was high birth weight. Babies weighing more than 4,000 grams (about 9 pounds) were more likely to develop rheumatoid arthritis than those of average weight. Another was breast-feeding; breast-fed babies were less likely to develop the disease. Another was the father's occupation. Babies of office workers were more likely to develop rheumatoid arthritis than those of manual laborers.

The birth weight association has been seen in other studies, Jacobsson says, but he admits frankly, "I can't say why it is so."

The journal paper proposes several reasons for the association: the way the immune system develops in the womb, the way the immune system develops after birth, or simply "unmeasured confounding factors." Your guess is as good as his about which might be correct, Jacobsson says.

He does plan more studies to get a clearer picture of the genetic and environmental factors that can lead to rheumatoid arthritis.

Jacobsson's attitude of bewilderment is shared by many in the arthritis medical community. Asked, "What is the cause of arthritis?" on a Johns Hopkins University School of Medicine Web site, Dr. Alan K. Matsumoto, an assistant professor of medicine in the Hopkins division of molecular and clinical rheumatology, posted this answer:

"There are many different types of arthritis and each has different causes. Likely even the same type of arthritis has multiple causes involving a complex interplay of genetic and environmental factors. Ask me again in 50 years."

More information

You can get an overview of rheumatoid arthritis from the Arthritis Foundation or the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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THURSDAY, MAY 15, 2003

Study: Fish Fine for Pregnant Women

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 15, 2003

THURSDAY, May 15 (HealthScoutNews) -- Pregnant women who eat fish-rich diets don't consume enough mercury to threaten the health of their baby's brain.

So says a new study of women and children in the Seychelle Islands of East Africa, where ocean fish are a daily staple. The study, appearing in the May 17 issue of The Lancet, found no solid evidence that babies exposed to mercury in the womb suffered neurological deficits later in life.

"To date we have not found evidence to support" a link between fish consumption by pregnant women and developmental problems in their babies, says Dr. Gary Myers, a neurologist at the University of Rochester Medical Center and leader of the research.

But not for lack of trying. Myers and colleagues have been looking for such an association for the last 30 years. They became curious about the idea after investigating an outbreak of mercury poising in Iraq during the early 1970s, caused when people ate seed grain coated with methyl mercury to deter fungus.

The vast majority of American women have relatively minor contact with methyl mercury, the organic form of the element and the version believed to be most toxic. However, about 8 percent of women have blood levels of the metal above the acceptable limit set by the U.S. Environmental Protection Agency, a recent study found.

People are exposed to mercury through coal burning, the incineration of medical waste, dental fillings, and in various occupations. But the principal route of exposure is the diet, through fish and seafood that accumulate the toxin in their own food chain. Mercury levels are almost four times as high in women who eat at least three servings of fish a week, compared to those who eat no fish.

Certain ocean fish are higher in mercury than others. The U.S. Food and Drug Administration recommends that pregnant women avoid eating swordfish, shark, tilefish and king mackerel altogether. Other fish and shellfish should be limited to no more than 12 ounces per week, or between two and four servings. However, most people in this country eat only one fish dish a week.

Myers says the latest study suggests the FDA's recommendations are reasonable.

The researchers tracked neurological development in 779 children and their mothers, who ate an average of 12 fish meals a week. Mercury exposure during pregnancy was measured by sampling the women's hair, which stores the toxin and can be used to estimate the amount a fetus would encounter in the womb.

The typical woman in the study had mercury levels of 6.9 parts per million in her hair, or about seven times the average U.S. exposure.

When the children were 9, the researchers ran them through 21 mental and motor tests to evaluate their language skills, memory, and other important developmental benchmarks. In only one case -- a peg-board test -- increased exposure to mercury predicted a worse score, and only in boys. The researchers attribute this result to chance. Higher mercury exposure also was associated with lower scores on a test for hyperactivity, which again the scientists consider a fluke.

Fish are a good source of important brain-building nutrients, like fatty acids, and it's possible that loading up on these overcomes any deleterious effect of mercury, Myers says. His group is now looking for such an effect in their Seychelles subjects.

Dr. Constantine Lyketsos, a psychiatrist at Johns Hopkins Hospital in Baltimore and author of an editorial accompanying the study, says pregnant women should heed the FDA's caution, though he doubts most are aware of the guidelines. "I think in general fish consumption is probably fine if the concern is the neurodevelopment of the children," he says.

Still, much about mercury remains a mystery, Lyketsos says. In high doses, mercury is certainly toxic, and even deadly. Yet scientists don't know the lower boundary for how much exposure can harm the brain. Nor do they know if exposure over time or a single, high dose is more dangerous. "There's a range of exposure which for some people is harmful and for others is not," he says.

More information

For more on mercury, try the U.S. Food and Drug Administration or the U.S. Environmental Protection Agency.

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New Medical Journal Refuses Drug Ads

By Karen Pallarito
Reuters Health
Thursday, May 15, 2003

NEW YORK (Reuters Health) - Six medical organizations will launch a new research journal this month that stands apart from many other peer-reviewed publications in a very visible way: it won't run drug advertising.

The new Annals of Family Medicine, an outlet for health care research focusing on the whole person, will be supported mainly through dues paid by members of the sponsoring organizations. The journal will accept classified advertisements but has invoked a ban on commercial drug advertising.

Several major medical journals have taken steps to curb the pharmaceutical industry's influence over published research results and improve disclosure of financial ties with the drug industry, yet they continue to take money from pharmaceutical manufacturers to run ads for their products.

"Journals are doing a lot of work now to try to avoid the conflicts-of-interest involved in that," explained Annals of Family Medicine editor Dr. Kurt Stange, a family physician, epidemiologist and professor at Case Western Reserve University in Cleveland.

Dr. Jesse Gruman, executive director of the Center for the Advancement of Health and a member of the journal's editorial board, said the decision by Stange and the board to take drug ads off the table as an issue reflects a strong commitment by the sponsoring medical groups.

"In some ways, it's a real statement," she told Reuters Health. If it works, she said, it could "really be a challenge to the status quo."

With backing from the American Academy of Family Physicians, American Board of Family Practice, Society of Teachers of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors and the North American Primary Care Research Group, the Annals of Family Medicine will strive to fill a gap in existing peer-reviewed literature.

"I work in the business of trying to make the best possible use of scientific information in health care policy and practice, and one of the problems we see again and again is that research doesn't answer the questions people have," Gruman said.

To bridge the gap, the bimonthly journal will seek to run content crossing various disciplines and focusing on those things doctors on the front lines need to know to work better.

For the audience the journal is targeting, "the latest little quiver of some liver enzyme" is less important than "talking to people about taking their drugs right," for instance, Gruman said.

The Annals will also serve as an outlet for the growing body of evidence being produced by researchers in primary care-based settings, Stange said.

The premier issue will feature studies on prostate cancer screening, attention-deficit/hyperactivity disorder and Cesarean section, among others.

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Epilepsy Drug Shows Promise in Alcoholism

By Emma Ross
AP Medical Writer
The Associated Press
Thursday, May 15, 2003

LONDON - An epilepsy drug offers significant promise in helping alcoholics quit drinking and appears to be more effective than drugs now in use for the problem, a new study shows.

Half of the 55 alcoholics who took the anti-seizure drug topiramate either quit drinking altogether or cut back their drinking sharply.

Researchers found that those given the medication were six times more likely than those on a dummy pill to abstain from alcohol for a month, according to the report published Friday in The Lancet.

"This finding is a major scientific advance in the treatment of alcoholism," said Dr. Domenic Ciraulo, head of phsychiatry at Boston University, who was not connected with the research.

Three drugs are now available worldwide for combatting alcoholism. One of them, disulfiram, sold as Antabuse, makes people feel sick when they drink.

"The problem with that drug is that people know that if you want to drink, all you have to do is throw the tablet away. It is not a treatment. All it does is punish you for drinking," said Dr. Bankole Johnson, chief of alcohol and drug addiction research at the University of Texas at San Antonio and lead investigator in the latest study.

The other two drugs acamprosate, available in Europe but not the United States, and naltrexone are given to ward off relapses once an alcoholic has stopped drinking.

"What is good about topiramate is you can take it while you are still drinking," Johnson said.

Scientists believe that the brain chemical dopamine is what provides the pleasure from alcohol and that topiramate, sold as Topamax by Johnson & Johnson, works by washing away the excess dopamine released by drinking alcohol.

Long-term studies in epileptic patients show no serious problems related to topiramate.

The study involved 103 hardcore alcoholics followed for three months. Many had already tried methods such as Alcoholics Annonymous, medication, psychotherapy and rehab clinics. When they enrolled in the study it had been at least six months since they had been in treatment and they were drinking the equivalent of two bottles of wine a day.

Fifty-five drinkers were given topiramate, while 48 were given a dummy pill. The dose of topiramate was gradually increased.

All the participants got regular counseling to encourage them to keep taking the drugs and refrain from drinking.

By the time the study ended, 13 out of the 55 in the topiramate group, or 24 percent, had abstained continuously for a month. That compares with two out of 48 people, or 4 percent, in the placebo group.

"This is continuous abstinence. This is the strictest way of looking at it. You are not including people who may have had the odd drink," Johnson said.

The gap between the two groups was even wider when it came to binge drinking.

In the topiramate group, 28 out of 55, or 50 percent, did not binge in the final month, compared with 8 out of 48, or 16 percent, of those taking the fake pill. This means those taking the drug were nearly four times less likely to binge.

In the topiramate group, reported cravings were cut in half, compared to a 15 percent drop in the placebo group.

Ray Litten, chief of treatment research at the U.S. National Institute on Alcohol Abuse and Alcoholism, said topiramate could be a significant advance in treating alcoholism.

"It does look like topiramate might be stronger than naltrexone or acamprosate," Litten said. "It's very promising and it certainly has potential, but this is only one study and more trials need to be done."

Litten said a combination of drugs and psychological therapy is considered the best treatment.

"Alcoholism is a complex disease and there's no magic bullet out there," Litten said. "But just to get a menu of different treatments is a step in the right direction."

Many experts say abstinence should still be the goal, but Johnson argues that treatments that help alcoholics cut down say, from 10 drinks a day to two a day is worthwhile.

"If you can make most people stop drinking at a hazardous level, you have done them a power of good. You are going to improve these people's quality of life, help save their marriages, their jobs," Johnson said.

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No Clear Link Between Alcohol, Parkinson's: Study

By Linda Carroll
Reuters Health
Thursday, May 15, 2003

NEW YORK (Reuters Health) - While some research suggests alcohol drinkers have a lower risk of Parkinson's disease than abstainers, a study out Thursday shows no clear association between drinking and Parkinson's -- though there was evidence moderate beer intake might offer some protection.

But because no alcohol other than beer was tied to a lower Parkinson's risk, researchers suspect that a beer ingredient other than alcohol might bestow the benefit.

Their report is published in the online edition of the Annals of Neurology.

Over the past few decades, researchers have debated whether cigarettes, coffee and alcohol can help stave off Parkinson's disease, a movement disorder that arises from the loss of brain cells that produce the chemical dopamine.

Several recent studies have produced strong evidence that cigarette smokers and caffeine consumers have some protection against Parkinson's, and researchers believe it's biologically plausible that tobacco smoke and caffeine might shield brain cells from the damage that marks the disease.

But there is another possibility.

Some scientists have suggested that the absence of these addictive behaviors -- caffeine consumption, smoking, drinking -- might be a sign of a certain kind of personality, according to the authors of the new study, led by Dr. Miguel A. Hernan of the Harvard School of Public Health in Boston.

"It has been hypothesized that people who are destined to develop Parkinson's disease have a characteristic personality -- moralistic, law-abiding, conscientious, risk averse -- that leads them to avoid novelty seeking behaviors or that they have an underlying metabolism (genetic or as a result of a toxic insult early in life) that makes these behaviors particularly unrewarding to them," the researchers explain.

If this hypothesis is correct, then drinking, smoking and caffeine consumption should all appear to reduce the risk of developing Parkinson's, Dr. Alberto Ascherio, a study co-author also at Harvard, told Reuters Health.

"Our result does not support that," Ascherio said in an interview.

"Indirectly," he added, "it supports the idea that caffeine and something in cigarette smoke is protective."

Currently, there are ongoing studies to look at the effects of caffeine in people who already have Parkinson's, Ascherio noted.

For the new study, the researchers looked at data from two large, long-running U.S. studies -- the Nurses' Health Study and the Health Professionals' Follow-up Study.

After examining information from nearly 89,000 women and 47,000 men, the researchers found "little association between total alcohol consumption and Parkinson's disease incidence," according to the report.

When they broke the data down into different types of alcohol, though, people who drank moderate amounts of beer did show a 30-percent lower risk of Parkinson's.

But, the authors write, "because this lower risk was not found among wine or liquor drinkers, it is possible that some components of beer, other than (alcohol), may reduce the risk of Parkinson's disease."

Source: Annals of Neurology 2003;54.

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Veteran Journalist Shines Light on Depression's Darkness

By Gary Gately
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 15, 2003

THURSDAY, May 15 (HealthScoutNews) -- When it all got to be too much, when the darkness of depression had sapped his last remnants of joy, Tom Johnson would sneak off to a room adjoining his office.

And the one-time publisher of the Los Angeles Times would lie on the floor, waiting for the despair to lift.

At the paper, only his assistant and a friend in human resources knew that one of the most influential figures in journalism often felt like he couldn't bear being alive. He maintained the public persona -- a "Herculean" effort -- because, in the late 1980s, he thought he had no other choice.

"Because of the stigma, people thought of depression and mental illness as a sign of weakness," says Johnson, 61. And in corporate America, he says, "leaders are expected to be supermen and superwomen. But no matter what position you hold in life, depression can hit you."

Behind the facade, his world shrank, eclipsed by depression's shadows. He lost all interest in his beloved Dodgers. He avoided friends and public functions where he'd always thrived. Eventually, he sought the shelter of staying home in bed whenever he could.

Johnson kept his illness out of public view and struggled to wear the mask and the mantel of the corporate executive.

And, in what he now realizes was a big mistake, he didn't heed his wife's initial advice to see a psychiatrist. "I had resisted going to a psychiatrist because, frankly, like with most other things in life, I dealt head-on with it and thought I could work my way through it," he says.

So Johnson started running three to five miles a day. He lost lots of weight, but not the much heavier burden of depression. He finally went to see a psychiatrist at the University of California, Los Angeles, beginning arduous trial-and-error attempts to find medications that worked, everything from Lithium to Prozac. He experienced serious side effects -- dry mouth, a "zombie-like" wooziness -- but the depression persisted.

The sense of hopelessness grew nearly unbearable in June 1989, when Johnson got word he was being replaced as the Times' publisher. "After that came the darkest periods," he says. "I continued to just spiral downward, and that was when I first started having thoughts of suicide."

He finally found relief more than a year later after moving to Atlanta to become head of CNN News. A psychiatrist prescribed Effexor, a newer antidepressant that acts on two key brain chemicals thought to affect moods.

Johnson went public with his struggle in January 2002, and quickly learned just how many others knew intimately the malaise that William Styron called "darkness visible." From all across the country, calls, notes and e-mails poured in, congratulating Johnson, asking his advice, thanking him for shining a light on a taboo subject.

Today, Johnson is retired from CNN, though still acting as a consultant to the network. But the story this veteran journalist feels most compelled to tell is at once intensely personal and familiar to the 20 million Americans who suffer depression.

He's made it his personal mission to help eliminate the stigma of depression, to demystify the malaise. He knows it's a disease and a life-threatening one. Among the estimated 30,000 Americans who kill themselves each year were some of Johnson's acquaintances: an Atlanta doctor, two business executives, a CNN staffer. None of them, he says, had gotten treatment for their depression.

Perhaps they thought, as he once had, that they could beat it alone. Perhaps others gave them familiar advice with the best of intentions. "Unless you have experienced depression, you can't really describe it," Johnson says. "People want you to get up, get out. They say, 'What's wrong with you? You need more exercise or a better diet.'"

Johnson knows that often, depression sufferers need much more than that. So he keeps telling his story, writing about it, speaking about it. He gives freely of his time and money to support mental health treatment centers. He has testified before Congress and a presidential commission. He advises national health policy leaders like the ones who just launched "Real Men, Real Depression," a massive public-awareness campaign aimed at encouraging men to seek treatment for depression.

He urges insurance companies to stop what he calls discriminatory practices that impose limits on coverage of mental disorders. And he responds personally to pleas for help strangers battling depression.

"It's important for those of us who've had depression to try to help others, to keep others from taking their own lives, to eradicate this stigma that keeps people from telling others, and keep people from getting treatment," Johnson says. "I'm convinced today that, with the right diagnosis and treatment, most people can get better, in most cases, get back to their old selves -- before the depression hit them."

More information

Learn more about the national public-awareness campaign, Real Men, Real Depression. You can take an online depression screening test developed by the New York University School of Medicine.

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Viral Protein Explains Why Some HIV+ Stay Healthy

By Alison McCook
Reuters Health
Thursday, May 15, 2003

NEW YORK (Reuters Health) - A group of Canadian and U.S. scientists reported Thursday that people who stay healthy even years after infection with HIV are more likely than other HIV-positive people to be infected with virus that has an alteration in a particular protein.

The finding offers another possible explanation why a small number of people with HIV never develop AIDS, and points toward new therapies that might prevent the progression of HIV in other patients, as well.

Experiments with the HIV protein, known as viral protein R (Vpr), revealed that altering or deleting the protein altogether greatly decreased the number of immune cells destroyed by HIV, the process that enables HIV to progress to AIDS.

Since Vpr appears to play an important role in turning HIV into AIDS, treatments that block Vpr may help infected people stay healthy, study author Dr. Andrew Badley of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.

"Since mutations in Vpr can alter the outcome of HIV disease, it is possible, if not likely, that we can develop inhibitors of Vpr that may also modify disease outcome," Badley said.

In the small number of HIV patients known as nonprogressors, levels of the virus in the bloodstream remain low, even without treatment, and AIDS does not develop. Some nonprogressors have now lived as long as two decades with no signs of the illness.

Researchers have long been puzzled over how this can happen, but new clues are emerging. About 25 to 30 percent of those patients just happen to lack receptors that HIV uses to enter and infect cells.

To see if a weaker virus might explain other cases, Badley and his team examined the makeup of HIV extracted from the blood of people with HIV, some of whom were nonprogressors. Once the researchers identified that a particular mutation was present more often in HIV from nonprogressors, they designed samples of HIV that contained normal or mutated forms of Vpr, and some samples that lacked the protein altogether.

Badley and his team then mixed those different forms of HIV with human blood cells, and discovered that each type of virus had a different effect on immune cells, according to the report in the Journal of Clinical Investigation.

"The amount of cell death was minimal in the virus that did not have Vpr, was quite high in the virus that contained normal Vpr, and was kind of halfway in between in the virus that contained the mutant Vpr," Badley said.

He explained that HIV in nonprogressors likely succeeds in killing immune cells, but at such a slow rate, people are able make new immune cells fast enough that their immune system does not become compromised.

Given that HIV in nonprogressors is more likely to contain this mutation than virus in progressors, Badley said it is possible that people who become infected with HIV from nonprogressors are more likely to be nonprogressors as well.

Whether that is, in fact, the case, remains unclear, Badley added.

"But certainly that is one of our hopes," he said.

He noted that he and his colleagues are currently looking at developing Vpr inhibitors, but stressed that new treatment options based on this principle are not around the corner.

"Certainly, we're talking a number of years, as opposed to a number of months" before a new treatment would be available for people, he said.

Source: Journal of Clinical Investigation 2003;111:1547-1554,1455-1457.

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Understanding Prostate Cancer

HealthScoutNews
Thursday, May 15, 2003

THURSDAY, May 15 (HealthScoutNews) -- Three new University of California-Davis Cancer Center studies try to understand why some prostate cancers become resistant to androgen-suppression therapy.

About 190,000 men in the United States develop prostate cancer each year, and a number of them require androgen-suppression therapy to lower their levels of male hormones. This treatment can shrink or limit the growth of prostate cancers.

However, the treatment eventually fails as prostate cancer cells adapt to an androgen-depleted environment. It's called androgen independence and, when it occurs, there are few remaining treatment options.

The UC Davis studies focused on trying to determine how androgen independence develops and how it can be countered.

"If we could prevent androgen independence from happening, it would have a dramatic impact on treatment and outcomes for prostate cancer," Ralph deVere White, chairman of urology at UC Davis School of Medicine, says in a news release.

The UC-Davis studies were presented recently at the annual meeting of the American Urological Association in Chicago.

More information

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

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In Women, Low Bone Mass Linked to Alzheimer's

By Alison McCook
Reuters Health
Thursday, May 15, 2003

NEW YORK (Reuters Health) - Women with low bone mass in their later years appear to have a higher risk of eventually developing the memory-robbing disease Alzheimer's, researchers said Thursday.

The same relationship between bone mass and memory decline was not present in men, however.

In women, it is not likely low bone mass itself, but what it represents, that may increase the risk of memory problems, study author Dr. Zaldy Tan told Reuters Health.

Studies have shown that the drop in estrogen production at menopause accelerates bone loss in women, and the amount of bone mass a woman carries into old age is a "marker for lifelong estrogen exposure," Tan said.

Consequently, if a woman has low bone mass in her 70s, "that may mean (her) estrogen exposure during (her) lifetime is not as high as it should be," he added.

Previous research has also suggested that estrogen may protect the brain from memory loss, the researcher said.

As such, he reasoned that the findings are "suggestive" that lifetime exposure to estrogen may help prevent Alzheimer's disease and dementia.

However, Tan added that it is too soon for doctors to attempt to gauge a woman's risk of memory decline in old age using bone scans conducted years earlier.

This current study produced "definitely an interesting finding," said Tan, who is based at Beth Israel Deaconess Medical Center and Harvard University in Boston.

"But I think we need some more studies to confirm this" before doctors begin applying this information to their patients, he added.

Tan and his colleagues reported their findings during the annual meeting of the American Geriatrics Society in Baltimore.

During the study, Tan and his team recorded bone mass measurements for 987 men and women, average age 76, then followed them for up to 13 years and noted who developed Alzheimer's or dementia.

They found that women with the lowest bone mass measurements were more than twice as likely to later develop Alzheimer's or dementia as those with stronger bones.

In men, however, earlier bone mass had no relationship to Alzheimer's or dementia risk, suggesting that changes in estrogen may have a different effect on men than women, Tan said.

Although the findings suggest that estrogen may protect against dementia and Alzheimer's in women, Tan noted that previous research has shown that estrogen does not help treat these conditions once they develop.

"I think, ultimately, (estrogen) will be more of a prevention than treatment" of mental decline, he predicted.

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How Hot is Hot?

HealthScoutNews
Thursday, May 15, 2003

(HealthScoutNews) -- If you're a tea drinker and believe in its health benefits, then you need to know what the perfect brewing temperature is.

According to Toxicology Letters, researchers at the Food Safety and Toxicology Center of Michigan State University in Lansing studied the question of which brewing temperature yielded the best extracts of polyphenols, the chemicals in tea that have all the health benefits.

The answer turns out to be 176 degrees Fahrenheit (80 degrees Celsius). Anything less won't extract the same levels of polyphenols, and anything more will damage the polyphenols with too much heat.

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Cell Changes May Explain Diabetes Risk in Elderly

HealthScoutNews
Thursday, May 15, 2003

NEW YORK (Reuters Health) - Diabetes may become more common with age because of a decline in the function of mitochondria, the powerhouses of the body's cells, researchers reported Thursday.

The good news, they say, is that exercise might counter this decline.

In a study that compared 13 healthy people ages 18 to 39 with 16 healthy people ages 61 to 84, the elderly participants were found to have greater insulin resistance, which is a precursor to type 2 diabetes.

However, the difference was not due to higher body fat among the older participants, who were just as lean as their younger counterparts.

Insulin is a hormone produced by the pancreas that allows blood sugar, or glucose, to enter cells so it can be used as energy. Mitochondria, found in a cell's cytoplasm, are responsible for converting glucose and fatty acids into energy.

This process is impaired during insulin resistance, when the body becomes less sensitive to the effects of insulin, prompting the pancreas to pump out more insulin to try to compensate.

A big question has been why older adults have high rates insulin resistance and full-blown type 2 diabetes. Type 2 diabetes affects about one in four people older than 60, noted study author Gerald I. Shulman of the Howard Hughes Medical Institute at Yale University in New Haven, Connecticut.

In the new study, reported in the May 16th issue of Science, Shulman and colleagues showed that the metabolic activity of the mitochondria in muscle cells was about 40 percent lower in the older participants.

They also showed more fat accumulation in their muscle and liver tissue, assessed through non-invasive scans.

"This finding is important because studies in our lab and others have shown that the amount of lipid (fat) inside the muscle cell is a very good predictor of insulin resistance," Shulman said in a statement.

The results suggest that fat builds up in the muscle of older people because of the decreased activity of the cells' fat-burning mitochondria, according to the researchers.

"These data support the hypothesis that an age-associated decline in mitochondrial function contributes to insulin resistance in the elderly," they conclude in the report.

On a positive note, exercise may help counter this process, because research has shown that physical activity increases mitochondria in muscle by activating an enzyme known as AMP kinase, Shulman explained in the statement.

"This is yet another reason for seniors to maintain an active lifestyle," he said.

Source: Science 2003;300:1140-1142.

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Green Tea Gives Skin Healthy Glow

HealthScoutNews
Thursday, May 15, 2003

THURSDAY, May 15 (HealthScoutNews) -- The skin-healing properties of green tea may help scientists develop new treatments for skin disease and wounds, say researchers at the Medical College of Georgia.

Green tea contains compounds called polyphenols, which help eliminate free radicals. These free radicals can cause cancer by altering DNA. Polyphenols also protect healthy cells while promoting the death of cancer cells.

Cell biologist Dr. Stephen Hsu recently began studying the most abundant green tea polyphenol, called EGCG, and its effect on skin cells. Hsu and his colleagues compared the growth of normal skin cells to those exposed to EGCG.

They found the EGCG reactivated dying skin cells.

"Cells that migrate toward the surface of the skin normally live about 28 days, and by day 20 they basically sit on the upper layer of the skin getting ready to die. But EGCG reactivates them. I was so surprised," Hsu says in a news release.

He and his colleagues also found other ways that EGCG benefits skin cells.

The findings indicate that EGCG may offer potential benefits for skin conditions including psoriasis, rosacea, wrinkles and wounds.

The research appears on the online version of the Journal of Pharmacology and Experimental Therapeutics.

More information

Here's where you can learn more about green tea.

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Study Links Migraine, Major Depression

Reuters Health
Thursday, May 15, 2003

NEW YORK (Reuters Health) - New research suggests that migraine headaches may raise the risk of major depression, and vice-versa.

This two-way relationship supports the idea that the disorders involve some of the same biological factors, the study authors report in the journal Neurology.

Understanding the nature of the major depression-migraine association could have "important clinical implications" and provide clues to how each disorder arises, write Dr. Naomi Breslau, of the Henry Ford Health System in Detroit, and colleagues.

Their study found that migraine sufferers were five times more likely than people with no history of severe headaches to develop major depression over two years. And those with major depression at the study's start had a more than three-fold higher risk of developing migraines compared with people without depression.

The findings are based on interviews with 496 adults with a history of migraine, 151 people with a history of severe headaches but not migraines, and 539 people without severe headache problems. The entire group was followed for two years.

At the start of the study, 42 percent of participants in the migraine group had suffered from major depression at some point, as did 36 percent in the severe-headache group and 16 percent of those without a history of severe headaches.

Major depression is defined clinically as the presence of at least five types of depressive symptoms -- including generally low mood, changes in weight and sleep habits, feelings of worthlessness, and concentration problems.

Along with the higher rate of major depression among migraine patients, Breslau's team found that major depression appeared to increase the risk of a first migraine, and migraine history had the same effect on the risk of a first bout of depression.

These findings "indicate that the relationship between migraine and major depression is bidirectional, with each disorder increasing the risk for the subsequent first onset of the other," the researchers conclude.

What's more, they say, the study does not support the notion that major depression is a psychological response to chronic severe headaches.

"If major depression in persons with migraine were caused by the pessimism and distress associated with recurrent severe headaches, we should have observed the same increased risk also in persons with other headaches of similar severity," the authors write.

Similarly, they point out that if migraine were merely a "pain complaint" associated with major depression, then they should also have observed a higher risk of other types of headaches in people with a history of major depression.

Instead, the authors conclude, their findings support the idea that the two disorders share some biological underpinnings, perhaps related to hormones or brain chemicals that transmit nerve signals.

As such, the researchers recommend that patients with either disorder should be evaluated for the presence of the other.

"Treatments that might improve both migraine and major depression may benefit patients with both disorders," they write.

Source: Neurology 2003;60:1308-1312.

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Study: Radiation Starves Cancer While Killing It

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 15, 2003

THURSDAY, May 15 (HealthScoutNews) -- Radiation kills cancer cells in more than one way, says a new study that lends support to a sometimes controversial theory.

In addition to killing cells directly, radiation also stops angiogenesis, the growth of blood vessels that are essential for a tumor's growth, says a report in the May 16 issue of Science. This is the first genetic evidence that damage to the blood vessels that feed a cancer can cause that cancer to shrink, say researchers from the Memorial Sloan-Kettering Cancer Center in New York City.

Dr. Judah Folkman of Harvard Medical School proposed the theory several years ago that stopping angiogenesis could be an effective way to treat cancer. However, that theory remains controversial because a number of trials aimed at stopping angiogenesis in cancer patients have produced mixed results.

Radiation kills cancer cells directly. But working with genetically engineered mice, the researchers showed that it damages cells other than those of the cancer -- the delicate endothelial cells that line blood vessels and are essential to their function.

The mice were manufactured to be deficient in an enzyme called acid sphingomyelinase, which regulates apoptosis, the process of natural endothelial cell death.

Cells of two kinds of cancer, melanoma and fibrosarcoma, were implanted in those mice. The tumors grew at twice the rate seen in normal mice. And the cancers did not shrink when the mice were exposed to radiation, as would normally happen.

The new study arose from previous work indicating that damage to small blood vessels played a role in the injury caused to the gastrointestinal tract caused by radiation, says a statement by Dr. Richard Kolesnick, head of Memorial Sloan-Kettering's signal transduction laboratory and a leader of the research team.

"It was unclear that this would also happen in tumors," Kolesnick says. "Our new study shows that damaging the angiogenic blood vessels of the tumor does indeed contribute to tumor regression."

There are several ways the finding could be used to improve cancer treatment, says Dr. Carlos Cordon-Cardo, director of the Memorial-Sloan Kettering division of molecular pathology and a member of the research team.

"Knowing that these blood vessels respond to specific factors, we can aim therapy at those factors," he says.

And it may be possible to combine anti-angiogenesis therapy with radiation therapy that is aimed not at the cancer cells themselves but at the factors that promote blood vessel growth, Cordon-Cardo says.

But more research is needed to determine such important factors as the exact role radiation treatment would play in such combined therapy and the most effective radiation doses, the researchers say.

More information

You can learn about the role of radiation in cancer therapy from the National Institutes of Health. To learn more about blood vessels and their role in cancer, visit the Angiogenesis Foundation.

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U.S. Moms Stop Breastfeeding Too Soon: Study

By Jesse J. Logan
Reuters Health
Thursday, May 15, 2003

NEW YORK (Reuters Health) - During the last decade, more and more new mothers in the U.S. have started breastfeeding their babies, but most new moms stop sooner than health experts would like, health officials report.

African-American moms, in particular, show low rates of exclusive breastfeeding, according to a survey by the U.S. Centers for Disease Control and Prevention (CDC).

As a part of the national Healthy People 2010 program, health officials aim to increase the proportion of mothers who breast-feed their infants to 75 percent soon after birth, 50 percent at six months and 25 percent at one year.

However, according to a telephone survey of the families of more than 700 children, about two-thirds (65.1 percent) of babies had ever been breast-fed. At six months, 27 percent of babies were fed some breast milk. This percentage dropped to about 12 percent at 12 months.

At 7 days old, close to 60 percent of babies were given only breast milk. However, between the ages of 2 and 3 months, the number of babies being breast-fed experienced a "sharp decline," researchers report in the journal Pediatrics.

By six months, the proportion of babies being breast-fed exclusively dropped to about eight percent.

"The U.S. is not in good shape in terms of breastfeeding," Dr. Ruowei Li, lead author of the study and an epidemiologist at the CDC in Atlanta, told Reuters Health. She noted that the study is consistent with previous findings about racial and ethnic disparities in breastfeeding.

"The number of African Americans compared to whites is still consistently lower in both the initiation and duration of breastfeeding," Li said.

Though breastfeeding is widely recognized as beneficial for both infants and mothers, Li said, "there is still lots we need to do to promote breastfeeding in U.S."

She said that the health care system "has an important role to play in the promotion and support of breastfeeding."

For example, she suggested that maternity care and newborn facilities should find ways to make their environments more "conducive" to nursing. In addition, health care providers should be supportive, knowledgeable and skillful about breastfeeding, Li said.

Also, a mother's network of family, friends and co-workers should understand and encourage breastfeeding, she added.

The decline in breastfeeding when a baby is between 2 to 3 months old coincides with the time when many women return to work or school and need additional support in order to continue breastfeeding, Li and her colleagues point out in the report.

Lack of support is a "major barrier" against maintaining breastfeeding, according to the researchers.

"Societal and environmental support is very, very important, including in the health care system and in the work environment," Li said.

"The public should be aware that breastfeeding has a wide range of benefits for both mother and baby," she added.

Besides providing the "ideal nutrition" for infant growth, Li said, breast milk is more likely to protect babies against infection and from developing chronic conditions such as obesity when they get older. She also noted that breastfeeding gives a new mom and her baby a chance to bond.

Source: Pediatrics 2003;111:1198-1201.

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Study Contends Secondhand Smoke Won't Kill You

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 15, 2003

THURSDAY, May 15 (HealthScoutNews) -- Secondhand smoke may not be as harmful as thought -- or at least it may not kill those exposed to the smoker. But they do face an increased risk for such chronic respiratory problems as bronchitis and emphysema.

That's the conclusion of a highly controversial study in the May 17 issue of the British Medical Journal that found secondhand smoke did not significantly increase the risk of death from lung cancer or coronary heart disease for non-smoking spouses of smokers.

The study immediately fanned the ongoing debate over the dangers of inhaling other people's cigarette smoke.

Several of the world's top scientists meeting for a conference in Miami, including a former U.S. Surgeon General, slammed what they called a tobacco industry-funded study that flies in the face of repeated research that documents the dangers of secondhand smoke.

"This study is just the latest in a long string of studies designed to deny the evidence and confuse the public," Dr. Julius Richmond, the U.S. surgeon general from 1977 to 1981, said in a statement. "The first study linking secondhand tobacco smoke and lung cancer was published 22 years ago when I was Surgeon General, and the evidence has only become stronger since then."

The American Cancer Society also attacked the study's credibility.

"We are appalled that the tobacco industry has succeeded in giving visibility to a study with so many problems it literally failed to get a government grant," Dr. Michael J. Thun, the society's national vice president of epidemiology and surveillance research, said in a statement. "The American Cancer Society welcomes thoughtful, independent peer review of our data. But this study is neither reliable nor independent."

And the British Medical Association issued a statement criticizing the study. "It reanalyses a small part of the data from a study that was dropped by its original funders, the American Cancer Society. Most of the data has been around for decades (the study was begun in 1959) but was judged by many expert groups to be inadequate to accurately measure passive smoking."

However, Geoffrey Kabat, a co-author of the study and an independent researcher, defended the merit of the research.

"It's a very large study and very carefully conducted," said Kabat, formerly an associate professor of preventive medicine at the Stony Brook University School of Medicine in New York. "It's one of the biggest studies on this issue. It's conducted very meticulously. They're barking up the wrong tree."

And co-author James Enstrom, a researcher at UCLA's School of Public Health, also said, "I can fully defend the independence [of this research]."

Asked about the study's source of funding, Enstrom said he received money from the Center for Indoor Air Research, which was funded by tobacco companies until it was disbanded in 1999.

"Basically they gave me the money at the same time they went out of business, and they left me alone. And I've never spoken to the tobacco industry since," he said.

Added Kabat: "This is a peer-reviewed study. There's no way that the tobacco industry is going to influence reporting on the results. The study reports what we found."

For the British Medical Journal study, the researchers revisited people who had participated in an American Cancer Society cancer-prevention study that took place from 1959 until 1998. The original study had 118,094 participants. The authors of the new study restricted their analysis to 35,561 participants who had never smoked as of 1959 and who had a spouse in the study who did smoke. In mid-1999, these people were asked to fill out a two-page questionnaire on smoking and lifestyle.

The researchers concluded secondhand smoke did not significantly increase the non-smoking spouse's chances of dying from coronary heart disease or lung cancer, regardless of how much the spouse smoked.

"Even people who seemed to be exposed to higher levels of spouse's smoke didn't have a statistically higher risk of lung cancer or heart disease," said Kabat.

Nonsmokers, however, did have an increased risk for chronic obstructive pulmonary disease (COPD), a term that refers to chronic bronchitis and emphysema, the study found.

"For COPD, in both men and women, we found a 60 percent increase in people who had heavy exposure," Kabat said. "That is suggestive of an effect."

Not surprisingly, smokers themselves had a higher risk for coronary heart disease, lung cancer and chronic obstructive pulmonary disease. And that risk increased with the number of cigarettes they smoked, the researchers found.

Other experts questioned whether death rates from lung cancer and heart disease are appropriate ways to assess the harmful effects of secondhand smoke.

"Cardiovascular disease mortality may not be a good measure of non-fatal effects such as myocardial infarction, stroke, etc.," said Frank Gilliland, an associate professor of preventive medicine at the Keck School of Medicine at the University of Southern California in Los Angeles.

Gilliland is the lead author of a study in the May 15 issue of the American Journal of Epidemiology that found exposure to secondhand smoke in the house increased absenteeism among children with asthma and, to a lesser degree, children without asthma.

Referring to the new study, Dr. Norman H. Edelman, consultant for scientific affairs for the American Lung Association, said, "It's an interesting contribution, but the answer certainly isn't in."

Based on several previous studies, the American Heart Association, the U.S. Surgeon General and other organizations have concluded that "environmental tobacco smoke" -- secondhand smoke -- increases the risk of coronary heart disease and lung cancer by about 25 percent.

The topic is a controversial one because of difficulties in measuring and assessing damage from so-called passive smoke.

But the latest study isn't likely to change regulations or sentiments about smoking, particularly in public places.

"Our smoking regulation has to do with the workplace, which is a qualitatively different situation," said Dr. John Rich, medical director of the Boston Public Health Commission, which on May 5 banned smoking in the workplace.

"Workers are in a setting for eight hours or so where they're exposed not to the smoking of one person like a spouse, but high levels of tobacco smoke in the air," Rich said. "When one looks at evidence about workers, it's much more clear that they suffer a risk of 50 percent in some studies of lung cancer and the like."

And even the authors of the new study are against relaxing smoking restrictions, even if their evidence appears ambiguous.

"If it's hard to say with certainty the increased risk of someone who smokes one cigarette a day religiously every day for 40 years, you can imagine how hard it is to say anything about this. There's no reason to think that from one whiff of smoke or one evening out that you're going to be set on the road to heart disease or lung cancer or other diseases," said Kabat, who is a nonsmoker.

"[But] there's no reason why you should be subjected to inhaling other people's tobacco smoke," he added. "People should have the right not to breathe this extra form of air pollution."

More information

The U.S. Centers for Disease Control and Prevention has more information on smoking and lung disease. Visit the American Lung Association for information on quitting smoking.

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New York City Women Less Likely to Get Mammogram

By Charnicia Huggins
Reuters Health
HealthScoutNews
Thursday, May 15, 2003

NEW YORK (Reuters Health) - Women living in New York City and the surrounding area are less likely to get mammograms than their counterparts living in other parts of New York state, researchers report.

The findings, released this week, also show that mammography rates were about 14 percent higher among white women than among African-American women. The rates were based on Medicare claims filed from October 2000 to September 2002.

Nationwide, 60 percent of women ages 52 to 69 received mammograms during the study period, and in New York state overall, 58 percent of women the same age received mammograms.

But only 47 percent of such women living in either New York City or Long Island had had a mammogram, in comparison to nearly 65 percent of women living in other parts of New York state.

"All the states are a little different," said Dr. Clare B. Bradley, senior vice president and chief medical officer of IPRO, the independent health care quality improvement organization that released the study findings.

"Some are probably a little better, some might be a little worse," she told Reuters Health. "We in New York are seeing higher rates upstate than we are in New York City."

The reason for the discrepancy in mammography rates is unknown.

"We're not sure why that's so," Bradley said. But, she added, the reasons may be similar to those cited for any medical procedure.

Those reasons include differences in physicians' practices in referring women for mammography, geographical and cultural issues, as well as social and economic issues.

The second-most common cancer among women in the U.S., breast cancer is also the second-leading cause of cancer death among women, after lung cancer. The American Cancer Society estimates that more than 211,000 women will be diagnosed with the condition in 2003.

One of the largest studies to date into the benefits of mammograms, published recently in the medical journal The Lancet, shows that the screening technique reduces deaths from breast cancer by about 28 percent. That study was conducted among 210,000 Swedish women between the ages of 40 and 69.

"We don't only want to depend on docs referring women," Bradley said. "We want women to be proactive -- know that this is a test that they all need to have, that in the event that they develop breast cancer that they can improve their survival."

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Aging May Shortcircuit Body's Ability to Ward Off Diabetes

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Thursday, May 15, 2003

THURSDAY, May 15 (HealthScoutNews) -- Power shortages in the body's cells may contribute to insulin resistance and, eventually, the development of type 2 diabetes in elderly people.

Researchers reporting in the May 16 issue of Science say that problems with mitochondria, which are the cell's energy centers, may be at the root of insulin resistance, which is a defining characteristic of type 2 diabetes.

The discovery could eventually lead to new drugs for type 2 diabetes, which is affecting a growing number of Americans, particularly older ones.

"These advances are very important for us to understand why certain things happen," says Dr. Edmund Giegerich, an endocrinologist and executive vice president for medical affairs at Long Island College Hospital in New York City. "The application will obviously come when someone can produce a medication that will affect mitochondrial function."

About 25 percent of Americans over the age of 60 suffer from type 2 diabetes, which occurs when the body's insulin fails to function properly. Under normal circumstances, insulin, a hormone produced by the pancreas, is responsible for ushering glucose out of the blood stream after people eat. Once glucose and fatty acids are safely inside the cell walls, mitochondria convert them into energy through the process of oxidation.

When insulin isn't doing its job, however, glucose remains in the blood stream and, after prolonged periods of time, can result in such complications as blindness and kidney failure.

Dr. Gerald I. Shulman, senior author of the new study and an investigator at the Howard Hughes Medical Institute in Chevy Chase, Md., had already discovered that an accumulation of fat in muscle and liver tissue could lead to insulin resistance in those same tissues.

The question he needed to answer was what was behind the accumulation of fat. Shulman, who is also a professor at Yale University School of Medicine, figured the answer lay in one or both of two processes: that fat cells were releasing more fatty acids than necessary or there was a problem with the mitochondria's break-up of fatty acids.

To figure out what was going on, the researchers decided to compare glucose and fatty acid metabolism in healthy elderly people with young adults. The two groups were matched for lean body mass as well as fat mass, so these factors could not affect differences in insulin resistance.

The elderly participants turned out to be more insulin-resistant, especially in muscle tissue, than the younger participants. Magnetic resonance spectroscopy revealed that the older group also had higher levels of fat in the muscle tissue.

When the researchers looked more closely, they discovered that the fat cells were not releasing the extra fat building up in the muscle. In fact, mitochondrial activity was reduced by about 40 percent in the older group of participants.

"At least in the elderly, it looks like it's mitochondrial dysfunction that leads to the accumulation of fat inside the cells of muscle and livers," Shulman explains. "That then leads to insulin resistance through pathways we've described previously."

Part of the significance of the study is in its specificity.

"This really helps pinpoint where one would now try to focus on improving mitochondrial oxidative function," Shulman says. "The next question is why is mitochondrial function down? Is it simply a reduced number or is it actually something wrong with each individual mitochondria?"

Shulman also wants to know if similar defects are occurring in the insulin-resistant offspring of parents with type 2 diabetes.

"You can be in your 20s and be lean and have the same type of insulin resistance as we're seeing in the elderly," he says. "They also have an accumulation of fat in muscle and the same question exists: Is it due to abnormalities in fat cells or defects in mitochondrial function?"

Some good news is that researchers have already shown that exercise can increase the number of mitochondria. Until new medications are developed, this study is yet another argument to get moving.

More information

For more information on type 2 diabetes, including insulin resistance, visit the American Diabetes Association or the National Institute of Diabetes & Digestive & Kidney Diseases.

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WEDNESDAY, MAY 14, 2003

Remember This

HealthScoutNews
Wednesday, May 14, 2003

(HealthScoutNews) -- How good is your memory?

Not the part of memory that stores the lyrics to favorite songs or reminds you when to send birthday cards. We're talking about the memories of your own life and feelings.

Here's a clue from the Journal of the American Academy of Child and Adolescent Psychiatry.

In 1962, researchers at Northwestern University Medical School in Chicago interviewed 73 mentally healthy 14-year-old boys. They asked questions about family relationships, home environment, dating, sexuality, religion, parental discipline and general activities. Then they put the files away, with a note to pull them out 34 years later.

When a new group of researchers found the participants and asked them to recall their original answers, the answers were no better than would have been expected by random chance.

The researchers' advice? Don't take personal memories as truth, just as reconstructions.

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U.S. Changes Guidelines on Blood Pressure

By Lauran Neergaard
AP Medical Writer
The Associated Press
Wednesday, May 14, 2003

WASHINGTON - Some 45 million Americans with blood pressure levels once considered normal or borderline actually have "prehypertension," say new government guidelines that urge them to exercise, avoid salt and make other changes to stave off full-blown high blood pressure.

It's a major change that affects people with blood pressure as low as 120 over 80 once thought to be a good level but now considered not good enough.

Scientists now say that damage to arteries from the pressure of blood pounding through them begins to increase at levels as low as 115 over 75. Even a small jump from that low to 130 over 85, a level previously considered in the normal range means a doubling of the risk of later death from heart disease, say the guidelines by the National Heart, Lung and Blood Institute.

Hence the new emphasis on at least delaying the gradual rise in blood pressure that so many Americans see with age. Still, the report promises to be a shock for people told for years their blood pressure was healthy, only to learn they're now considered "prehypertensive" unless their level is below 120 over 80.

"We don't want to frighten the public, we want to get action," said Dr. Aram Chobanian, dean of Boston University's medical school who chaired the government-appointed committee that drafted the guidelines. "Even small changes in blood pressure are important."

Other recommendations in the broad report, published in a special online edition of the Journal of the American Medical Association on Wednesday, are generating controversy, as doctors debate just which medication is best once hypertension hits.

The guidelines say most people who already have high blood pressure will need at least two medications to control the dangerous disorder and most should at least try a cheap, old-fashioned diuretic as initial therapy.

At a major meeting of hypertension experts, doctors argued Wednesday that that was the wrong advice for many people.

"They haven't justified those steps," said Dr. John Laragh of New York Hospital/Cornell University Medical Center, who contends only 35 percent of people with hypertension have the type that responds to diuretics. Many of the rest, he said, could do fine with one other drug, such as an ACE inhibitor or beta blocker.

The authors responded that the guidelines say diuretics aren't the only option and that patients with additional diseases, such as heart-attack survivors, may do better with other medications.

"Nobody's advocating some kind of cookbook medicine," said Dr. Claude Lenfant, director of the federal heart institute.

The guidelines also say that:

  • Blood pressure is measured as two values and the first number, the systolic pressure, is the most important for anyone over 50 something too few doctors and patients understand. If nothing else, that number should be below 140.
  • Doctors should be far more aggressive in treating hypertension. Almost a third of people with high blood pressure don't know it and two-thirds of the diagnosed don't have the disease under control too often because doctors hesitate to prescribe a second or third medication, said co-author Dr. Daniel W. Jones of the American Heart Association.

An estimated 50 million Americans have high blood pressure, often called the silent killer because it may not cause symptoms until the patient has suffered damage. It raises the risk of heart attacks, strokes, heart failure, kidney damage, blindness and dementia.

High blood pressure measures 140 over 90 or more. That level hasn't changed.

Until now, optimal blood pressure was considered 120 over 80 or lower; normal was up to 130 over 85; and levels above that were called borderline until patients reached the hypertension range.

But the new guidelines classify normal blood pressure as below 120 over 80 and readings anywhere from 120 over 80 up to 140 over 90 as prehypertensive.

They should lose weight if they're overweight, get regular physical activity, avoid a salty diet and consume no more than two alcoholic drinks a day all factors that increase blood pressure, the guidelines say.

"We hope it's going to catch people's attention," Jones said of the new prehypertension category. "They are at higher risk for going on to develop hypertension and they need to take action."

On the Net:

JAMA: http://www.jama.com

Federal hypertension info: http://www.nhlbi.nih.gov/hbp

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A Drink a Day Improves Overall Heart Health

Reuters Health
Wednesday, May 14, 2003

NEW YORK (Reuters Health) - People who drink one drink a day -- wine, beer or hard liquor -- show significantly better elasticity of their body's arteries, an important measure of cardiovascular health, results of a new study suggest.

"We thought only red wine helps, but we found if people drink one beer or one unit of hard liquor a day, they also have improved arterial elasticity, better than nondrinkers," said Dr. Reuven Zimlichman of Wolfson Medical Center and Tel Aviv University in Israel.

The research is scheduled to be presented Thursday at a meeting of the American Society of Hypertension.

When arteries lose elasticity, they fail to relax as the heart pumps blood. This causes a rise in the systolic blood pressure, something Zimlichman calls a "terrible predictor" of future strokes, cardiovascular disease and heart attacks.

The researchers also found that moderate drinkers had pulse rates that were significantly lower than those of nondrinkers.

"There's been lots of study of pulse rates and the risk of disease," Zimlichman said. He noted that higher pulse rates are associated with an increased risk of disease and death.

In comparing wine drinkers with drinkers who favor other alcoholic beverages, the researchers observed that beer and hard liquor drinkers had slightly higher blood pressure than wine drinkers. But all drinkers had blood pressure within normal ranges, Zimlichman said.

The researchers studied 243 healthy people between the ages of 15 and 80 who volunteered to fill out questionnaires and be tested at clinics in seven European countries.

They excluded people who drank more than one drink a day and adjusted their findings for age because arterial elasticity commonly gets worse with age.

Asked if this study means nondrinkers should start drinking, Zimlichman pointed out that heavy drinking itself can cause high blood pressure.

"Whenever you recommend drinking, you have to consider the possibility that somebody will like it too much and over-drink and cause damage to his health," he said. "But if someone has a high risk of cardiovascular disease, I recommend to my patients that they drink one glass of red wine a day."

Although his study showed similar benefits for beer and hard liquor as for wine, Zimlichman only recommends wine.

"Those who drink one drink of hard liquor a day have more of a chance to increase the dose," he noted.

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Too Much Booze Damages Key Hormones

HealthScoutNews
Wednesday, May 14, 2003

WEDNESDAY, May 14 (HealthScoutNews) -- Chronic alcohol abuse causes severe and persistent damage to hormones that regulate electrolyte and water balance in the body.

So says a German study in the May issue of Alcoholism: Clinical & Experimental Research.

The changes in these hormones may account for some withdrawal symptoms and may also lead to long-term health problems even after chronic alcohol abusers stop drinking, the study adds.

The researchers monitored the major water and electrolyte-regulating hormones in 21 alcoholics who underwent detoxification. They were followed from early withdrawal up to 280 days of alcohol abstinence.

The hormones that were monitored were arginine vasopressin (AVP), atrial natriuretic peptide (ANP) and aldosterone and angiotensin II. Kidney and liver function was also monitored during the study.

The study found AVP levels were suppressed for the entire length of the study, while ANP levels were elevated for the entire time. The study found no persistent alterations in aldosterone or angiotensin II.

"We learned that we are dealing with profound, long-lasting alterations of key hormones of water and electrolyte balance notwithstanding at least nine months of controlled abstinence," researcher Hannelore Ehrenreich, Max-Planck-Institute for Experimental Medicine, says in a news release.

"These observations imply a number of causes and consequences: they may explain excessive thirst and fluid intake, what we call diabetes insipidus; may explain how alcohol-related cardiomyopathy develops; and may show that there is a subclinically impaired renal function in these patients which clearly underlines the concept of multi-organ involvement in alcoholism, that is, not only are the liver and brain affected, but basically all organs are," Ehrenreich says.

More information

Here's where you can learn more about alcoholism.

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CDC: Fourth of Americans Get No Exercise

The Associated Press
Wednesday, May 14, 2003

ATLANTA - A quarter of all American adults are couch potatoes, getting virtually no exercise either at work or on the weekends, a government study found.

Three-fourths of all Americans, though, engage in least moderate activity three times a week or more, according to the report released Wednesday by the Centers for Disease Control and Prevention.

Of that number, roughly 20 percent are considered very physically active, exercising moderately five times a week for 30 minutes or vigorously three times a week for 20 minutes.

The study, based on 32,000 interviews conducted in 2000, gauged both work and leisure activities.

"One of the most interesting things we found was people who were active in their usual daily activity also were active in leisure activity," said statistician Pat Barnes. "An example is someone who does landscaping is more likely to do some leisure activity than someone who sat at a desk all day long."

The government recommends adults get at least 30 minutes of moderate exercise most days of the week to fight obesity, heart disease, stroke and diabetes. It wants 30 percent of adults to exercise 30 minutes five or more days a week by 2010.

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A Hair-Raising Discovery

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Wednesday, May 14, 2003

WEDNESDAY, May 14 (HealthScoutNews) -- David Van Mater was trying to grow tumors, but ended up with hair instead.

The discovery could prove to be good news for people struggling with certain types of hair loss.

Van Mater, a University of Michigan graduate student, was researching the activities of a protein called beta-catenin in mice as part of an investigation into colon cancer. The protein is involved in the development of human embryos and is also activated in the majority of colon cancers. But no one knows exactly how it works.

Van Mater and his colleagues wanted to see if they could induce tumors by activating beta-catenin, and get rid of the tumors by turning off the protein.

The researchers applied a chemical called 4-OHT, which activates beta-catenin, to shaved areas on the backs of lab mice. To their surprise, no tumors appeared.

But they did see exaggerated growth of hair follicle cells along with other changes in the skin sections that seemed to indicate the hair was in its growth phase. Adult hair follicles go through a cycle consisting of periods of growth, regression and rest.

Dr. Andrzej Dlugosz, an associate professor of dermatology at the University of Michigan Medical School, suggested turning on the beta-catenin for just a short period of time, instead of the longer period they had tried for the tumor. The scientists started over, applying 4-OHT once, instead of every day, and doing it during the follicles' resting stage.

After 15 days, the mice had grown new hair that was exactly the same as the old hair, and went through the growth cycle as if it were normal.

"From a developmental standpoint, the most interesting part of the study is just by [turning on] beta-catenin for this very short period of time, we were able to put in place the full complex series of events needed for hair to regenerate," says Van Mater, who is lead author of a paper detailing the research in the May 15 issue of Genes & Development.

"The nice thing is that briefly turning on one molecule can activate the entire process and it's a very complicated process," adds Dlugosz.

But simply turning on the process is not enough to reverse male pattern baldness, say both Van Mater and Dlugosz.

"Male pattern baldness is a complicated process," Dlugosz says. "One of the major things that happens is that hair follicles become very, very tiny. Even if you can trigger the growth of those follicles, they're so small that any hair that's produced is not like normal hair."

However, it's possible that manipulating this pathway might help with other types of hair loss, such as loss from chemotherapy.

Other experts are even more sanguine.

"They found the on/off switch and just flicked it. I'm very impressed," says Dr. Ted Daly, director of pediatric dermatology at Nassau University Medical Center in East Meadow, N.Y. "I wouldn't underestimate the ability to understand what the trigger is."

Daly also thinks the issue of miniaturization of hair follicles can eventually be overcome.

More information

For more on hair loss, visit the American Academy of Dermatology or the American Hair Loss Council.

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Even Short Walk Reduces Deadly Clot Risk in Obese

By Alison McCook
Reuters Health
Wednesday, May 14, 2003

NEW YORK (Reuters Health) - Obese people who are relatively inactive may have trouble dissolving potentially deadly blood clots, but moderate exercise a few times per week appears to help restore that ability, according to new research.

U. S. investigators discovered that obese, sedentary people are less able than those of normal weight to produce and release a clot-busting substance known as tissue plasminogen activator (t-PA), the body's primary defense mechanism against the formation of blood clots.

Obese people have a higher-than-average risk of developing heart attack or stroke, both of which can be caused by blood clots.

While obese people are more likely to carry a host of conditions that help explain that trend, such as diabetes or high blood pressure and high cholesterol, study author Dr. Christopher A. DeSouza suggested that the increased risk seen in obesity may also stem from problems dissolving blood clots.

"What we just showed here is this is another system that is impaired" in obese people, he told Reuters Health.

But obese people are not doomed, DeSouza added. After spending only three months walking for around 45 minutes every day for five days each week, almost half of obese study participants began releasing more t-PA when needed.

After exercise, the ability of some obese people to release t-PA "looked very similar to their lean, age-matched counterparts," he said.

These findings provide "further evidence that exercise can be very beneficial," DeSouza, based at the University of Colorado in Boulder, noted. "All we asked these people to do was to go on a walk every day."

DeSouza and his colleagues reported their findings last week during the American Heart Association fourth annual conference on Arteriosclerosis, Thrombosis and Vascular Biology in Washington, D.C.

During the study, the researchers measured the amount of t-PA released by the cells lining the blood vessels of 36 sedentary men, 24 of whom were obese.

Participants were then asked to spend between 40 and 45 minutes walking five times each week for three months. DeSouza explained in an interview that the men were asked to walk at a "modest" pace, during which they could easily carry on a conversation.

Before the exercise program, obese men showed a 30 percent smaller increase in the amount of t-PA their bodies released in response to a drug designed to stimulate release of the substance.

And after only three months of exercise, and despite the fact that they did not lose any weight, 10 of the obese men experienced a significant improvement in their ability to release t-PA.

These findings suggest that exercise improves the general health of arteries, DeSouza said, enabling them to release t-PA when needed. Why that is remains unclear, he said.

The researcher added that he and his colleagues have also shown that the ability to release t-PA declines with age, but, in older adults, that impairment appears to also improve with exercise.

Exercise "can be a potential benefit to everyone," he said.

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Broccoli Could Be Prostate Cancer Fighter

By Randy Dotinga
HealthScoutNews Reporter
HealthScoutNews
Wednesday, May 14, 2003

WEDNESDAY, May 14 (HealthScoutNews) -- It's no secret that men who eat lots of vegetables seem more likely to avoid prostate cancer, but researchers now think a chemical in broccoli and cauliflower could help doctors treat the disease, too.

No one has tested the chemical on humans yet, however, and it may take years to turn it into a usable drug. "It's interesting early work, but it's a long way from something going on in a test tube to exactly what goes on in humans," says Dr. Durado Brooks, director of prostate and colorectal cancers for the American Cancer Society.

Prostate cancer is the most commonly diagnosed cancer among men in the United States and kills about 30,000 each year, according to the National Prostate Cancer Coalition. A number of treatments are available, but side effects commonly include incontinence and impotence.

Prostate cancer rates are lower in countries where people eat plenty of fruits and vegetables, although the exact link between diet and the disease isn't clear, Brooks says.

Researchers at the University of California at Berkeley decided to investigate the cancer-fighting effects of chemicals in cruciferous vegetables such as broccoli, cauliflower, kale, Brussels sprouts and cabbage.

"We realized that what was missing was a comprehensive study of how these natural compounds affect the growth and function of reproductive cancer cells," says study co-author Gary Firestone, a professor of molecular and cell biology at the University of California at Berkeley.

The researchers found that a chemical known as 3,3'-diindolylmethane (DIM), a byproduct of eating cruciferous vegetables, appeared to prevent the growth of breast cancer cells. They next turned to prostate cancer cells.

The researchers found that prostate cancer cells treated with DIM grew 70 percent slower than untreated cells.

Their research will appear in the June 6 issue of the Journal of Biological Chemistry.

The chemical appears to prevent cancer cells from receiving signals from the hormone testosterone, Firestone says. That, in turn, prevents the cells from growing.

By contrast, traditional hormone therapy for prostate cancer patients is designed to prevent testosterone from getting to the cells in the first place. "You cut off the signal that makes the prostate cancer cells grow," Firestone says.

It's possible that the chemical could be used in combination with hormone therapy, Firestone says, letting doctors dampen the side effects of lowering testosterone levels.

Producing drugs from the vegetables may be easy and inexpensive, he adds: "There's a lot of broccoli and cabbage, and you should be able to obtain a lot of this chemical at a very cheap price."

However, Brooks says hormone treatment is much less common than other prostate cancer treatments. Surgery and radiation are the usual treatments.

Research into chemicals derived from vegetables may be more important in terms of prevention, says Satya Narayan, an associate professor of anatomy and cell biology at the University of Florida. "These compounds may be of greater importance for prostate cancer prevention at the early stages of the prostate cancer development, instead of at the later stages when the cancer is advanced."

But it's still not clear how many vegetables men would need to eat to protect themselves from getting prostate cancer in the first place.

More information

Learn about the disease by visiting the National Prostate Cancer Coalition or the National Cancer Institute.

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Obesity Reported to Cost U.S. $93B a Year

By Laura Meckler
Associated Press Writer
The Associated Press
Wednesday, May 14, 2003

WASHINGTON - Obesity is costing not only American lives, but dollars too. A study tallies that $93 billion per year goes to treat health problems of people who are overweight.

About half that tab is picked up by the government through Medicare, which provides care to the elderly, and Medicaid, which serves the poor.

Overall, spending attributed to excessive weight made up 9 percent of all medical spending in 1998, researchers reported Wednesday on the Web site of the journal Health Affairs.

They arrived at the figure by comparing the medical expenses of adults who are not overweight with the expenses of those similar in most ways but who were overweight or obese .

The difference in spending on people who are overweight and those of normal weight were, for the most part, not statistically significant by themselves. But major differences appeared for those who were obese: The average increase in spending over a person of normal weight was $732 per year 37.4 percent more.

Altogether, medical spending attributable to extra weight totaled $78.5 billion in 1998, or $92.6 billion in 2002, inflation-adjusted dollars.

The financial burden now rivals that attributable to smoking, the authors say, arguing that government and health insurance companies should offer incentives to help people lose weight.

"Although some insurers subsidize memberships to health clubs to promote physical activity, most do not include incentives to encourage weight loss," wrote authors Eric Finkelstein and Ian Fiebelkorn of RTI International in North Carolina and Guijing Wang of the Centers for Disease Control and Prevention in Atlanta.

The study examined a representative sample of 9,867 adults ages 19 and older, with data from the 1998 Medical Expenditure Panel Survey and the 1996 and 1997 National Health Interview Surveys. The research was paid for by the CDC.

Weight was assessed using body-mass index, a height-to-weight ratio. People with a BMI of 30 or above are considered obese; those between 25 and 30 are considered overweight.

Someone who is 5 feet, 5 inches tall who weighs 150 pounds would have a BMI of 25. At a weight of 180 pounds, this person's BMI would be 30.

On the Net: Health Affairs: http://www.healthaffairs.org.

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Acetaminophen Fights High-Altitude Headaches

By Gary Gately
HealthScoutNews Reporter
HealthScoutNews
Wednesday, May 14, 2003

WEDNESDAY, May 14 (HealthScoutNews) -- Hiking in rarefied air high in the mountains can be heavenly. It can also give you a ferocious headache.

Dr. N. Stuart Harris, a longtime mountain climber and resident emergency physician at two Harvard-affiliated hospitals, knows all about "high-altitude headaches," caused by reduced oxygen levels.

Harris also knows ibuprofen, which has been widely viewed as the best medicine for high-altitude headaches, can worsen the nausea that typically accompanies the headaches.

He wanted to find out whether acetaminophen, which doesn't cause nausea, would be as effective for high-altitude headaches. So he set out to answer the question -- by testing the two pain relievers on hikers trekking some 14,000 feet up in the mountains of Nepal.

The conclusion: Acetaminophen and ibuprofen are equally effective, both providing headache relief within a few hours, Harris and fellow researchers report in the May issue of the Journal of Emergency Medicine.

"Up until now, there hasn't been any evidence to suggest that there was anything better than ibuprofen" for high-altitude headaches, Harris says. "It had become accepted as the standard of treatment. Ours is the first study proving that acetaminophen is as effective as ibuprofen against high-altitude headaches."

Of course, quick relief -- without nausea -- is no small concern when you're thousands of feet up in the mountains in an area so remote that it takes 12 days to hike to the nearest road and five to seven days to hike to the nearest airstrip.

"If you aren't both physically fit and feeling well, then you stay put," Harris says.

This gives your body time to get acclimated to the higher elevations. "But," he says, "taking a rest day without a headache is much more fun."

You don't have to be hiking in the shadows of Mount Everest to experience high-altitude headache, the primary symptom of "acute mountain sickness" -- a syndrome that also can cause not only nausea, but also sleeplessness, loss of appetite and fatigue.

Each year, according to the study, some 7 million people who travel to U.S. elevations over about 6,500 feet will suffer acute mountain sickness severe enough to limit activity.

The condition is common, for example, among skiers who head to the mountains of Colorado. "Suddenly, rather than going out and skiing hard and enjoying time on the slopes," Harris says, "they're moping around with headache and nausea, and suddenly their very expensive trip is being wasted."

In the double-blind study, Harris and colleagues surveyed hikers arriving at a Nepal camp and enrolled 74 who had symptoms of high-altitude headache. (The researchers excluded those who had a history of chronic headaches, migraines or allergy to ibuprofen or acetaminophen.)

Of the 74 patients, 39 received ibuprofen and 35 got acetaminophen, and all the patients took surveys measuring headache symptoms and severity before taking the medications and 30, 60 and 120 minutes after taking them.

Both groups reported a similar decrease in headache pain during the two-hour study period as well as slightly decreased levels of nausea.

None of the patients suffered a rare and sometimes dangerous complication of acute mountain sickness that can cause edema -- a buildup of fluid -- in the lungs or brain. Harris stresses people in high altitudes shouldn't continue to ascend if they suffer symptoms such as worsening headaches, shortness of breath and confusion.

For Harris, the three months of research in 1999 provided a chance to pursue two passions: high-altitude hiking and medicine.

His outdoor laboratory of sorts afforded spectacular views of Mount Everest, an ancient rhododendron forest where the white and pink flowering plants grow 20 to 30 feet tall, and a deep valley where the river slices through the mountains.

"It's gorgeous," he says. "You've got Everest at 29,028 feet, you got the Khumbu Glacier coming from the South Col into the valley. Where it melts, the river starts and gives birth to wild white water rolling down the middle of the valley. It's a spectacular spot."

And, he adds, not a bad place to do scientific research either.

More information

For more on high-altitude illness, visit the American Academy of Family Physicians or the American Medical Association.

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Nicotine-Blocking Drug May Curb Alcohol Cravings

By Jacqueline Stenson
Reuters Health
Wednesday, May 14, 2003

NEW YORK (Reuters Health) - A drug that blocks nicotine receptors in the brain may help dampen the appeal of alcohol, suggest findings from a small study.

Mecamylamine reduced the stimulant and euphoric effects of alcohol among casual drinkers and also diminished their desire to drink more, according to results published in the May issue of Alcoholism: Clinical and Experimental Research. The hope is that the drug will have the same effects on alcoholics.

Sold as Inversine, mecamylamine is an old medication originally used to treat high blood pressure. Some researchers have used it in combination with the nicotine patch to help smokers kick the habit.

Smoking and drinking often go hand in hand, and scientists have speculated that they may have shared effects on the brain.

The investigators in the new study said they suspect that by blocking nicotine receptors that alcohol acts on, mecamylamine may, in turn, decrease the feel-good brain chemical dopamine that normally surges when alcoholics drink.

It appears that the drug "blocks the stimulant-like effects of the alcohol," said study author Dr. Harriet de Wit, an associate professor of psychiatry at the University of Chicago in Illinois.

The study involved 14 men and 13 women, all of whom were nonsmoking "social" drinkers in their 20s or early 30s.

During six separate sessions in the lab, the participants were given either a pill containing one of two doses of mecamylamine or a dummy pill. Two hours later they were given either an alcoholic drink or one that contained just a hint of alcohol and was not expected to have any effect on the brain. Then they were monitored for the next two hours and periodically asked to rate how they felt.

Results showed that the highest dose of the drug reduced alcohol's impact on mood and the desire to consume more. But the effects were most pronounced in men, for reasons that are largely unclear but may have to do with the different ways alcohol affects women and men, according to de Wit.

If the research pans out in heavy drinkers, mecamylamine may be used one day as part of a treatment plan for alcoholics, de Wit said.

"It's unlikely we'll ever come up with a single drug for alcoholism because alcohol works on so many systems," she told Reuters Health.

The next step, according to de Wit, is to see if the drug not only curbs alcohol cravings but also actually prevents people from drinking more when it's offered.

"We need to make the leap between the mood-altering affects of alcohol and the likelihood of consuming alcohol," de Wit said.

Source: Alcoholism: Clinical and Experimental Research 2003;27:780-786.

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Drinking Gives Pause to Thinking

By Serena Gordon
HealthScoutNews Reporter
HealthScoutNews
Wednesday, May 14, 2003

WEDNESDAY, May 14 (HealthScoutNews) -- If you've had too much to drink, you may think you can just wait an hour or two and then you'll be fine to drive.

That's not necessarily so, says a new study.

Alcohol continues to affect cognitive functioning even after you feel like you're sobering up, reports the study, published in the May issue of Alcoholism: Clinical and Experimental Research.

"People generally feel down or a little depressed [as they're sobering up], but they don't feel drunk," says study author Robert Pihl, a professor of psychology and psychiatry at McGill University in Montreal. "Yet cognitive deficits are worse at that time."

Pihl says some of the important cognitive functions affected by alcohol are spatial reasoning, planning and the ability to control behavior.

For this study, Pihl's team recruited 41 male college students. Twenty-one were given enough alcohol to get legally intoxicated. The other group was given a placebo -- orange juice mixed with several drops of alcohol, so it would smell as if they were drinking an alcoholic beverage.

The researchers gave six cognitive functioning tests to all of the volunteers at the start of the study. Then, participants were randomly assigned to be tested again when their blood-alcohol level was 0.08 on either the ascending or descending limb of the blood-alcohol curve.

The blood-alcohol curve is a measure of how alcohol is absorbed by the body. During the ascending limb of the curve, blood alcohol levels are rising and people feel stimulated. It is during this part of the curve that people feel most intoxicated. On the descending limb, blood-alcohol levels are going down and people may feel a little down, but they generally don't feel like they're drunk any longer, Pihl says.

In most states, it's illegal for someone with a measurement of 0.08 to drive.

The intoxicated volunteers showed cognitive impairment on both limbs of the blood alcohol curve, but the descending limb group showed even greater deficits, especially in spatial functioning.

That means, says Pihl, "If you're drinking heavily, but want to be cautious and responsible, add five hours to what you think is safe."

"When people stop drinking, it doesn't mean their body just returns to normal," says William McKeithan, a certified addiction specialist and director of preventive services at Graham Windham, a family services program in New York City. "Alcohol has lingering effects."

James Fell, director of traffic safety and enforcement programs for Mothers Against Drunk Driving (MADD), says this study just reinforces the group's position.

"At MADD, we say don't drink and drive. There is no safe level. While we believe that 0.08 is the right level for the law, even at lower blood alcohol levels, some people are affected. Appoint someone as your designated driver." Or, Fell recommends, "If you plan to drink, don't drink as much and make sure you wait long enough that your blood-alcohol content is down to zero."

It's not only driving that's a concern. Cognitive function deficits can seriously affect behavior, making you more aggressive and argumentative, Pihl says.

"The essence of behavioral control is soluble in alcohol for many people," he says.

More information

If you've ever wondered how alcohol affects the body, check out HowStuffWorks.com. This chart details how alcohol can impair your driving ability.

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Teens Exposed to Alcohol Ads, Study Says

By Deanna Bellandi
Associated Press Writer
The Associated Press
Wednesday, May 14, 2003

CHICAGO - Magazines popular with teenagers, such as Rolling Stone, Sports Illustrated and People, tend to have more liquor and beer ads than other titles, suggesting the alcohol industry may be indirectly targeting underage drinkers, according to a study.

"Kids also read these magazines, and if this is truly a public health concern, then we need to find ways to talk about decreasing adolescent exposure to advertising," said one of the researchers, Dr. Craig Garfield of the Evanston Northwestern Healthcare Research Institute in the Chicago suburb of Evanston, Ill.

The researchers compared 35 magazines and found that for every 1 million more readers ages 12 to 19, a magazine had about 60 percent more beer and distilled liquor ads.

"We're not in any way trying to suggest that they are doing this intentionally. It simply may be worth it for them to look a little more closely at their advertising strategies," said another one of the researchers, Dr. Paul Chung of the medical school at the University of California at Los Angeles.

The study was published in Wednesday's Journal of the American Medical Association and was funded by the Robert Wood Johnson Clinical Scholars Program.

The Distilled Spirits Council of the United States, a major trade association, ridiculed the study as "typical of the Robert Wood Johnson Foundation-funded advocacy efforts: rife with flagrant technical errors bordering on junk science." It said the study's tables show that only 16 percent of the magazines' total readers are ages 12 to 19, so the overwhelming majority of those seeing the ads are adults.

The council said its member companies "are strongly committed to responsible marketing and advertising policies directed to adults."

The researchers said major alcoholic beverage trade associations have codes of conduct pledging to avoid marketing to teens. The researchers said that if self-regulation by the industry is not enough, then maybe the government or an independent auditor needs to monitor the situation.

"We always consider that stuff to be the last resort," Chung said.

The Beer Institute, a trade association for the malt beverage industry, said more regulation will not reduce underage drinking.

"The strongest influences on young people are their parents and their peers," the group said in a statement. "Providing materials to parents that the beer industry does in abundance that allows them to talk about drinking with their kids, is the sort of effective solution that this industry's critics should embrace."

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Italians Getting Healthier and Taller: Survey

Reuters Health
Wednesday, May 14, 2003

FLORENCE (Reuters Health) - They struggle with their weight and smoke too much, but Italians these days are healthier and taller than in the past, a doctors group said on Wednesday.

A new survey released by hospital doctor group FADOI at its national congress in Bologna shows that six in 10 Italians are in good health, three feel fairly well and only one complains about poor health.

"If only they would eat and smoke less, walk more, and forget for a while worries about their career, they would be even in better health," the doctors group said.

Good health is mirrored in Italians' stature, according to the poll. For example, it recorded an increase of 29 millimeters on average among men born in 1975 and those born in 1980.

The survey suggests that smoking remains a big problem. The number of smokers decreased only marginally -- from 24.9 percent to 24.4 percent -- between 1999 and 2000. However, since then, the government has passed laws designed to tackle the problem.

And although most of Italy's 58 million citizens are on a diet, the effort lasts only a couple of months. Indeed, 8.9 percent of Italians are currently obese, while 33.4 percent are overweight.

Nevertheless, the results suggest Italians are gradually learning to take care of their health, said FADOI president Ido Iori.

"But they need efficient and appropriate services in every region. Waiting lists can be reduced," he said in an open letter to President Carlo Azeglio Ciampi.

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Sleep Working

(HealthScoutNews) -- While you sleep, your body doesn't.

The Journal of Pediatric Endocrinology and Metabolism reports that your endocrine glands are at work all night long -- but not all at the same time. It all depends on how deeply you sleep.

Growth hormone starts secreting during the first phases of sleep, and continues during the deepest sleep periods.

  • Prolactin -- best known for its role in breast milk production and possibly immune system function -- is only secreted during deep sleep.
  • Thyroid stimulating hormone and cortisol, the stress hormone, aren't secreted until the deepest sleep periods are over and you start to wake up.

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TUESDAY, MAY 13, 2003

Personality Keeps Changing with Age, Study Finds

By Linda Carroll
Reuters Health
Tuesday, May 13, 2003

NEW YORK (Reuters Health) - In contrast to the theory that an adult's personality is set in stone by age 30, a new study suggests personality does change throughout life -- and often for the better.

Researchers who surveyed more than 130,000 adults ages 21 to 60 found that men and women tend to become more agreeable and more conscientious with age.

In fact, agreeableness -- a person's warmth, generosity and helpfulness -- showed the biggest improvement after age 30, according to findings published in the May issue of the Journal of Personality and Social Psychology.

Many scientists believe that personality is simply an inherited trait that remains the same regardless of environmental effects, the study's lead author, Sanjay Srivastava of Stanford University in California, said in an interview with Reuters Health.

But "we find gradual but meaningful changes, on average," Srivastava said. "And the average trends tended to be improvements. People are getting better at things as they age. They're not becoming grumpy old men."

The survey was conducted on the Internet, Srivastava noted, and participants were volunteers. "People could come to the Web site and fill it out," he explained. "In exchange they got feedback in the form of a score and a description of what it meant."

When the researchers looked at the participants' scores for agreeableness, they found that people became increasingly warm and nurturing in their 20s, 30s and beyond. The greatest improvement in conscientiousness scores was seen among people in their 20s.

Among young adults, women tended to be more neurotic and more outgoing than men, but the difference diminished with age. Neurotic individuals are more prone to worrying and anxiety.

Although the slight differences between the sexes appear to fall in line with sexual stereotypes, Srivastava said he doesn't think people should read too much into the findings.

"The variation in personality among women is much bigger than the variation between men and women," he said.

Another trait measured -- openness -- appeared to decline slightly with age for both men and women.

Because the study was based on a survey done at one point in time and the researchers did not follow the same group of people over several decades, they can't be sure that the results do not reflect differences among the generations, Srivastava acknowledged.

Still, he said, "our findings are consistent with other studies that ruled out generational differences."

Source: Journal of Personality and Social Psychiatry 2003;84:1041-1053.

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Magazines Shower Teens With Alcohol Ads

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 13, 2003

TUESDAY, May 13 (HealthScoutNews) -- Magazines that boast more teen readers are more likely to run ads for beer and liquor that their young patrons aren't old enough to drink, a new study has found.

While it might not be surprising that teens are attracted to publications with sports and music titles that appeal to young adults, the study found that as youth readership rises, so, too, does the number of alcohol ads.

"We expect that some teens will be exposed [to alcohol ads], but for whatever reason, there just seems to be an inordinate number of teens that are being exposed," said study co-author Dr. Paul Chung, a pediatrician at the University of California, Los Angeles' David Geffen School of Medicine.

Another study co-author, Dr. Craig Garfield, a child health specialist at the Evanston Northwest Healthcare Research Institute in Illinois, said the alcohol industry needs to do a better job of policing itself when it comes to advertising and underage audiences.

If that sounds familiar, it should.

In 1999, the Federal Trade Commission (FTC) issued a report concluding the alcohol industry's safeguards weren't sufficient to avoid marketing their products to minors. The industry's three trade associations have voluntary codes that generally state companies should restrict their ads to outlets where at least half the audience is over age 21.

The FTC in its report declared that standard too weak, however, and called on the alcohol industry to raise its demographic bar. But the new study, which appears in the May 14 issue of the Journal of the American Medical Association, suggests that hasn't happened.

Instead, the researchers said, stricter government regulation, or a group of independent auditors, is needed to help monitor alcohol advertising to underage drinkers.

A survey in 2002 found 20 percent of the nation's eighth graders said they'd had a drink of alcohol in the previous 30 days. That number shot up to 35 percent for 10th graders and almost 50 percent for 12th graders. Some evidence has tied exposure to alcohol ads with youth drinking, which itself has been linked to an increased risk of suicide, unsafe sexual activity, deadly car accidents and other serious problems.

Garfield, Chung and a colleague analyzed beer, wine and liquor ads in 35 magazines with varying degrees of teen readership published between 1997 and 2001. Magazines with a large number of teen readers included National Geographic (which had no beer or wine ads and relatively few for hard liquor), Reader's Digest (which had only eight alcohol ads during the study period), Vibe, Rolling Stone, People, Newsweek and Sports Illustrated, which had the highest number of alcohol ads. In that time, alcohol companies bought 9,148 ads, at a price of almost $700 million. The vast bulk (82 percent) were for liquor; 13 percent pitched beer and 5 percent were for wine.

Levels of teen readership, defined as children aged 12 to 19, ranged from 1 million (Marie Claire) to 3 million (Newsweek), to 5.8 million (Sports Illustrated) and 7.1 million (TV Guide).

Wine marketing didn't appear to be linked to young audiences. But with every increase of 1 million teen readers, the amount of beer and liquor ads rose by 60 percent, the researchers said.

The study found a slight decline in the number of ads per year, Garfield says, but nothing that indicated the 1999 FTC report had made a significant impact on industry marketing practices.

Garfield and Chung said they can't draw any conclusions about what's behind the association and whether the alcohol industry intends to market to underage drinkers.

"It's certainly possible that they're focusing on lifestyle groups rather than age groups," Chung said. "But teens are being exposed out of proportion to their readership."

Jeff Becker, president of the Beer Institute, said in a statement Tuesday:

"More regulation, as called for in the JAMA article, will not reduce under-aged drinking. The strongest influences on young people are their parents and their peers. Providing materials to parents -- which the beer industry does in abundance -- that allows parents to talk about drinking with their kids, is the sort of effective solution that critics should embrace."

David Jernigan, research director for the Center on Alcohol Marketing and Youth in Washington, D.C., said that so far there's no evidence the alcohol industry is deliberately targeting underage drinkers in the way tobacco companies aimed their messages at minors.

"We don't have the documents that show intent. But [research] does show the effect: that this advertising is reaching kids more effectively than the people for whom it's intended," he added.

More information

For more on the impact of alcohol advertising on teens, try the Center on Alcohol Marketing and Youth. For more on underage drinking, visit the American Academy of Pediatrics.

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Starting Exercise May Help Older Women Live Longer

Reuters Health
Tuesday, May 13, 2003

NEW YORK (Reuters Health) - Embracing physical activity beyond age 65 may help women live longer lives, study findings released Tuesday suggest.

People who exercise have consistently been shown to lower their risks of heart disease, diabetes, physical disability and some forms of cancer -- but whether older adults can extend their lives by taking up exercise has been unclear, according to the report in the Journal of the American Medical Association.

In the new study -- of more than 7,500 women age 65 and up -- researchers found that sedentary women who became more active during the study had a 48 percent lower risk of death from any cause than those who remained inactive.

The researchers, led by Dr. Edward W. Gregg of the Centers for Disease Control and Prevention in Atlanta, followed the women for up to 12.5 years, asking them about their exercise levels at the study's start and again several years later.

All of the women estimated how much they walked each day and the frequency and duration of leisure activities such as dancing, gardening, aerobics and swimming during the previous year. The researchers also evaluated the women's medical records.

They found that women who became newly active during the study had a 36 percent lower heart disease risk and a 51 percent lower risk of cancer than those who stayed sedentary.

"Modest increases in physical activity could have wide-ranging benefits ranging from improved risk factors to reduced disability," the authors write.

"Our findings suggest these benefits may translate into substantial reductions mortality," they add, noting that more needs to be done to increase walking and other low-intensity activities among older women.

However, the study authors note, their findings suggest that boosting exercise levels may be less beneficial for women age 75 and up and those already in poor overall health.

Women 75 years and older did lower their risk of death when they went from a sedentary to an active lifestyle, but the effect was not as strong as for younger women.

Women who were active throughout the study also had lower risks of death from cardiovascular disease or any other cause than sedentary women did.

Source: Journal of the American Medical Association 2003;289:2379-2386.

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Study Suggests War in Africa Spread an AIDS Virus

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 13, 2003

TUESDAY, May 13 (HealthScoutNews) -- European scientists are speculating that HIV-2, one of the viruses that causes AIDS, may have crossed over to humans as early as 1940.

The same researchers, writing this week in the Proceedings of the National Academy of Sciences, say the virus may have become epidemic as a result of war conditions in Guinea-Bissau in the 1950s and 1960s.

Other experts don't believe that the data should induce a sea change in our thinking.

"The dates are very iffy," asserts Ernest Drucker, a professor of epidemiology and social medicine at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.

The oldest evidence of HIV-2 in an actual patient dates from the mid-1960s, while the oldest actual example of HIV-1 is from 1959 in what is now the Democratic Republic of Congo, he adds.

"All we really know is that we have HIV-2 in hand from actual patients from the '60s," Drucker says. "That's the oldest example of HIV-2."

The scope of HIV-2 is limited primarily to West Africa and to parts of the world that were once under the control of Portugal, says Dr. David Markovitz, a professor of internal medicine and infectious diseases at the University of Michigan Medical School in Ann Arbor. In West Africa, the virus infects about 1 percent of the population. In the United States, by contrast, fewer than 100 people are known to be infected with HIV-2.

"The thing about HIV-2 that's very striking is that it's so similar and yet so different from HIV-1," Markovitz says. The majority of AIDS cases are caused by HIV-1.

Genetically, the two strains are only about 40 percent similar, yet they produce the same proteins. They also produce vastly different effects in the people who are infected. HIV-2 is harder to transmit than HIV-1 and, once transmitted, generally has a slower rate of infection.

Scientists believe that both HIV-1 and HIV-2 crossed over at some point from primates into humans. The big scientific questions of the day are when and how did this happen.

For this analysis, the study authors compared genetic sequences from historic and modern-day HIV-2 samples to SIV-SM, a predecessor of HIV-2 that is found in sooty mangabeys, a type of primate.

They then estimated the number of mutations separating the two viruses to try to estimate when the virus made the jump.

According to the study authors, two types of HIV-2 that eventually became epidemic, HIV-2A and HIV-2B, crossed over into humans in about 1940 and 1945, respectively.

The viruses, they say, did not reach epidemic proportions in Guinea-Bissau until much later, probably between 1955 and 1970. The nation's war of independence lasted from 1963 to 1974, leading the authors to hypothesize that the war itself -- perhaps partly because of a jump in the use of dirty needles -- may have pushed HIV-2 to epidemic status.

HIV-2 can be transmitted via needles, but the rate of transmission is probably going to be lower than that of HIV-1, Markovitz says. "It would require more blood," he says.

To Drucker, however, the exact date that SIV made the transition to HIV is less interesting than the fact that there are two different viruses that made the jump and that they come from two different monkeys. HIV-1 originated with chimps and HIV-2 with sooty mangabeys, two animals that live a thousand miles apart and have nothing to do with each other.

"Most people think HIV-2 is a branch of HIV-1, but it's not. It's a different virus," Drucker says. "Why did two of these viruses cross over into humans in a very short period of time?"

Drucker is working on the theory that the introduction of injections into Africa in the 1950s allowed the simian version of the virus to mutate until it was able to infect humans.

"Not just two but maybe five different monkey viruses crossed over into humans in a small period of time. We had hundreds of centuries before it didn't cross over," Drucker says. "That makes a compelling case that happened in Africa in mid century that led to this multiple species crossover." (HIV-1 and HIV-2 are the only strains that attained epidemic proportions. The others were not spread within the human population.)

As Drucker sees it, the timing that really makes sense is the introduction of massive-scale injections (such as those for penicillin) into Africa after World War II and the use of transfusions. "They didn't use clean needles," he says.

While it's plausible that injections also played a role in the spread of HIV-2 in Guinea-Bissau and other parts of West Africa, the dates don't entirely line up, Drucker says. "Everything points to more recent dates," he says.

More information

For more on HIV-2, visit the Centers for Disease Control and Prevention or the New York State Department of Health.

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Genentech Arthritis Drug Fails Key Test

By Paul Elias
AP Biotechnology Writer
The Associated Press
Tuesday, May 13, 2003

SAN FRANCISCO - The plans of Genentech Inc. and corporate partner Xoma Ltd. to enter the increasing lucrative rheumatoid arthritis market were dashed after a drug they were developing failed to effectively treat the disease.

The San Francisco Bay Area companies will halt further testing of the drug Raptiva on patients with the disease and their immediate goal to grab a piece of the multibillion dollar rheumatoid arthritis drug market, which is now dominated by bigger biotechnology rivals.

The companies said Monday they remain hopeful federal regulators will approve Raptiva to treat the skin disorder psoriasis. They applied to the Food and Drug Administration for that approval earlier.

But the psoriasis market is far smaller than the expanding rheumatoid arthritis market. Analysts estimate that biologically engineered drugs dubbed "biologics" such as Raptiva will ring up a combined $2 billion in psoriasis sales by 2007.

In comparison, approved rheumatoid arthritis biologics from Amgen Inc. and a Johnson & Johnson subsidiary already accounted for nearly $2 billion in sales last year.

Some 2 million Americans suffer from rheumatoid arthritis, and an increasing number of doctors are prescribing biologics to treat the disease in place of traditional chemical-based drugs. The FDA has approved three such drugs in the past four years.

In January, the FDA approved the newest rheumatoid arthritis drug, Abbott Laboratories' Humira. Humira sales totaled $26 million in the first three months of the year about $6 million more than Wall Street analysts had anticipated.

Based on the encouraging results from its U.S. debut, Abbott raised its 2003 sales forecast for the drug to $200 million from $150 million. It left unchanged its estimate that Humira will generate $500 million in sales next year.

Rheumatoid arthritis is not the wear-and-tear joint damage that affects the elderly. Instead, the immune system goes awry and destroys a patient's own joint tissue at a young age. The disease strikes mostly women between the ages of 25 and 50.

Standard treatment has been methotrexate, a cancer chemotherapy drug with many unwanted side effects. Doctors like the approved biotechnology drugs because they have fewer side effects and often work better than methotrexate.

"It's a huge market and it's disappointing Raptiva doesn't work for rheumatoid arthritis," said Felicia Reed, an analyst at Adams, Harkness & Hill. Reed doesn't own stock in Xoma or Genentech, but her company has a banking relationship with Xoma.

Reed and other analysts, though, were optimistic the FDA will approve Raptiva for psoriasis and boost the fortunes of Xoma, a money-losing company. Raptiva's failure effects Genentech much less than Xoma.

Genentech, the world's second largest biotechnology company, reported a $150 million profit last year. The company is also testing its cancer drug Rituxan for use by rheumatoid arthritis patients.

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Mental Risk High in Children of Schizophrenic Mom

By Linda Carroll
Reuters Health
Tuesday, May 13, 2003

NEW YORK (Reuters Health) - While it's long been known that children of schizophrenics are at increased risk of the illness themselves, a new study suggests that such children are more likely to have a host of mental health problems in young adulthood, such as depression, anxiety and substance abuse.

Swedish researchers found that 89 percent of such children had one or more signs of mental health problems, about 13 times the risk of children born to women without schizophrenia. The findings are published this week in the Archives of General Psychiatry.

A schizophrenia expert unaffiliated with the new study said it provides valuable insight into the disease.

"What is unique about this study is that they followed the mothers during the pregnancy and the children through adolescence and early adulthood," said Dr. Raquel Gur, a professor at the University of Pennsylvania School of Medicine and director of the Schizophrenia Research Center.

In the general population, there is a one percent lifetime risk of developing schizophrenia, a disease characterized by delusions, hallucinations and disordered thinking.

But in children who have a schizophrenic parent, the risk rises to 10 to 15 percent. The disease usually shows up in late adolescence or in the early 20s, Gur said.

For the new study, researchers followed the children of 28 women who had schizophrenia. They compared these children to the offspring of 91 healthy women, as well as to those of 22 women with mood disorders and 10 women with psychosis. By the end of the study, the children were an average age of about 22.

Out of the children born to mothers with schizophrenia, two showed signs of psychosis, while a full 40 percent showed signs of depression. In comparison, 12 percent of children of women who were not schizophrenic developed depression.

It's possible that depression could be an early warning sign of developing schizophrenia, but "depression also might be an appropriate ... response to having grown up in environments characterized by maternal psychosis rather than as a result of genetic influence," according to the researchers, led by Dr. Erland W. Schubert, of the department of psychiatric epidemiology at the University Hospital at Lund University in Sweden.

Schubert and his colleague, Dr. Thomas F. McNeil, may learn the answer to that question as they continue to follow their subjects, Gur said.

The researchers found fewer cases of schizophrenia than one would expect given the rates reported in other studies. But, said Gur, "it's possible that more will develop schizophrenia in the future, especially the women. Women commonly develop schizophrenia three to four years later than men."

By studying children of schizophrenic parents, researchers hope to learn the early signs of the disease so that treatments might be devised to stave it off or even block its full development, Gur said.

Gur compares the illness to a heart attack.

"If someone has a heart attack, you can look back and see that there were signs before it happened," she said. "There are risk factors. It could be a family history, or high blood pressure or high cholesterol. If you know someone is at risk, you can try to identify them and change the course of the disease."

If children who are at risk of developing schizophrenia are identified early, doctors might have a chance of preventing, or at least ameliorating the disease, Gur said.

Source: Archives of General Psychiatry 2003;60:473-480.

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Inactivity Blamed for Teens' Weight Gains

By Ira Dreyfus
Associated Press Writer
The Associated Press
Tuesday, May 13, 2003

WASHINGTON - Over two decades, teenagers have been getting fatter because they have been exercising less, not because they have been eating more, a study says.

Researcher Lisa Sutherland of the University of North Carolina at Chapel Hill analyzed federal data on the diet, weight and physical activity of teens, ages 12 to 19. From 1980 to 2000, calories eaten rose 1 percent and obesity rose 10 percent, while physical activity dropped 13 percent.

Those percentages show that teenagers must have been getting fat primarily because they burned fewer calories. "If caloric intake is flat and physical activity is declining, there is a cause and effect relationship there," Sutherland said.

She presented her findings last month in San Diego at a scientific conference of the Federation of American Societies for Experimental Biology. However, although other experts accept the idea that teens have become less active, the experts find it hard to swallow the conclusion that teens have not been overeating as well.

Sutherland looked at three large federal surveys. Data on weight came from the National Health and Nutrition Examination Survey, and data on physical activity was from the Youth Risk Behavior Survey, both maintained by the Centers for Disease Control and Prevention. Data on caloric intake was from the Nationwide Food Consumption Survey maintained by the Agriculture Department.

The study said that teenagers ate an average of 2,290 calories a day over the 20 years. It also said that while 42 percent of teens reported doing at least 30 minutes of physical activity on a typical day at the start of the study, only 29 percent did at the end.

The study was funded by an unrestricted grant from the National Soft Drink Association. But Sutherland said that in keeping with university rules, the association had no control over any aspect of the research.

"I was trained as a nutritionist," Sutherland said. "The data kept coming out that caloric intake was basically flat, but there was a huge drive to look at diet. I said, 'Let's look at physical activity.'"

It's not surprising that teens have become less physically active, Sutherland said. Today's kids have more and better computers and video games, and less school physical education or after-school play, she said.

"I remember wanting to go outside the minute the sun came up, and my parents dragging me to go inside at sunset," said Sutherland, who is 35.

She noted that her study was limited because the three surveys had differing methodologies, and the decline in physical activity was based on students' self-reports.

While they accept Sutherland's idea that teenagers are burning too few calories, some outside observers think the report underestimates the damage also done by bad diet.

"I would take exception to that 1 percent (increase in calories)," said Dr. Reginald Washington, of Denver, who chairs the sports medicine and fitness committee of the American Academy of Pediatrics. "I think it's much higher than that."

Fast food calories are a big part of teens' eating patterns, and supersizing is making the portions grow, Washington said.

"We are pretty sure they are eating too much, no matter what the data say," said Dr. Nancy Krebs of the University of Colorado Health Sciences Center in Denver, who chairs the pediatricians' group's committee on nutrition. "There is quite a consensus that it is due to a combination of factors."

"Our view is that it is a complex issue," said clinical nutritionist JoAnn Hattner of Stanford University, a spokeswoman for the American Dietetic Association. "It may well be their activity is down, and for some it may be a combination of increased caloric intake and decreased activity."

Accepting the conclusion that food is not a big part of the problem could take pressure off food companies to cut the calories they feed the nation, Hattner said.

"There is enough clamor throughout the country that we are getting corporations to change," Hattner said. "We need to continue that clamor."

On the Net:

Youth Risk Behavior Survey: http://www.cdc.gov/nccdphp/dash/yrbs/2001/youth01online.htm

National Health and Nutrition Examination Survey: http://www.cdc.gov/nchs/nhanes.htm

Nationwide Food Consumption Survey: http://www.barc.usda.gov/bhnrc/foodsurvey/home.htm

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African Milkbush Plant May Cause Childhood Cancer

By Patricia Reaney
Reuters
Tuesday, May 13, 2003

LONDON (Reuters) - A plant used in Africa to make glue and herbal remedies may be an important cause of the most common childhood cancer in Africa, scientists said on Tuesday.

 

 

Children use the sap from the milkbush plant to make toys, but researchers believe exposure to the sticky liquid may make them more susceptible to the effects of a virus that causes Burkitt's lymphoma, a tumor of the immune system.

"It is a critical clue to what might be driving the high frequency of Burkitt's lymphoma in Africa. It also gives us an idea of how we can begin working on preventing the cancer in the children as well," Dr. Rosemary Rochford, of the School of Public Hygiene at the University of Michigan, said in an interview.

The milkbush is common in countries like Kenya and Tanzania, where it is grown as fencing and used in medicines. Children also use it to make toys.

But Rochford and her team found evidence that children may unknowingly be putting themselves in danger.

When they studied the impact of the sap on the virus in the laboratory, they discovered low concentrations switched on three genes that were important in various stages of the virus, allowing it to replicate, kill cells and infect new ones.

Their research is reported in the British Journal of Cancer.

Burkitt's lymphoma is a very aggressive disease that has been linked to the Epstein-Barr virus. Although children are most affected by the disease, adults can also develop it. It is usually treated with chemotherapy.

Scientists had previously noticed that illness rates are higher in areas of Africa where the milkbush is more common.

"Burkitt's lymphoma is found in western countries, as well as Africa, but you never see it in the jaw in western countries," Rochford explained.

She suspects that while playing with the sap children might be putting their hands to the face and absorbing it into the mouth and stomach.

Educating parents and children about the dangers of the milkbush could help to prevent the cancer, Rochford added.

"Further research is necessary to confirm the link between exposure to milkbush sap and Burkitt's lymphoma. But this study could be important if avoiding exposure to the plant reduced the number of children suffering from the disease," said Sir Paul Nurse of the British charity Cancer Research UK.

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Genetics Play Part in Hardening of Arteries

HealthScoutNews
Tuesday, May 13, 2003

TUESDAY, May 13 (HealthScoutNews) -- Johns Hopkins Medical Institutions researchers have identified a common gene variant that's a potent risk factor for early-onset atherosclerosis, or hardening of the arteries.

Their report, in the May issue of the American Journal of Human Genetics, says people with at least one copy of the KL-VS version of the "klotho" gene are almost twice as likely to have undetected atherosclerosis.

That increased to a tenfold greater risk in smokers with the gene variant who had low amounts of "good" cholesterol.

The researchers analyzed information from two previous studies of more than 900 people at high risk for heart disease.

All people have two copies of the klotho gene, but there are several versions of the gene. In previous research, the Johns Hopkins scientists found the KL-VS version was associated with earlier death from all causes.

They also found that about 2.5 percent of people have two copies of this bad version and another 25 percent of people carry one bad copy.

Atherosclerosis is a major risk factor for heart attack and stroke, two of the leading causes of death in the United States. Eating a healthier diet, quitting smoking, getting more exercise and taking certain drugs can reduce cholesterol levels and weight and lower the risk of death.

More information

Here's where you can learn more about atherosclerosis.

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Some Rehab Patients Use Illicit Drugs to Ease Pain

By Charnicia E. Huggins
Reuters Health
Tuesday, May 13, 2003

NEW YORK (Reuters Health) - At least one in four people enrolled in substance abuse treatment programs may experience chronic severe pain, and many use illicit drugs to get relief, researchers reported Tuesday.

In the study, 37 percent of participants in methadone maintenance treatment programs and 24 percent of inpatients in short-term, residential drug-treatment programs said they had suffered chronic severe pain.

And among these, half of inpatients and one-third of those on methadone maintenance said they self-medicated with illicit drugs and alcohol.

"Because patients are treated for addiction does not imply that their pain is being treated," study author Dr. Andrew Rosenblum of the New York-based National Development and Research Institutes, Inc. (NDRI) told Reuters Health.

He noted that the study participants' pain was not related to withdrawal symptoms or any other aspects of their addiction.

"They may have two disorders," Rosenblum said, "addiction and chronic pain, although each can complicate the other."

In general, the prevalence of chronic pain among people with chemical dependency is "likely to be at least as high" as in the general population, the report indicates. Surveys have suggested that more than 70 million adults in the U.S. have chronic pain.

"Pain is extremely common ... and it's devastating to an individual's quality of life," study co-author Dr. Russell K. Portenoy, of Beth Israel Medical Center in New York, told Reuters Health. "This is true also in people with addiction."

Yet among the study participants -- who were most commonly receiving treatment for heroin, alcohol or cocaine use -- nearly half of inpatients and a third of those in the methadone maintenance programs were not receiving prescription medications for pain.

The findings are published in the May 14th issue of the Journal of the American Medical Association.

Most study participants said the chronic, severe pain interfered with their sleep, and many said it disrupted their work, mood and general activity.

This indicates how "devastating the experience of chronic pain is for this population," Portenoy said.

Patients in substance abuse treatment programs "are struggling to have pain adequately treated, just as others in our society are struggling to have pain treated appropriately," the researcher said.

"It is likely," he added, "that their ability to access care is going to be more difficult than the general population because of their disease of addiction."

Among inpatients with chronic severe pain, 35 percent said they had used alcohol to treat the pain, while 29 percent had used cocaine and 26 percent each had used opioids or marijuana. Thirty percent of those on methadone maintenance with chronic pain had used opioids for pain relief.

The study included 390 participants in two New York methadone maintenance programs and 531 inpatients in short-term, residential treatment programs, also in New York. Up to 80 percent of patients in both groups said they had had some type of pain during the previous week.

The study was funded by the Center for Drug Use and HIV Research and the National Institute on Drug Abuse.

Source: Journal of the American Medical Association 2003;289:2370-2378.

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The Key to Vision?

HealthScoutNews
Tuesday, May 13, 2003

TUESDAY, May 13 (HealthScoutNews) -- A University of Florida study offers the first photographic evidence that a protein crucial to vision moves inside eye cells in response to light.

The finding may help explain how people and animals are able to see in a wide range of lighting conditions. Information about this protein's movement may also help scientists better understand diseases such as night blindness or macular degeneration, the leading cause of vision loss in Americans over age 65.

The study was published online in the journal Experimental Eye Research.

The protein is called visual arrestin. It regulates a chemical reaction that's responsible for vision that begins in the retina.

"The movement of arrestins probably impacts how we're able to regulate the light sensitivity of our eyes. If you go from a darkened theatre to bright sunlight, the light intensity can increase by a factor of 10 billion. Not many receptors are capable of dealing with that kind of range, but our eyes can," researcher W. Clay Smith, an assistant professor of ophthalmology, says in a news release.

He and his colleagues examined retinal cells called rods. These rods operate in low-light conditions but don't perceive color. The researchers traced arrestin's movement in rod cells by introducing a gene derived from luminous jellyfish into African clawed frog tadpoles.

That caused the tadpoles' eyes to produce arrestin that glowed bright green when exposed to blue light. That made it easy for the researchers to detect and photograph the arrestin.

More information

Here's where you can learn more about eyes and vision.

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Big Eaters May Live Longer with Colorectal Cancer

By Alison McCook
Reuters Health
Tuesday, May 13, 2003

NEW YORK (Reuters Health) - Despite the dangers associated with a high-calorie diet, new research released Tuesday suggests that people who eat more calories live longer after a colorectal cancer diagnosis than light eaters.

However, eating a high-calorie diet has also been linked to a higher risk of developing colorectal cancer in the first place, according to study author Dr. Marie-Christine Boutron-Ruault.

Although the reasons behind these seemingly contradictory findings are not clear, Boutron-Ruault said that she and her colleagues suspect that people who develop colorectal cancer as a result of eating a high-calorie diet may have a form of the disease that is less deadly than people who have cancer as a result of other causes.

"The main hypothesis is that the cancer due to this particular risk factor -- here, high energy intake -- has a lesser malignant potential than cancers due to other causes," Boutron-Ruault, based at the Institute for Food and Nutrition in Paris, France, told Reuters Health.

Since so much remains unknown, Boutron-Ruault cautioned that people should not interpret these results to mean that eating too many calories is healthy, even if they have colorectal or other cancers.

"I would say that getting a cancer is certainly not a good thing and that there are many studies leading to the conclusion that high energy (intake) increases the risk of cancer. It is too early to know if once the patient has got a cancer, it is beneficial to have a high-energy diet," she said.

Colorectal cancer is the second-deadliest form of the disease in the U.S., and only approximately 45 percent of patients are alive five years after being diagnosed.

To determine whether calorie intake influences survival time, Boutron-Ruault and her colleagues looked at an earlier study that recorded 148 patients' eating habits during the year before they were diagnosed with colorectal cancer. The researchers then followed up with the patients about 10 years after they underwent surgery.

Reporting in the journal Gut, the researchers found that people who ate the most calories -- from carbohydrates, protein, or fat -- were more than 80 percent more likely to be alive five years after a cancer diagnosis than people who ate the least amount of calories.

Boutron-Ruault noted in an interview that whether patients were obese had no influence on their risk of dying. "Our findings do not encourage (patients) to be obese to better survive colorectal cancer," she said.

"What we hope will be the main consequence of our findings is that medical doctors, especially oncologists, take some interest in the nutritional status and the diet of their patients," Boutron-Ruault said.

She added that more research is needed to investigate the relationship between post-diagnosis diet and cancer prognosis.

Source: Gut 2003;52:868-873.

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The Odds of Beating Prostate Cancer

HealthScoutNews
Tuesday, May 13, 2003

TUESDAY, May 13 (HealthScoutNews) -- Men with prostate cancer face a 27 percent probability that they'll develop metastatic cancer within seven years of their initial diagnosis.

That finding comes from researchers at the University of California-Davis Cancer Center and five other institutions in the United States.

And men with metastatic cancer have a tenfold greater risk of dying than men whose cancer is confined to the prostate, says the study, presented recently at the annual meeting of the American Urological Association in Chicago.

There's more bad news. The study found men with metastatic cancer faced $13,650 more in medical bills, almost twice as high as men with localized prostate cancer, the study found. Total costs were $30,626, compared to $16,676.

Researchers analyzed the medical records of 2,056 Detroit men treated for prostate cancer between 1995 and 2000. The overall death rate was 9 percent, but men with metastatic cancer had a death rate 10 times greater than those with localized prostate cancer.

When they looked for links between cancer progression and the first-line treatment methods, the researchers found the initial treatment for prostate cancer didn't influence the rate of metastasis.

"This high probability of metastatic progression we observed underscores the need for improved treatments to reduce the rate of metastases and death from this disease," UC Davis researcher Christopher Evans says in a news release.

More information

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

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Protein Speeds Bone Healing in Animal Studies

Reuters Health
Tuesday, May 13, 2003

NEW YORK (Reuters Health) - Preliminary research in animals suggests that a naturally occurring protein may one day be used to help speed healing of broken bones.

Fractures are known to heal too slowly or fail to heal altogether in roughly 10 percent of people who break a bone, according to Dr. Vishwas M. Paralkar of Pfizer Global Research and Development, Groton Laboratories, in Groton, Connecticut, and colleagues.

"New therapies that could ensure rapid healing of fractures and bone defects would lessen the need for further medical intervention and greatly reduce (illness) and loss of independence associated with immobilization," they write.

Previously, scientists had discovered several proteins that play a crucial role in the bone-healing process.

However, the "cost effectiveness, degree of clinical benefit and long-term safety of these therapies have not been fully elucidated," the authors write.

In the current study, Paralkar and colleagues evaluated the ability of a protein called CP-533,536 to heal bones in rats and in dogs. The findings are published in the Proceedings of the National Academy of Sciences.

When the protein was directly injected into the bone marrow of rats, it induced "robust bone formation," the report indicates. CP-533,536 resulted in "increased total bone area, total bone mineral content and total bone density at the injection sites."

Similarly, CP-533,536 was also associated with "dramatically accelerated" bone healing in broken leg bones in dogs, according to the researchers. In those experiments, the protein was injected daily into a matrix of collagen that was surgically placed in the broken bones.

In addition, the authors say that CP-533,536 is not associated with side effects such as diarrhea and lethargy, which have been observed with other types of bone healing proteins.

CP-533,536 "offers a promising therapeutic alternative for the enhancement of bone healing and treatment of bone defects and fractures in patients," the authors conclude.

Source: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.1037343100.

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Painting an Unappetizing Picture

HealthScoutNews
Tuesday, May 13, 2003

(HealthScoutNews) -- Danish pastries those goodies wrapped in cellophane and sold in fast-food stores for the morning crows -- are often mass produced with some pretty unappetizing ingredients, says author David Bodanis.

Because keeping that enticing sugar icing white is not easy, bakery companies use dollops of titanium dioxide, "the same chemical in the buckets of leftover white latex paint in the garage," says Bodanis in his book, The Secret Family.

And, he says, "Where some brown, caramel-suggestive swirls are needed, brown waxes, including the indelible rosin used on violin bows, are often used."

Besides the usual flower, sugar, nuts and oils, Bodanis says the really cheap pastries contain "processed chicken feathers or the scraped belly stubble from scaled pig carcasses as their extracted proteins help in softening the flour that's used."

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Regular Drinking May Raise Rectal Cancer Risk

By Alison McCook
Reuters Health
Tuesday, May 13, 2003

NEW YORK (Reuters Health) - People who down at least 14 alcoholic drinks each week, regardless of the type of alcohol, may be more likely than non-drinkers to develop rectal cancer, researchers said Tuesday.

But what a person drinks does have some influence on risk, the authors note, for people who included wine in their menu of alcoholic beverages had a lesser increase in risk than those who stuck mainly with beer and spirits.

And the study found no association between alcohol intake and the risk of colon cancer.

Regardless, the increase in rectal cancer risk provides heavy drinkers with another reason to cut back, study author Dr. Morten Gronbaek of the National Institute of Public Health in Copenhagen, Denmark, told Reuters Health.

"Heavy drinkers should worry about so many other diseases and conditions, and simply try to cut down their intake anyway," Gronbaek said.

Cancers that originate in the colon and rectum are the fourth most commonly diagnosed cancers in the U.S., and represent the second-leading cause of death from cancer. Approximately one-third of the cases of colorectal cancer are actually cancers of the rectum, Gronbaek said.

During the current study, Gronbaek and colleagues followed around 30,000 men and women for an average of almost 15 years, recording how much alcohol they drank each week and who developed cancer of the colon or rectum.

By the end of the study period, 411 people had developed colon cancer, and another 202 were diagnosed with rectal cancer, the authors report in the journal Gut.

People who reported drinking more than 14 servings of beer and spirits every week, but not wine, were more than three times more likely than non-drinkers to develop rectal cancer, Gronbaek and colleagues report.

However, those who drank just as much but included wine as more than 30 percent of their total alcohol intake had a lower risk -- though it was still close to twice that of non-drinkers.

This increase in risk seen with relatively heavy drinking is as significant as other known risk factors for rectal disease, Gronbaek said, such as physical inactivity and low amounts of dietary fiber.

The researcher added that it is unclear why including wine may reduce the risk associated with drinking. He noted that the beverage contains ingredients not present in beer or spirits that are known to have anti-cancer properties.

The lack of a relationship between alcohol drinking and colon cancer risk is also somewhat of a mystery, according to Gronbaek.

"The tissue is rather similar in the two parts of the organ -- colon and rectum -- and one might expect the same mechanism in developing the disease," Gronbaek said. However, he added that previous studies have also found that alcohol has an effect on the rectum but not the colon.

Source: Gut 2003;52:861-867.

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Do More Calories Help Colon Cancer Patients?

By Adam Marcus
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 13, 2003

TUESDAY, May 13 (HealthScoutNews) -- High-calorie diets may actually protect you in a battle with colorectal cancer.

That's the surprising result of a new study from French scientists, who say that energy intake before a diagnosis of colorectal cancer predicts the odds of surviving the disease over time. Why eating more benefits these people isn't clear, however, and some experts aren't convinced the link is real. A recent study from the American Cancer Society found that being overweight or obese raises the risk of dying from any cancer, including colorectal tumors, by between 50 percent and 60 percent.

But study author Dr. Marie-Christine Boutron-Ruault believes people who eat more may develop a less aggressive form of colorectal tumors than do people whose diets are lower in calories. "We are going to follow up this idea by studying the genes of tumors" in patients with high and low energy intake, says Boutron-Ruault, a nutrition researcher at French Institute of Health and Medical Research in Paris.

Boutron-Ruault and her colleagues report their findings in the June issue of Gut. The researchers looked at 148 elderly men and women, whose average age was 64, who had undergone surgery to remove colorectal cancer. Subjects were asked to recall how much they ate before they were diagnosed with the disease.

The strongest predictor of a patient's risk of death over the 10 years after surgery was how advanced their disease was at the time of the operation.

Yet diet also appeared to play a role. People in the bottom two-thirds of daily energy intake were about 80 percent less likely to be living five years after surgery than those in the upper third of energy intake -- above roughly 3,000 calories a day for men and 2,300 calories a day for women. Although that amount of food is unusually high, especially for the elderly, not everyone in this group was obese, nor did being overweight seem to affect the results.

Since the study relied on people's memories of their diets, it used an imperfect measure of energy intake. What's more, the findings could simply be showing that people with less aggressive forms of colorectal cancer are able to eat more than those with deadlier tumors.

Martha Slattery, an epidemiologist who studies diet and cancer at the University of Utah School of Medicine in Salt Lake City, says the findings raise a "big red flag" in light of research linking obesity to a greater risk of developing colorectal cancer. "The two don't go together," says Slattery, who has looked at the issue.

What may explain the French results, she says, is if people who eat more are generally healthier than those who eat less. That could make them more prone to colorectal cancer, and presumably other tumors that become more likely with age.

In an unrelated study also published in Gut, Danish researchers say heavy drinking seems to raise the risk of rectal tumors, but not colon cancer. However, people whose tippling included at least 30 percent wine, while still at increased risk, cut their chances of rectal cancer significantly compared with beer and liquor drinkers.

More information

For more on colon cancer, visit the American Cancer Society or the National Cancer Institute.

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Compound May Ease Side Effects of Parkinson's Drug

By Keith Mulvihill
Reuters Health
Tuesday, May 13, 2003

NEW YORK (Reuters Health) - Animal research suggests an experimental drug may counteract a common and debilitating side effect of levodopa, the most widely used drug for Parkinson's disease, French scientists report.

They found that in monkeys with Parkinson-like symptoms, the compound eased levodopa-associated dyskinesia -- involuntary movements of mouth, face and limbs that are a frequent side effect of the drug in people with Parkinson's.

The encouraging results, published this week in the advance online edition of the journal Nature Medicine, should give the green light for clinical trials of the drug in patients with Parkinson's, according to the study's authors.

Parkinson's disease is a progressive, neurological disorder that causes tremor, muscle rigidity and movement problems. The disease involves a loss of cells in the brain that produce the chemical dopamine, which plays a key role in regulating movement.

The main treatment is the drug levodopa, or L-dopa, which helps restore diminishing levels of dopamine in Parkinson's patients. But long-term use of the drug often leads to potentially disabling side effects.

Roughly 40 percent of Parkinson's patients taking L-dopa will develop dyskinesia after four to five years of treatment, explained lead investigator Dr. Pierre Sokoloff of INSERM in Paris, in an email interview.

"There is no current safe therapeutic cure of dyskinesia," said Sokoloff, noting that "the only one that has been introduced into the clinics, amantadine, is partly efficacious and can induce psychiatric troubles."

"Thus, minimizing dyskinesia is a major concern in the management of Parkinson's disease," he added.

Previously, it was discovered that L-dopa works by attaching to a receptor on cells called D3.

In the current study, the researchers studied the effects of L-dopa when it is combined with another compound called BP 897 that mimics dopamine and also binds to the D3 receptor.

"The study shows that the D3 receptor is specifically involved in both the therapeutic effect and dyskinesia produced by L-dopa," said Sokoloff.

"The novel finding in the study is that it points to a major role of a particular receptor for dopamine, the D3 receptor, which (was) discovered in 1990, and whose role in Parkinson's disease has not been previously demonstrated," he added.

Given the dual role of the D3 receptor, Sokoloff's team hoped to fine-tune its function, he explained.

This was achieved by administering BP 897, a mimetic of dopamine, acting selectively at the D3 receptor. However, BP 897 only partially mimics dopamine, so that it preserves the therapeutic response of L-dopa and avoids excessive receptor stimulation that leads to dyskinesia, according to Sokoloff.

"The next step is clinical trials with Parkinson's disease patients," the researcher said. "Although the animal model we have used produces symptoms remarkably similar to Parkinson's disease, there is always a piece of uncertainty when going from animals to humans."

Source: Nature Medicine 2003;10.1038/nm875.

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North Americans Better at Controlling High Blood Pressure

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 13, 2003

TUESDAY, May 13 (HealthScoutNews) -- Score one for North America in the battle to tame high blood pressure.

A new study finds the average blood pressure in Europe is 136/83, compared to 127/77 in the United States and Canada.

High blood pressure -- a reading in excess of 140/90 -- is more prevalent on this side of the Atlantic than cardiologists would like, with 28 percent of Americans and 27 percent of Canadians afflicted with the condition. But those numbers look downright rosy compared to several European countries: 55 percent in Germany, 49 percent in Finland, 47 percent in Spain, 42 percent in England and 38 percent in Sweden and Italy.

The study appears in the May 14 issue of the Journal of the American Medical Association.

One European country notably missing from the survey is France. With what some might regard as typical insouciance, the French haven't done the kind of national study that could give solid information on blood pressure levels, says study co-author Dr. Richard S. Cooper. He is chairman of the department of preventive medicine and epidemiology at Loyola University Stritch School of Medicine in Illinois.

However, Cooper notes, while the French have a low rate of heart disease, their risk of stroke matches ours.

For the other countries, Cooper and his colleagues got the numbers from national studies conducted in the 1990s -- the first of their kind, Cooper notes.

High blood pressure is a major risk factor for both heart disease and stroke. And the numbers on stroke clearly show the transatlantic difference. The European stroke mortality rate is 41.2 per 100,000 people; over here it's 27.6 per 100,000, the study says.

While the study wasn't designed to detect the reason for the difference in high blood pressure rates, Cooper says his best bet is that it is due to diet. "Treatment rates [for high blood pressure] are higher in the United States and Canada, but the treatment rate is not the underlying factor," he says.

But Dr. Robert A. Phillips, chairman of the department of medicine at Lenox Hill Hospital in New York City and president of the eastern chapter of the American Society of Hypertension, disagrees that diet is the deciding factor. Instead, he points to a long-running campaign to educate Americans about the dangers of high blood pressure.

"Europeans have taken a laissez-faire attitude toward high blood pressure for half a century," Phillips says. "The United States started an education program in the 1970s, with a tremendous effort to educate the public and physicians about the dangers of hypertension."

The result, Phillips says, is "one of the greatest victories we've had in western medicine, the control of high blood pressure and reduction of heart attack, stroke and renal disease."

Despite such advances as the creation of new treatments for high blood pressure, there is a long way to go, Phillips says. Only 30 percent of Americans with high blood pressure are getting treatment to reduce pressure to a maximum of 140/90, the desired safety level, he says. "We want to get it up to 60 percent," he says.

More information

For details on high blood pressure and how to control it, visit the American Heart Association or the National Heart, Lung, and Blood Institute.

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New Malaria Drug Combo Said Promising

By Stephen Pincock
Reuters Health
Tuesday, May 13, 2003

GLASGOW (Reuters Health) - Vietnamese researchers reported on Tuesday that a new drug combination for malaria, costing about one euro per treatment, is fast-acting, highly effective and well tolerated.

A spokeswoman for the World Health Organization (WHO) said the drug combination, from a collaboration of Chinese and Vietnamese groups, was an impressive development.

"We have no doubt about the effectiveness," she told Reuters Health in a telephone interview. "It seems very promising, and we are actually working with the developers to see that it becomes a reality."

At the European Congress of Clinical Microbiology and Infectious Diseases, the Vietnamese researchers reported on a trial comparing the new CV8 combination -- containing dihydroartemisinin, piperaquine, trimethoprim and primaquine -- against Malarone, a combination of atovaquone and proguanil currently used to fight malaria.

In the study, a total of 161 patients with malaria caused by the Plasmodium falciparum parasite received either four doses of CV8 or three doses of Malarone, over three days. Patients' signs and symptoms, along with parasite counts, were taken every eight hours for the three days, and after discharge were monitored weekly for a month.

Tolerance to both combinations was good, and all patients recovered rapidly, Dr. Phan Trong Giao from Cho Ray Hospital in Ho Chi Minh City told the meeting. The average parasite clearance time was about 35 hours for both combinations, and fevers cleared in about 24 hours with both treatments.

"Our study demonstrates that CV8 and Malarone are equally effective, fast-acting and tolerable," Giao said, adding that they are promising for areas with multi-drug-resistant malaria, such as Vietnam.

"CV8 can be used in developing countries due to its low cost, at about one euro per course," he said.

The WHO spokeswoman noted that the manufacturing standards for the drug meet local regulations, but need to be formally evaluated by WHO.

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Fewer People Get Health Info Online Than Thought

By Amanda Gardner
HealthScoutNews Reporter
HealthScoutNews
Tuesday, May 13, 2003

TUESDAY, May 13 (HealthScoutNews) -- Fewer Americans are logging onto the Internet for health information than originally thought, a new study contends.

While previous reports put the figure as high as 80 percent of people with Internet access, the new study says a more realistic number is about 40 percent of online users -- or only about 20 percent of the adult population.

Even fewer people say cyberspace has directly affected their health-care decisions, according to the study, which appears in the May 14 issue of the Journal of the American Medical Association.

"We should always keep in mind that there are a lot of different sources [of information] -- families, friends, print sources, calling your doctor, calling a nurse. The Internet is useful and is out there for a lot of folks," says study author Laurence Baker, an associate professor of health research and policy at Stanford University School of Medicine.

"But we shouldn't come to the point that it's the only source or the only source people should be looking at," Baker says. "If there is a subset of folks who have questions about health, and a subset of those who think the Internet is the most useful tool, then 40 percent might actually be a pretty big number."

He cites a U.S. Census Bureau survey that found 62 percent of adults who go online check the news, weather or sports; 39 percent use it to shop; 18 percent to bank or pay bills; and 9 percent to trade stocks.

The new study was based on a survey collected in December 2001 and January 2002 from 4,764 individuals aged 21 or over who described themselves as Internet users.

They were asked to answer a series of questions about their use of the Internet and e-mail for health-care information. They were also asked about five chronic health conditions they might have -- heart problems, cancer, diabetes, hypertension and depression.

About 40 percent of the respondents said they'd used the Internet for health or health-care information during the past year. About one quarter reported e-mailing family or friends about health issues. Somewhat fewer people used e-mail or the Internet to communicate with other patients, while only 6 percent had emailed a health-care provider in 2001.

Although about a third of respondents said the Internet had affected a health or health-care decision, the specific impact was hard to gauge. Ninety-four percent said the Internet had not affected the number of times they visited their doctor, and 93 percent said the Web had not affected how often they telephoned their doctor. Only 5 percent said they had gotten prescription drugs or pharmaceutical products online. About one third of the respondents, however, said they'd used the Internet or e-mail to learn more about a particular prescription drug.

What's more, people didn't use the Internet all that often, according to the study. About three-quarters of those surveyed said they went online for health information once every two to three months or less. Twenty-two percent said they used it once a month or more.

Two-thirds of people who did not have one of the five chronic conditions outlined in the survey said the Internet had improved their understanding of health-care issues.

Individuals with less education were less likely to venture into cyberspace for health information.

Candy Tsourounis, an associate clinical professor of pharmacy at the University of California, San Francisco School of Pharmacy, says she was "surprised that the numbers were lower than other estimates."

UCSF runs two different online "Ask Your Pharmacist" programs, one worldwide and the other only for Californians. Based on the track record of those services, Tsourounis would have guessed more people used the Internet for health-related information. It's possible that use varies based on location, one question the study authors did not answer, she adds.

Baker says the survey's findings could affect decisions by the medical community about the Internet in the future.

"There's been a lot of discussion of where the Internet is going to head over the next few years," he says. "There's a lot of interest in the medical community about using e-mail and electronic communication among patients. There's a general sense that activity is widespread and that we need to move with the world as the world moves into this in a big way."

But it's crucial to know exactly how much activity is going on. "It makes sense for us to be realistic about how many people are doing this and build a tool that's really useful," Baker points out.

More information

The University of North Carolina School of Public Health has information on how to use the Internet for health information. So does the Canadian Health Network.

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MONDAY, MAY 12, 2003

Pneumonia Vaccine May Hold Heart Benefits

By Randolph E. Schmid
Associated Press Writer
The Associated Press
Monday, May 12, 2003

WASHINGTON - Vaccine used to prevent pneumonia may also have benefits for the heart, new research indicates.

Mice vaccinated using a bacteria that is a common cause of pneumonia developed high levels of an antibody that slows or halts the progression of heart disease, researchers working in California and Finland found.

Trials are under discussion to see if the same response occurs in larger animals, says Gregg J. Silverman of the University of California, San Diego, a co-author of the study.

"If we can harness this potential, we may have new ways to treat patients with heart disease, as well as the possibility of developing a vaccine for our children to prevent this disease from ever developing in their later years," Silverman said.

But the situation is far more complicated in humans than mice, said university colleague Joseph J. Witztum, a co-author of the paper.

Immunizing mice with pneumococcus leads to the generation of antibodies that the researchers believe lead to the protection from heart disease, he said. "We do not yet know if such a dominant and important response occurs in people."

The mouse vaccine is not the same as that used in humans. It was designed to increase production of particular antibodies that can affect the heart.

"New formulations for (human) clinical use would be required," Silverman said, "but such a vaccine should be straightforward to develop and test."

Dr. William Schaffner, head of preventive medicine at Vanderbilt University School of Medicine, welcomed the findings.

"Is this provocative? Yes," said Schaffner, who was not involved in the research. "This is exceedingly provocative and I hope it stimulates all kinds of work, not only by this group but also by industry.

"Wouldn't it be marvelous if one could develop a vaccine that not only protected against pneumococcus but also offered, simply by biological chance or fluke, the added advantage of offering some protection against atherosclerosis."

The findings, reported in Monday's online issue of the journal Nature Medicine, come a month after other researchers reported that, among 286,000 older people, hospital stays for heart disease or stroke during two flu seasons were substantially reduced for those who got flu shots.

Mice and humans with atherosclerosis in which deposits build up inside blood vessels often have high levels of antibodies that target the diseased areas in their blood vessels, Silverman said.

When researchers analyzed the antibodies, they "were surprised to discover that some of these antibodies were exactly identical to antibodies that were known to also protect mice from bacterial infections," Silverman said.

"This led us to wonder whether the same antibodies might be important for defense from common infections, and for defense from what is now the most common lethal disease" in the United States, heart disease.

So the team fed mice a high-cholesterol diet for 24 weeks and then checked their arteries for the development of deposits.

Mice getting repeated injections of the pneumonia vaccine showed a 21 percent reduction in the atherosclerosis in their aortas, compared with mice not vaccinated.

"We believe that the pneumococcal vaccinations in our studies induced antibodies that removed the lipids and cell breakdown products, preventing their deposition in the critical arteries," Silverman said.

He said the body's immune system is probably always working to protect against this disease and the vaccinations may be a way to boost the efficiency of this natural defense.

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Hospital Water Can Carry Fungus Dangerous to Some

By Stephen Pincock
Reuters Health
Monday, May 12, 2003

GLASGOW (Reuters Health) - A fungal infection that is potentially deadly for transplant and leukemia patients can be spread through hospital water, Dutch researchers said on Monday.

In one Norwegian hospital, Dr. Adilia Warris from University Medical Center in Nijmegen found that nine of 13 patients infected with the fungus, called aspergillus, were carrying strains genetically linked to the hospital's water supply.

Hospitals currently focus prevention efforts on keeping fungal spores out of the air, where they can be inhaled. But as many as 15 percent of immunocompromised patients still become infected, despite stringent air filtration and other measures.

Experts said the latest results, which were reported at the European Congress for Clinical Microbiology and Infectious Diseases, provide the first conclusive evidence genetically linking fungus in hospital water to infections in patients with weakened immune systems.

They highlight the need for hospitals to consider their water supply as a source of the fungus, which kills about 50 percent of patients with severely weakened immune systems who become infected.

Dr. Alistair Leanord, an infection control expert from Monklands Hospital in Airdrie, Scotland, said aspergillus infection is one of the most feared complications in severely immunocompromised patients.

"The finding that water plays an important role will allow doctors to take the appropriate control measures to combat this serious infection," said Leanord, who was not part of the study.

The Dutch researchers took 21 samples from 13 aspergillus patients and compared them with 55 samples from taps, showers and water pipes in the hospital and the lake where the water originated, and 25 samples from air circulating in the hospital.

They found nine patients were carrying fungus that was genetically similar to aspergillus isolated from the hospital water system and lake. In two of those cases the fungal isolates were exact genetic matches.

"There were strains found in the water that are identical to those found in the patients," Warris told reporters at the conference.

In one case, a strain genetically identical to one found in the water supply was detected in a patient's post-mortem lung biopsy, a sign that the fungus had caused disease.

Aspergillus expert Dr. Paul Verweij, who collaborated on Warris' work, said aspergillus would be most likely to trigger disease when water forms aerosols that can be inhaled, such as in a shower or a splashing tap.

"The question now with water is how dangerous is it if you want to take a shower?" he said, adding that more data was needed before that could be definitively answered.

The researchers said the problem was most likely to arise for hospitals that get their water from lakes or reservoirs where the fungus is more likely to grow. They didn't find it at all, for example, in a Dutch hospital that used water from an underground source.

"If you go to countries with open water sources, then you will immediately find it," said Professor Andreas Voss, a consultant clinical microbiologist who was also involved in the Nijmegen research. "It will be in all the water in countries using open water sources."

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Fen-Phen Gone, but Other Diet Drugs Still Popular

By Eric Sabo
Reuters Health
Monday, May 12, 2003

NEW YORK (Reuters Health) - Despite growing safety concerns at the time, the use of a weight loss drug combo known as "fen-phen" continued to soar until the Food and Drug Administration removed two of the medications in 1997, an analysis of prescription records shows.

The report, published Tuesday in the Archives of Internal Medicine, suggests that the fallout has hardly put a dent in America's robust appetite for weight loss treatments.

In fact, anti-obesity drugs are as popular now as when fen-phen first took off in the early 1990s, with both old and new medications competing in their place.

"Fen-phen hit when obesity was starting to be seen as a medical problem, rather than a personal responsibility issue," said the study's lead author, Dr. Randall S. Stafford, a disease prevention expert at Stanford University. "Patients and doctors were ready to accept a change."

While such quick public health responses can be beneficial in some cases, Stafford said that fen-phen offers the opposite lesson.

"Clearly the enthusiasm got of hand here," Stafford told Reuters Health.

Fen-phen became the diet craze of the 90s after published research found a positive slimming effect from combining two old appetite suppressants, fenfluramine and phentermine. With the approval of a newer fenfluramine agent, called dexfenfluramine, prescriptions for these medications skyrocketed in 1996 alone.

But reports from the Mayo clinic and others began linking the "fen" part of the combo to potentially harmful heart valve defects. By the fall of 1997, the FDA removed both fenfluramine agents from the market, citing concerns that their off-label use with phentermine was putting people at too high a risk.

If it wasn't for the FDA stepping in, Stafford said, fen-phen would probably be a popular weight-loss aid today.

"Even though there was little evidence that it could work, the use of fen-phen just took off," Stafford said. "These drugs tapped into something we hadn't seen before."

The rise and fall of fen-phen also corresponded with a yo-yo effect in obesity statistics. For instance, the total number of obese patients who saw a doctor for a weight problem nearly doubled from 1995 to 1996. These rates have since dropped to four million a year, roughly the same as they were before fen-phen hit its peak.

The number of overweight people seeking treatment solely to lose weight increased as well, jumping from 59 percent in 1991 to 71 percent in 1996.

This is not what anti-obesity drugs were intended for, according to Stafford.

"Many patients receiving these drugs aren't the ones who have obesity-related medical problems, like hypertension," said Stafford, adding that those who are just trying to shed a few pounds with drugs potentially stand to do more harm than good.

European drug agencies have banned phentermine in addition to the fenfluramines, based on the chance that phentermine might also cause heart valve defects and other side effects. This appetite suppressant, sold under brand names such as Fastin, is still available in the U.S.

The FDA recently approved two other anti-obesity treatments, Meridia and Xenical. These drugs may turn out to be helpful, said Stafford, but it's important that people not rush to take the latest diet pill without understanding the potential downsides.

"There is no quick and easy approach for losing weight," Stafford pointed out. Before embracing the newest fad, he said, "we need to apply a great deal more scrutiny."

Source: Archives of Internal Medicine 2003;163:1046-1050.

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Spread of HIV Strain Began in 1940, Spurred by War

By Alison McCook
Reuters Health
Monday, May 12, 2003

NEW YORK (Reuters Health) - Strains of HIV largely limited to West Africa appear to have first infected humans in the 1940s, and the current epidemic involving these strains may have originated between 1955 and 1970 as a result of war, an international group of researchers said Monday.

The current report focuses on HIV-2, one of the two major types of the virus. The other major type is HIV-1.

Both cause AIDS and are transmitted through sex or infected blood and from mother to child. But HIV-2 is less readily transmitted and appears to progress to AIDS more slowly than HIV-1.

Although infection with HIV-1 has progressed into a worldwide epidemic, HIV-2 infections have remained largely confined to West Africa, where the virus has infected approximately one percent of the population.

HIV closely resembles a virus that infects primates, known as SIV. However, HIV-1 appears most closely related to the strain of SIV that is present in chimpanzees, while HIV-2 appears to have its predecessor in a strain of SIV present in sooty mangabeys.

By analyzing HIV-2 samples taken from people, and comparing them to SIV samples taken from sooty mangabeys and other primates that acquired SIV from sooty mangabeys, the researchers estimate that the two subtypes of HIV-2 that became epidemics first infected humans around 1940 and 1945, according to a report in the Proceedings of the National Academy of Sciences.

Study author Dr. Anne-Mieke Vandamme of Katholieke Universiteit Leuven in Belgium told Reuters Health that HIV-2 may have crossed from sooty mangabeys to humans as a result of bushmeat slaughtering or hunting, the same process that may have enabled HIV-1 to infect humans.

The researchers also discovered evidence suggesting that the West African country Guinea-Bissau, the presumed site of origin of HIV-2, experienced a significant increase in new HIV-2 infections between 1955 and 1970.

And that epidemic continues today, Vandamme noted.

"Since 1970, it is still epidemic up to the time of sampling of the sequences used in the analysis, which is 1991," she said.

This African region experienced a war of independence against the Portuguese between 1963 and 1974. The fact that the dramatic spread of HIV-2 in the region coincided with this event suggests that war may have encouraged an increase in infections in the region, according to Vandamme and colleagues.

War may have spawned an HIV-2 epidemic in this region by increasing the number of people who received unsterile injections in hospitals, the authors suggest. Moreover, reports from the region note that army-trained doctors started campaigns to inoculate residents of Guinea-Bissau.

Indeed, the first reported cases of HIV-2 in Europe occurred in Portuguese soldiers returned from the independence war, the authors note.

Source: Proceedings of the National Academy of Sciences 2003;10.1073/pnas.0936469100.

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A Pitch for Kid-Friendly Baseball

By Gary Gately
HealthScoutNews Reporter
HealthScoutNews
Monday, May 12, 2003

MONDAY, May 12 (HealthScoutNews) -- As the pint-sized boys and girls of summer return to America's baseball diamonds this spring, parents and coaches need to know the national pastime isn't without risk.

More than 90,000 children 14 and under suffered baseball-related injuries requiring emergency room visits in 2001, the U.S. Consumer Product Safety Commission says. Those injuries ranged from fractures and concussions to sprains, bruises and strains. And children aged 10 to 14 suffered three-quarters of all the injuries, the agency says.

Now, a new study suggests many injuries could be prevented among the estimated 5 million kids playing organized baseball.

In what they call the largest study of its kind, researchers from the University of North Carolina reviewed injuries resulting in health insurance claims being paid during three Little League seasons, 1997 through 1999. About 2.5 million children played each season in Little League -- one of several organized leagues in the United States -- and the researchers found 4,233 compensated injury insurance claims among them.

They also found that use of softer balls decreased ball-related injuries by 23 percent, while face guards attached to helmets reduced facial injuries by 35 percent, says the study, published recently in the Journal of the American Medical Association.

To determine the effectiveness of softer "safety balls" and face guards, the UNC researchers compared injuries in leagues that did and did not use the safety equipment.

Stephen W. Marshall, principal author of the study, says he has no doubt more use of the safety balls and face guards would reduce injuries among young ballplayers.

"Anything we can do to give them the skills of the game and give them the experience of playing together as a team while minimizing the risk of injury makes a lot of sense," says Marshall, a UNC assistant professor of epidemiology and orthopedics.

Ball-related injuries -- batted or thrown by a player other than the pitcher -- totaled 1,890, or about 45 percent, of all injuries, the study says. The 183 facial injuries comprised only about 4 percent of the total.

Some parents, baseball purists perhaps, resist the safety ball, optional in Little League, because they believe it changes the nature of the game, Marshall says.

He says 63 leagues tried, then discontinued, use of one type of safety ball, the "reduced-impact" baseball, made with a polyurethane center rather than traditional cork and yarn. The switch back to traditional baseballs often came after complaints about the bounce of the reduced-impact balls, which the study says reduced injuries by 29 percent.

The UNC study, however, cites research showing that when the labels were removed, neither children nor adults could tell the difference between traditional baseballs and the softer balls.

"There's lots of feeling that the modified ball just isn't the real ball," Marshall says. "I'm surprised at how much resistance there is."

That may have something to do with big-league dreams among parents, Marshall suggests.

"It's a minority, but some people truly have a perception that their child is destined for the pros and needs to learn to play the right way," he says. "They've kind of lost sight of what it's about. They kind of think it's about winning and losing and making the big time."

Among the study's findings:

  • Safety balls proved most popular among the youngest players, in T-ball (ages 5 to 8), where 85 percent of leagues used the softer balls.
  • Use of the safety balls dropped sharply in older age groups, ranging from about 8 percent to 15 percent of leagues.
  • Face guards, made of clear plastic or wire mesh and attached to helmets, have been slow to gain acceptance. About 26 percent of T-ball leagues used them, but the proportion dropped to just under 16 percent among leagues with players 13 years old and older.
  • Risk of injury increased with the age groups of players, while use of the safety equipment decreased.

"T-ball is incredibly safe," Marshall says. "Most of the injuries occur above the T-ball leagues, and that's where the safe equipment is needed, absolutely. You know, they get off to a good start certainly with the safety balls in T-ball, but it needs to continue up into older age groups."

Little League Baseball, the governing body for many of the nation's youth programs, assisted with the research, and the group's risk-management director, Dan Kirby, co-authored the UNC study.

Little League Baseball says it plans to review the study and make it available to local league volunteers. Softer balls and face guards are optional in Little League, which accounts for about half of all players in organized youth baseball in America.

Dr. Robert Gotlin, director of orthopedic and sports rehabilitation at Beth Israel Medical Center in New York City, says he hopes the study will inspire more use of safety equipment.

"I have been an advocate pushing for these safety issues for a long time," says Gotlin, a member of the National Youth Safety Council who coaches teams in Rockland County, N.Y. "This study really hits home... and brings to the forefront something important."

The U.S. Consumer Product Safety Commission (CPSC) says the study's results are consistent with the agency's findings.

The CPSC estimates safety equipment -- softer balls and face guards as well as breakaway "safety bases" designed to reduce sliding injuries -- could decrease baseball-related emergency room visits by up to a third.

We're talking about children here," says Ken Giles, a CPSC spokesman. "We need to do what we can to reduce the risk for kids, and we know these safety devices are out there and they reduce the risk."

More information

For more on preventing baseball injuries, visit the Academy of Orthopaedic Surgeons or KidSource Online.

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Americans Don't Understand Danger of Mini-Strokes

By Linda Carroll
Reuters Health
Monday, May 12, 2003

NEW YORK (Reuters Health) - Most Americans are unfamiliar with the signs, symptoms and risks associated with a "mini-stroke," a new survey shows.

Only 9 percent of those surveyed could give a definition or list symptoms for a mini-stroke, also known as a transient ischemic attack (TIA), according to a report published in the journal Neurology.

"A TIA is just a stroke that stopped," study co-author Dr. S. Claiborne Johnston, director of the stroke service at the University of California at San Francisco, explained in an interview with Reuters Health. "The person starts out having a stroke, but then the blood returns to the brain. TIA's are dangerous and they need to be taken seriously."

Often people dismiss a TIA as unimportant because the symptoms go away, Johnston said. But the TIA could be the warning sign of a full-blown stroke yet to come, he added. Approximately 11 percent of people who are diagnosed with a mini-stroke in the emergency room will have a stroke within the next 90 days.

"People need to come in and see a doctor even if the symptoms pass," Johnston added. "There are medications we can give to people that can reduce the chance of them going on to have a stroke."

Johnston and his colleagues surveyed more than 10,000 people by phone in 1999. The 10,000 were chosen at random and were all at least 18 years old.

Just over 3 percent of those surveyed had experienced TIA symptoms but never went to a physician to be evaluated. Among those who did get diagnosed with a TIA, only 64 percent saw a physician within 24 hours of the symptoms, and a full 16 percent didn't go to the doctor until more than a week after the TIA.

The symptoms of stroke and TIA are similar, Johnston noted. They include the following:

  • Sudden numbness or weakness of the face, arm or leg, particularly on one side of the body;
  • Sudden confusion, trouble speaking or understanding;
  • Sudden trouble seeing in one or both eyes;
  • Sudden trouble walking, dizziness or loss of balance or coordination;
  • Sudden severe headache with no known cause.

Symptoms of a TIA can last anywhere from 30 seconds up to hours, Johnston said. "The longer they last, usually the more worrisome they are," he added.

The new study was supported by a grant to the National Stroke Association from drugmaker Boehringer Ingelheim, Inc., which makes a medication that can reduce the risk of a stroke after a TIA.

Source: Neurology 2003;60:1429-1434.

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Cutting Down on Medication Mistakes

HealthScoutNews
Monday, May 12, 2003

MONDAY, May 12 (HealthScoutNews) -- A new brochure meant to reduce prescription medication errors is being offered by the Agency for Healthcare Research and Quality (AHRQ) and the National Council on Patient Information and Education.

Your Medicine: Play It Safe is a 12-page brochure, available in English and Spanish, that includes a detachable, pocket-sized medicine record that you can personalize.

Medication errors can occur when a person receives the wrong medicine, takes an incorrect dose, takes their medicine at the wrong time or inappropriately combines prescription, non-prescription, and/or other medicines, food or beverages.

The new brochure outlines four steps that help you safely use prescription medicines:

  • Provide your health-care team with all your important medical information.
  • Get all the facts about your medicine.
  • Stay with your treatment plan.
  • Keep a record of all your medicines.

An AHRQ-supported study released in March found that more than 1.9 million medication errors occurred among Medicare patients from 1999-2000. More than a quarter of those errors were preventable.

Most of those preventable errors occurred at the prescribing and monitoring stages, and problems with patient adherence to prescription information contributed to errors in more than 20 percent of cases, the study found.

Single copies of the brochure are available by phoning the AHRQ at 1-800-358-9295 or by sending an e-mail to ahrqpubs@ahrq.gov.

The guide is also available at the AHRQ Web site in English and in Spanish.

More information

Here's where you can learn more about your medicines.

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Study Looks at Chiropractic Treatment, Stroke Risk

By Alison McCook
Reuters Health
Monday, May 12, 2003

NEW YORK (Reuters Health) - People who undergo chiropractic neck and spine adjustments may be at higher risk of having a stroke as a result of tiny tears in their arteries, researchers said Monday.

However, experts said the risk of such a problem is rare at best and that chiropractic manipulations are safe overall.

Previous research has suggested that certain "high velocity" neck manipulations used by chiropractors can lead to a stroke-inducing condition called artery dissection, in which the inside wall of an artery becomes torn.

These findings, however, have been sharply criticized by representatives from the American Chiropractic Association, claiming that the research does not demonstrate that the manipulation is the cause of stroke.

In the newest study to suggest a link between chiropractic treatment and stroke, researchers found that people under age 60 who experienced stroke as a result of dissection were almost seven times more likely to have undergone a spine and neck adjustment 30 days before their stroke than other patients.

During the study, Dr. Wade S. Smith of the University of California, San Francisco, and colleagues interviewed 51 people who had experienced stroke as a result of arterial dissection and compared their chiropractic history to that of 100 patients who had a stroke as a result of other causes.

Their findings appear in the journal Neurology.

In an interview with Reuters Health, Smith said the results suggest that chiropractic manipulations can either cause the dissection to occur, or worsen a pre-existing dissection, causing stroke, he said.

He noted that more than half of the people whose stroke resulted from dissection reported a severe worsening of pain after their manipulations, a phenomenon not reported by any people who suffered stroke from other causes.

Smith noted, however, that he believed that the chance of stroke after neck manipulations was very small, and that chiropractic medicine was, overall, safe.

That said, Smith added that patients probably deserve to know that certain manipulations carry that risk. "I think that patients deserve the right to be informed about it ... to hear that this can cause injury, although it's probably rare."

However, Dr. Linda S. Williams of the Health Services Research and Development Service in Indianapolis, Indiana, who wrote an accompanying editorial, said she disagrees.

"I personally haven't felt consent for the procedure is something that definitely needs to be done," she told Reuters Health.

She explained that Smith and his colleagues did not determine which chiropractic manipulations were performed during patient visits and so cannot say that patients who developed dissections even received the potentially dangerous neck manipulation.

Moreover, the authors tried to determine if people developed dissection before or after their chiropractic manipulation by asking them if they felt neck pain before or after visiting a practitioner, a technique that is notoriously unreliable, Williams said. As such, errors in patients' abilities to recall when their pain occurred may have influenced the findings, she noted.

Dr. William Lauretti, a chiropractor in private practice in Bethesda, Maryland, and a spokesperson for the American Chiropractic Association, told Reuters Health that the study does not clearly establish that stroke-causing dissections are linked to chiropractic medicine.

He explained that previous research has shown that the neck manipulations featured in the study may not stress arteries enough to cause dissection.

Moreover, even if the procedure does increase the risk of dissection and stroke, Lauretti noted that the risk is so small that patients may have just as high a risk of dying in a car accident on the way to the appointment, but chiropractors are not required to warn them of that.

As evidence, Lauretti added that he has been in practice for 12 years and has performed around 15,000 head and neck treatments. "I've never seen any sort of a significant complication from it."

Source: Neurology 2003;60:1424-1428,1408-1409.

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Coffee Highs

HealthScoutNews
Monday, May 12, 2003

(HealthScoutNews) -- While that morning cup of coffee always seems to get you instantly stimulated for the day, you might be surprised to learn that it has another plus side.

According to a report from the Yale University School of Medicine in the June 2000 Journal of Clinical Endocrinology and Metabolism, caffeine packs an added punch.

When 20 people were given either caffeine or a placebo 90 minutes before physical exertion, the levels of muscle glycogen, a measure of energy stored, were about the same for both groups. And the caffeine group showed higher levels of lactate, a measure of muscle fatigue.

But the caffeine group also showed higher levels of cortisol, an anti-stress hormone, and endorphins, the body's natural pain killers. The placebo group showed only a small increase in cortisol and no increase in endorphins.

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Fewer Ear Infections for Babies Who Sleep on Backs

Reuters
Monday, May 12, 2003

WASHINGTON (Reuters) - Putting babies to sleep on their backs not only prevents crib death, or sudden infant death syndrome, but ear infections as well, U.S. doctors reported on Monday.

Some worried parents have resisted the "back to sleep" campaigns in the United States, Britain, Australia and other countries, fearing small infants left on their backs could choke. But the campaigns have reduced the incidence of SIDS by more than 40 percent.

Monday's study, published in the Archives of Pediatrics & Adolescent Medicine, found no adverse effects from keeping infants on their backs.

"Placing infants to sleep on their backs not only reduces their risk of sudden infant death syndrome, but also appears to reduce the risk for fever, stuffy nose, and ear infections," said Dr. Duane Alexander, director of the National Institute of Child Health and Human Development, which helped fund the study.

"Otitis media (ear infection) causes suffering in infants and young children, costs the American public an estimated $5 billion per year, and results in overuse of antibiotics," Alexander added in a statement.

Dr. Carl Hunt of the Medical College of Ohio and colleagues analyzed information gathered in 1995 from 3,733 U.S. infants. The mothers were asked whether the babies were put to sleep on their stomachs, backs or sides.

At 1, 3, and 6 months of age the mothers were asked about fever, cough, wheezing, stuffy nose, breathing trouble, sleeping problems and vomiting.

No infants choked on their own vomit or spit-up and the babies put down on their backs were less likely than stomach sleepers to develop fever or a stuffy nose, or to visit the doctor.

Hunt, who now heads the National Center on Sleep Disorders Research at the National Heart, Lung, and Blood Institute, was not sure why the back sleepers overall had fewer symptoms of illness.

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The Facts on Endometriosis

HealthScoutNews
Monday, May 12, 2003

MONDAY, May 12 (HealthScoutNews) -- To mark National Women's Health Week, the Endometriosis Research Center is offering free fact sheets and a free self-test for endometriosis.

The fact sheet discusses important concerns and questions that face women who have, or think they have, endometriosis. The self-test can be completed by women and girls, who can then take it to their gynecologist for review and further discussion. The research center is located in Delray Beach, Fla.

National Women's Health Week, from May 11-17, is an effort by an alliance of national organizations to increase awareness about steps that women can take to improve their health. The main message to women is the importance of incorporating simple preventative and positive health habits into their daily lives.

More information

Here's where you can find the endometriosis fact sheet and self-test. You can also phone 1-800-239-7280 and ask for National Women's Health Week materials.

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Less Patching for 'Lazy Eye' Still Effective: Study

Reuters Health
Monday, May 12, 2003

NEW YORK (Reuters Health) - Children with "lazy eye," or amblyopia, usually wear an eye patch to treat the condition, and now a new study suggests that two hours of eye patch use is just as effective as 6 hours.

The finding may help overcome a major treatment problem -- getting youngsters to actually wear the patch. Amblyopia is the most common cause of single-eye vision loss in both adults and children.

"Prior to these results, many children with amblyopia had to wear an eye patch during school hours," said Dr. Paul A. Sieving, director of the National Eye Institute, in a prepared statement. "For these children, the accompanying social and psychological stigma was very real. Many were stared at and teased by other children, which made them feel different. Now children can look forward to attending school without the patch."

Worn over the unaffected eye, adhesive patches force children to use their weaker or "lazy eye" and thus stimulate the area of the brain associated with vision development. Without treatment, the condition can lead to loss of vision in the weaker eye. About two to three out of every 100 youngsters has the problem.

However, doctors don't always agree on how many hours children must wear the patch. For children with moderate amblyopia, recommendations can range from one to two hours a day all the way up to 24 hours a day, according to the study published in the Archives of Ophthalmology.

In the new study, The Pediatric Eye Disease Investigator Group compared 2 hours of eye patch use to 6 hours in a group of 189 children younger than 7 who were diagnosed with moderate amblyopia. Both groups of children participated in at least one hour of near visual activities during patching. These included hand-eye coordination activities such as coloring, tracing, playing computerized video games and reading.

At the end of four months all of the children underwent further eye testing.

"We found that amblyopia improved with both patching regimens and that there was no demonstrable advantage to the greater number of patching hours, either in the rapidity of improvements or in the magnitude of improvement after four months," the research team writes.

"These results will change the way doctors treat moderate amblyopia and make an immediate difference in treatment compliance and the quality of life for the children with this eye disorder," said Sieving in the statement.

"This is very important because it is estimated that as many as three percent of children in the U.S. have some degree of vision impairment due to amblyopia," added Sieving.

The National Eye Institute in Bethesda, Maryland, provided funding for the study.

Source: Archives of Ophthalmology 2003;121:603-611.

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Scan Predicts Heart Trouble in the Healthy

By Ed Edelson
HealthScoutNews Reporter
HealthScoutNews
Monday, May 12, 2003

MONDAY, May 12 (HealthScoutNews) -- Put to the test, an imaging device called an electron beam computed tomography did warn of future cardiovascular trouble in healthy, seemingly trouble-free individuals.

"Half of deaths due to heart disease occur in people with no symptoms," says a statement by Dr. George T. Kondos, head of the team that did the test. "And a third of people with heart disease don't have any of the traditional risk factors -- diabetes, high blood pressure, high cholesterol, family history or peripheral vascular disease. Those individuals would go undetected by traditional screening methods."

Electron beam computed tomography (also known as EBCT or EBT) detects a different source of trouble -- calcium deposits in artery walls that can eventually be blocked, causing a heart attack or stroke. It is a fast form of X-ray imaging technology that can be done in a few minutes. And the amount of those calcium deposits did predict trouble, says a report in the May 13 issue of Circulation.

More than 5,600 men and women were given the test by Kondos, who is an associate professor of medicine at the University of Illinois' College of Medicine in Chicago. They were divided into four groups, depending on the extent of calcium deposits found by an EBCT scan.

Over the next three and a half years, men in the highest quarter of calcium scores were 2.3 times more likely to die or have a heart attack and 10.1 times more likely to have bypass surgery or artery-clearing angioplasty than those in the lowest quarter, the report says. There were no comparable figures on deaths and heart attacks for women, because few of them occurred, but the incidence of bypass surgery or angioplasty was 3.6 times higher for those in the highest quarter compared to those in the lowest.

"This is an important advance in the study of this technology," says Dr. Patrick G. O'Malley, an EBCT expert and chief of the division of general and internal medicine at Walter Reed Army Medical Center in Washington, D.C.

The research helps resolve a running debate on EBCT's effectiveness. "It is an open question whether it can predict over and above the conventional risk factors," O'Malley says.

O'Malley led a recently published study showing that EBCT readings must be followed up by doctors to make sure persons with high scores pay careful attention to the conventional risk factors to prevent heart attack and stroke

EBT is not for everyone, says Dr. William Weintraub, a professor of medicine at Emory University and author of an accompanying editorial.

"It is most appropriate for people at an intermediate level of risk," Weintraub says. Physicians must use judgment in selecting those individuals because there is "a tremendous range within the category of medium-risk individuals," he adds.

Whether EBT is cost-effective is a question that still has to be answered, Weintraub says: "In the meantime, until we learn more, it won't do any harm and may help, although it does cost money."

More information

You can learn about electron beam tomography and other imaging techniques from the American Heart Association, which also has a page on risk factors for heart disease.

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Tick Infections Often Go Undetected: Study

By Alison McCook
Reuters Health
Monday, May 12, 2003

NEW YORK (Reuters Health) - Approximately twelve percent of children living in the Southeastern and South Central U.S. may have been infected with the bacterium that causes the deadly tick-borne disease Rocky Mountain spotted fever, researchers said Monday.

Blood tests showed that the percentage of children in this part of the country who had a history of infection with Rickettsia rickettsii, the bacterium that causes the illness, ranged from 4 percent in Louisville, Kentucky, to 22 percent in Little Rock, Arkansas.

However, actual reported cases of the condition are extremely rare, study author Dr. Gary S. Marshall of the University of Louisville in Kentucky told Reuters Health.

"If they were truly infected at some time with R. rickettsii, then obviously most of these infections were either subclinical or self-limited, since so few actual cases of RMSF are reported," Marshall said.

The Kentucky researcher noted that other infectious diseases are caused by pathogens that cause problems in some people but not in others. "There are many examples of infectious diseases where some people get infected and never have disease whereas others do have disease."

Nevertheless, he added that these findings suggest that doctors should keep the possibility of Rocky Mountain spotted fever on their radar screen when faced with a sick child.

"Hopefully, the possibility that rickettsial infection is more common than suggested by disease incidence reports will raise awareness of RMSF and prompt clinicians to consider the diagnosis in children with fever and rash in the summertime," Marshall said.

Rocky Mountain spotted fever is spread from ticks to humans. Its initial symptoms include fever, muscle pain and headache followed by a characteristic spotted rash.

Only 1,253 cases of Rocky Mountain spotted fever were reported to the U.S. Centers for Disease Control and Prevention between 1993 and 1996, translating to an annual rate of around two cases for every one million Americans, according to a report in the Archives of Pediatrics & Adolescent Medicine.

Despite advances in the treatment of the condition, between three and five percent of people who develop Rocky Mountain spotted fever die as a result, making it the most common fatal disease transmitted by ticks in the U.S.

Although reports of Rocky Mountain spotted fever are rare, in some U.S. regions, many ticks carry the bacteria that cause the illness. Since humans often come in contact with ticks, experts have suggested that many cases of the illness are either missed or misdiagnosed.

During the current study, Marshall and his colleagues scanned around 300 blood samples from children and teens living in seven U.S. cities for the presence of antibodies against the Rocky Mountain spotted fever bacteria, a sign of past infection.

Besides Louisville and Little Rock, other cities included in the study were: Nashville, Tennessee; Oklahoma City, Oklahoma; Kansas City, Missouri; Memphis, Tennessee; and Winston-Salem, North Carolina.

In an interview, Marshall said that he expected that children living outside the Southeastern and South Central U.S. likely had a lower rate of past infection, because reported cases of Rocky Mountain spotted fever tend to be concentrated in Southeastern and South Central states.

Source: Archives of Pediatrics & Adolescent Medicine 2003;157:443-448.

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Many Asthmatics Ignore Added Risk of Smoking

By Serena Gordon
HealthScoutNews Reporter
HealthScoutNews
Monday, May 12, 2003

MONDAY, May 12 (HealthScoutNews) -- The last thing you'd expect to see someone with asthma do is light up a cigarette. But that's exactly what a sizable chunk of asthmatics do every day, new research says.

The study, published in the May issue of Chest, found that more than a third of asthmatics treated in the emergency room were smokers and nearly a quarter were former smokers. Less than 5 percent believed smoking had anything to do with the flare-up of their asthma symptoms.

"Smoking is all too common among individuals with chronic asthma, a disease that by itself causes breathing difficulty and can lead to hospitalization or even death," says study author Dr. Robert Silverman, an attending physician and director of research in the department of emergency medicine at Long Island Jewish Medical Center in New Hyde Park, N.Y.

"It was surprising and baffling to find so many -- more than one in three -- asthmatics were active smokers. Cigarette smoke is an irritant that inflames the lungs and causes wheezing and chest tightness, and one would have thought that asthmatics would be the least likely to smoke cigarettes," he adds.

Silverman and his colleagues interviewed 1,847 people with asthma from 64 different emergency departments in 21 U.S. states and four Canadian provinces. All of the study participants were being treated for acute asthma attacks. They were between the ages of 18 and 54 years.

Thirty-five percent reported being current smokers and 23 percent said they were former smokers. Only 23.4 percent of the U.S. population as a whole smokes, reports the U.S. Centers for Disease Control and Prevention.

The researchers found people in the study who were white, hadn't graduated from high school, had a lower income, had no private insurance and didn't regularly use inhaled steroids were more likely to be smokers.

Half of the smokers acknowledged that smoking made their asthma symptoms worse, yet only 4 percent believed smoking had anything to do with their current asthma attack.

Silverman says the current findings point to a need for doctors to ask about smoking and to educate smokers in the emergency room on the dangers of smoking, particularly for asthmatics.

"I would guess that many asthmatics are not asked whether they are active smokers because it seems counterintuitive that asthmatics would even consider smoking," Silverman says. "But based on the results of this study, a smoking history should be part of every emergency visit. For current smokers, the emergency department is a good place to start counseling patients, even if briefly."

Silverman explains that when people have an asthma attack they feel as if they are underwater and can't breathe in any air. He says this sensation is frightening, and might make smokers temporarily more receptive to messages about ways to improve their health.

"Every active smoker should be counseled on joining a smoking cessation program. For some individuals, a visit to the emergency department for a severe asthma attack can be the wake-up call needed to make this commitment," he explains.

Dr. Gailen Marshall, director of the division of allergy and clinical immunology at the University of Texas Medical School in Houston, wasn't surprised that so many people with asthma were smoking. He isn't so sure, however, that the emergency room is the right place for smoking cessation education, because there simply isn't enough time to properly address the subject.

"It's difficult to convince people with asthma that their asthma would get better if they stopped smoking," says Marshall, who believes primary-care and asthma-care physicians could better address smoking cessation with their asthma patients.

More information

To learn more about the effects of smoking on asthma, visit the United Kingdom's Action on Smoking and Health or the Asthma Initiative of Michigan.

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Gender, Ethnicity Impede Info Giving to Doctors

Reuters Health
Monday, May 12, 2003

NEW YORK (Reuters Health) - Gender and ethnicity can play a large role in the type of sensitive information a mother will reveal to a new pediatrician, a new study has found. In the study, African American mothers shared less information with white doctors while white mothers revealed less information to male doctors.

The findings indicate that new doctors may benefit from specialized training about how to listen more intently during meetings with patients and provide an environment that will encourage openness and trust, the study's authors say.

In general, physicians believe that people who see the same doctor over time eventually overcome communication barriers and go on to establish a rapport of trust and openness, according to Dr. Lawrence S. Wissow, of Johns Hopkins University in Baltimore, Maryland, and colleagues.

However, it is not known whether communication barriers related to ethnicity and gender diminish over time.

In a previous study, researchers found that African American and Hispanic patients were less likely than whites to have their feelings of depression detected.

Wissow's team evaluated taped conversations between several hundred mothers and pediatricians. The team compared interactions between mother and doctor during initial visits and during meetings that took place up to a year later. All physicians in the study were white.

Gender and ethnicity seemed to affect mother's discussion of psychological and social topics, including family relationships, feelings and behavioral issues related to their children.

"At early visits, African American mothers made 26 percent fewer psychosocial statements than white mothers," the authors write. Whether the physician was male or female did not make a difference, the researchers report in the May issue of the journal Archives of Pediatrics and Adolescent Medicine.

A doctor's sex did have an effect on white mothers, however.

"At early visits, white mothers made twice as many psychosocial statements when seeing white female compared with white male physicians," the researchers note.

Still, seeing a physician over the course of one year "demonstrated the potential to improve communication," according to the report.

However, Wissow's team stresses that pediatricians need to be "patient-centered" to make it easier for mothers to open up to doctors.

"The most important lesson gained from the study is that better communication skills can be learned," Dr. Abraham B. Bergman of Harborview Medical Center in Seattle, Washington writes in an editorial that accompanies the study.

Bergman stresses the need for new doctors to be taught how to listen to their patients.

Source: Archives of Pediatrics & Adolescent Medicine 2003;157:414-415,419-424.

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SUNDAY, MAY 11, 2003

Stuffy Nose Can Mean Many Things

HealthScoutNews
Sunday, May 11, 2003

SUNDAY, May 11 (HealthScoutNews) -- Has your honker ever been so congested that it barely qualified as a tweeter?

Nasal congestion goes by many different names -- including stuffy nose and nasal obstruction -- and has many causes. Most cases of nasal congestion are caused by a virus and the congestion typically disappears within a week, says the U.S. National Library of Medicine (NLM).

Nasal congestion can range from being an annoyance to a life-threatening condition. For example, it can interfere with nursing and cause dangerous respiratory distress for the first few months of an infant's life.

In older children and adolescents, nasal congestion may cause problems with hearing and speech development. It can also interfere with sleep.

Nasal congestion caused by influenza or the common cold is often accompanied by clear, watery discharge and a variety of other symptoms such as cough, fever, headache, sore throat and joint and muscle aches, the NLM says.

There is no medication that can cure influenza or the common cold. However, you can relieve the congestion with non-prescription drugs such as decongestants, acetaminophen, nose drops and sprays, cough remedies and throat lozenges.

Other ways to deal with nasal congestion include: drink lots of water or other fluids, rest as much as possible, and use a vaporizer or humidifier to increase indoor air moisture.

Hay fever can also cause nasal congestion. In those cases, the congestion is accompanied by clear, watery discharge, itching eyes and sneezing.

To treat stuffy noses caused by hay fever, you need to avoid exposure to as many allergens as possible. These allergens may include pets, certain foods, dust and pollen. Antihistamines and decongestants don't cure hay fever, but they can relieve symptoms.

A sinus infection can also cause nasal congestion. Along with congestion, signs of a sinus infection are thick, cloudy, yellow-green nasal discharge and pain or tenderness around the eyes and cheekbones that worsens when you bend forward.

More information

Here's where you can find out much more about your nose.

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SATURDAY, MAY 10, 2003

Kids Who Lost Parent in 9/11 Attacks Still Suffer

By Steven Reinberg
HealthScoutNews Reporter
HealthScoutNews
Saturday, May 10, 2003

SATURDAY, May 10 (HealthScoutNews) -- Many young children who lost a parent in the Sept. 11 terror attacks showed symptoms of post-traumatic stress disorder, new research reports.

"Children whose parents were exposed to the trauma of 9/11 did have stress-related behaviors," says study author Dr. Michael C. Thomasgard.

After breaking those studied into two groups -- kids aged 0 to 3 and those aged 3 to 6 -- the researchers found roughly half of the youngsters suffered some form of trauma a year later.

In the youngest group, 25 percent displayed separation anxiety and 17 percent exhibited hypervigilance or withdrawal, while in the older group 15 percent showed separation anxiety, 22 percent displayed hypervigilance and another 10 percent had withdrawal symptoms.

The surviving parents also had their problems, including difficulty separating from their children, says Thomasgard, who presented his findings this week at the Pediatric Academic Societies' annual meeting in Seattle.

Also, many of those providing psychological care to the children at the Family Assistance Center at Pier 94 in New York City continued to report high rates of stress a year after the attacks. These caregivers felt the need to recount their experiences and many continued to have trouble sleeping, Thomasgard says.

In September 2002, Thomasgard, an associate professor of pediatrics at Columbus Children's Hospital in Ohio, and a colleague mailed questionnaires to 93 of the caregivers from the Family Assistance Center. They weren't allowed to interview the children or their parents directly at the time of the tragedy, so they questioned caregivers about the children and their parents.

"We know that young children whose parents die are at a higher risk for problems later in life, especially if they had any preexisting emotional difficulties," Thomasgard says.

Parents also need help in knowing how to ensure their child feels safe and secure at time when their security has been threatened, Thomasgard says. In addition, there is a need to debrief care workers to deal with their continued feelings of stress.

There is limited data on children's response to terrorism, so it is difficult to tell what is normal and what isn't, Thomasgard says. "We need studies to determine how these kind of events affect the child's long-term development," he adds.

David Fassler, an associate professor of psychiatry at the University of Vermont in Burlington has written widely on stress in children, and he says this study is consistent with recent clinical experience.

"Many children showed increased signs of stress and anxiety in months following the events of 9/11. While the experience was traumatic for the country as a whole, the emotional repercussions were particularly acute in the New York area, Washington, D.C., and western Pennsylvania," he adds.

Fassler points out that levels of stress have been further exacerbated by the first anniversary of 9/11, the sniper shootings, the space shuttle tragedy and the war in Iraq.

"We know that very young children are quite sensitive to changes in the stability and predictability of their environment and surroundings, which would include disruptions to their normal routine or alterations in the emotional state or responsiveness of parents or other caregivers. For this reason, it's not surprising that they would demonstrate a range of reactions including hypervigilance, separation anxiety and difficulty sleeping," Fassler notes.

However, this study is part of an encouraging trend, where more attention is being focused on the effects of stress on very young children, he adds: "In a practical sense, the results may ultimately help us design and develop more effective screening tools as well as early intervention programs and prevention initiatives."

More information

For more on post-traumatic stress disorder (PTSD), see the National Center for PTSD or the National Institute of Mental Health.

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Sesame Oil Lowers Blood Pressure

HealthScoutNews
Saturday, May 10, 2003

SATURDAY, May 10 (HealthScoutNews) -- Using sesame oil instead of other cooking oils helps reduce high blood pressure and lower the amount of medication required to control high blood pressure, says a study by researchers in India.

The study looked at the effect of sesame oil on 328 people with hypertension who were taking 10 to 30 milligrams a day of the calcium channel blocker drug nifedipine, which lowers blood pressure by relaxing arterial membranes.

The average age of the people in the study was 58, and they had moderate to severe long-term hypertension but no history of stroke or heart disease.

They consumed an average of 35 grams of sesame oil a day for 60 days. Their blood pressure was measured at the start of the study, every 15 days during the study and on day 60.

The study found using sesame oil as their sole cooking oil lowered their blood pressure levels from 166 mm Hg systolic to 134 mm Hg and from 101 mm Hg diastolic to 84.6 mm Hg.

The average dose of nifedipine taken by the people in the study was reduced from 22.7 milligrams per day to 7.45 milligrams per day by the end of the study.

The findings were presented recently at the Scientific Meeting of the Inter-American Society of Hypertension.

More information

Here's where you can learn more about choosing fats and oils.

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